Carcinoid appendix

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Q) In Carcinoid appendix, False  statement is

a) It is the most common tumor of the appendix

b) Less than 1% of the overall  appendectomy specimens have carcinoid tumor

c) Size of the lesion is a good predictor of  malignant behavior

d)  Mostly carcinoid appendix are seen in the base of appendix

Answer

 

Suturing in vascular anastomosis

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Q) True about suturing technique in vascular anastomosis

a) Anastomosis may not be completely water tight

Roux stasis

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Q) True about Roux stasis syndrome

a) Dilated Roux limb present

b) Can be prevented by inter positioning 20 cm jejunum between stomach n duodenum

c) Delayed gastric emptying of solids

d) It is not related to the size of gastric remnant

Answer

Dumping Syndrome causes

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Q) Dumping all are true except 

a) Conversion of BI to BII

b)  More common in B1 as compared to BII

c) Most common after gastric pull up

d

Answer

Small bowel syndrome

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Q) Drug combination not recommended for diarrhea in the early treatment of SBS

a) Loperamide and PPI

b) Loperamide and octreotide

c) Octreotide and PPI

d) Cholestyramine and Oxalate

Answer

Non obstructive mesenteric ischemia

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Q) Not true about Non Obstructive Mesenteric Ischeamia (NOMI)

a) Occurs due to treatment with vasopressors

b) Occurs in cardiac shock

c) Can occur in Burns

d) Hypercoagulable state maybe responsible for NOMI

Answer

Renal cell carcinoma

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Q) False about Renal cell carcinoma is

a) More common in males

b) Associated with von hippel lindau syndrome

c) Always require radical nephrectomy

d) Has paraneoplastic manifestaions

Answer

c


Renal cell carcinoma is more common in males

Genetic

loss of heterozygosity in chromosome 3p

B/l RCC is associated with VHL syndrome

Paraneoplastic of RCC

Anemia, hypettension, erythrocytosis.

Radical nephrectomy is the gold standard but not always necessary and partial nephrectomies in selected cases give good clearance

Annular pancreas

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Q) All are true about annular pancreas except ( AIIMS GI Surgery Question bank)

a) They are mostly asymptomatic

b) It has equal incidence in children and adults

c) Treatment of choice is duodenojejunostomy

d) Associated with Down's syndrome


 Answer c

Annular pancreas is a congenital malformation but manifestations can appear in the adult life.

Annulus means a ring of pancreatic tissue around the duodenum. For annular pancreas to be diagnosed, this ring can be complete or incomplete.

Embryological basis

Normally the ventral buds of pancreas and  dorsal bud fuses together. Non rotation and fusion of these two leads to the formation of annular pancreas. It envelops the  2nd part of duodenum.

Age of presentation

Incidence is equal in both adults and children

Presentation in children is congenital anomalies and duodenal obstruction

Presents in adults as pancreatitis usually in 3rd or 4th decade

Association with other pancreatic conditions

1. Pancreas  divisum 35- 40%

2. Chronic pancreatitis 45- 50%

Other GI conditions

Annular pancreas is a possible etiology of congenital duodenal obstruction and is associated with other congenital anomalies such as Down syndrome, duodenal atresia, and imperforate anus.

Clinical Fetaures

Of those seen as adults, 75%were seen with pain

22% were diagnosed with pancreatitis

24%) had gastrointestinal (GI) symptoms that included vomiting,

11%had obstructive jaundice and/or abnormal liver function test results.

Ref BG page 869

Treatment

It is duodenal bypass and not resection of duodenum as duodenum excision can lead to pancreatitis

in children its duodeno - duodenostomy

in adults duodenoduodenostomy which has now replaced duodenojejunostomy

Sabiston

 

 

 

 

Arc of riolon

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Q . Engorged dilated Riolan arc vessel with retrograde flow suggests

a) SMA occlusion

b) IMA occlusion

c) Normal flow

d) Iliac artery occlusion

Answer

Budd chiari

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Q31) In Budd Chiari Syndrome best management for patients when all three hepatic veins are blocked with deranged LFT

a) Liver transplant

b) Side to side porto caval shunt

c) MEso atrial Shunt

d) TIPS

Answer