Bleeding on Clopidogrel

Q)  Patient on Clopidogrel has  Intraop bleeding  Which component will you transfuse to control it? ( #NEET 2018)

a) Platelets
b) FFP
c) Cryoprecipitate

d) PRBC

Ans ) A, platelets

Patients on clopidogrel who are actively bleeding and undergoing major surgery may require almost continuous infusion of platelets during the course of the procedure. Arginine vasopressin or its analogues (DDAVP) have also been used in this patient group

Platelet shelf life is 5 days and stored at temp of -24

Bailey 27th 

 

Gastric pullup

Q 35) Not a step in Gastric pull up mobilization?

a) Lesser sac entering

b) Posterior mobilization of the duodenum

c) dilatation of hiatus

d) ligation of lesser curve vessels
Answer 35

Stomach is the best esophageal substitute. It has a single anastomosis, consistent blood supply and is durable

Disadvantage is reflux in the long term.

Check the answer to the question on gastric pull up in the answer

Caustic Injury to esophagus

Q ) False regarding Caustic injury to Esophagus

a) Gastric lavage not done as it increases the chances of more injury

b) Neutralising  agents not given as it produces more injury than preventing it

c) Milk and albumin not given as it causes more damage

d) Activated charcoal not given as it doesn’t effectively absorb alkali

Check one more question on caustic injuries to esophagus here


Answer 

In  caustic injuries to the esophagus, early decisions have to be taken. The involvement of surgeon should be done early and patient should be placed under close monitoring.

Blind nasogastric and orogastric tubes should not be inserted and initially CT of chest and abdomen with contrast should be done to guide the subsequent procedures. Read on