January 2017 – Surgery MCQs – NEET SS New Pattern

Q Most common urological complication in Crohn’s disease is

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a) Ureteral obstruction

b) Entero vesical fistula

c) Pyonephrosis

d) Recto uretheral fistula

Answer Premium

Hemangioma Liver

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Q) True about management of hemangioma liver

a) All hemangioma more than 10 cm should be resected

b) OCPs and pregnancy should be avoided in young females as there is risk of rupture

c) Arterial embolization should be routinely done in large hemangiomas

d) If surgery is decided hemangioma located at the periphery should be enucleated

Ans)d

Whatever the size there is no role of resection for asymptomatic hemangioma. Risk of rupture is very small and therefore there is no rationale for stopping OCPS, pregnancy or physical activities.

Arterial embolization, which may be considered for temporary control of hemorrhage has limited success and is occasionally associated with morbidity

In symptomatic hemangioma liver resection is the treatment of choice, in peripheral tumors enucleation and in centrally placed tumors, formal resection should be done

REf Blumgart Surgery of liver 6th edition

Complications of Billroth 2 surgery

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Q) What is true regarding complications of Billroth 2 surgery?

a) It has less complications than Billroth 1 surgery

b) Recurrent ulceration is more common in the afferent limb as compared to efferent limb.

c) Afferent loop obstruction is more common after Billroth 2 surgery

d) Billroth I operation is preferred in scarred duodenum

Answer c -

In Billroth 2 surgery, afferent limb obstruction is more common

In Billroth 1 reconstruction The remnant is anastomosed to the duodenum

In Billroth 2 duodenum stump is closed and stomach is anastomosed to the jejunum limb

Advantages of Billroth 1

More Physiological as normal GI continuity is maintained
No problem of afferent and efferent limb
Future procedures like endoscopy and ERCP can be done
Reduced chance of gastric carcinoma in remnant stomach as compared to Billroth 2 ( SKF page 682)

In surgery for benign gastric ulcers, Billroth I reconstruction is the preferred choice.

Billroth II surgery has problems of

Retained antrum syndrome
Afferent loop obstruction
Duodenal stump leak (1-3%)

Billroth 2 surgery is done when there is

1. Inadequate mobility of the duodenum

2. Scarring of duodenum

Complications of gastric surgery
Complications of gastrectomy

Nutritional and weight loss - Iron deficiency, Copper deficiency, Vit B12 , Anemia
Delayed gastric emptying
Roux statsis- Seen in roux en y loops- Pain, nausea, vomiting, abdominal bloating
Cholelithiasis- Higher incidence in roux en y reconstruction as compared to B1 and B 2 gastrectomy
Recurrent ulceration

Complications of Billroth 2 surgery

Dumping syndrome Dumping symptoms have been reported in up to 70% of Billroth II patients and up to 75% of patients after RYGBP
for obesity.
Afferent loop obstruction - It can be minimized by keeping the length of afferent loop less than 20 cm and using a retrocloic approach.
Bile reflux gastritis - More common with billroth I and billroth 2 surgery, incidence is decreasing after the use roux en y anastomosis

Shackelford's Surgery of the Alimentary Tract, 2 Volume Set: Expert Consult - Online and Print

Q) Billroth 1 gastrectomy all are true except-

a) Normal anatomy of duodenum is preserved

b) ERCP can still be performed

c) Avoiding efferent and afferent limb problem

d) No risk for gastric cancer because of decreased alkaline reflux

Answer