Carcinoid appendix

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

Q) True about suturing technique in vascular anastomosis

a) Anastomosis may not be completely water tight

b) To prevent intimal injury needle should be moved from with in to out

c) 4-0 suture is preferred for aorta

d) Any bio degradable suture which is monofilament can be used


Answer

b

Vessels should always be sewn with the needle moving from within to without on the downstream edge of the vessel to avoid creating an intimal flap and to fix any atherosclerotic plaque.

Tip of the needle should be at right angle to the intima and curve of the needle should be followed

Distal clamp is released first

Non absorbable sutures should be used

2-0 should be used for aorta 4-0 for femoral and 6-0 for popliteal

Only non absorbable monofilament sutures are used in vascular anastomosis

Bailey 27 page 99

 

Roux stasis

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

In Roux stasis syndrome there is abnormal peristalsis in the roux limb and propulsion  is proximal. Read on 

Renal cell carcinoma

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

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


 

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 duodenum.

Age of presentation

Incidence is equal in both adults and children

Presentation in children is congenital anomalies and dudenal 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%

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