Gold Standard Investigations in GI Surgery and Onco Surgery

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Esophagus

Ambulatory pH monitoring is the gold standard for the diagnosis of GER. ( SKF 61)

Esophageal high-resolution manometry (HRM) is currently the gold standard for the evaluation of esophageal motility ( SKF 11)

The current gold standard for the operative treatment of GERD is the laparoscopic Nissen fundoplication. ( SKF 234)

Body Response to Injury

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Q Which is not a metabolic response to injury ( Similar Questions) 
A) Increased nitrogen requirements
B) Insulin resistance and glucose intolerance
C) Preferential oxidation of lipids
D) Decreased gluconeogenesis

This Question discusses and enumerates the metabolic responses to trauma and sepsis

Gastrinoma diagnosis

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Q) Gastrinoma false is (AIIMS GI 2020) 
a) Fasting sG 1000 g/ml
b) Duodenotomy should be done in all cases
c) Diarrhea most common symptom
d) SRS can localize 80% cases

Ans  )  c -

Duodenotomy detects 25% to 30% of tumors not seen on preoperative imaging.

Gastrin  levels higher than 1000 pg/mL are strongly suggestive of gastrinoma, provided that the patient demonstrated increased gastric acid  secretion ( gastric secretion ph should be less than 2) 

Most common is abdominal pain ( 75%) In 10% to 20% of patients, diarrhea is the only symptom ( Saby page 954) 

SRS should be performed because almost all gastrinomas express somatostatin receptors.

2nd primary tumors

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Q) In buccal mucosa cancer after surgery and CRT, after 2 year patient developed cancer at base of tongue with N3 nodes positive. Best line of management
A .Palliative RT
B. CTRT
c. Rehabilitation
D.  Surgery followed CTRT

There are two parts to this questions 

a) Second Primary tumor (SPM)

b) Management of Base of tongue tumors with N3

Both are discussed here ---

 

Subvesical duct

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Q) . False about  subvesical duct
a) Embedded in cystic plate
b) Communicate with CHD
c) Communicate  with  GB
d) Does not drain any specific segment of liver 

Obesity and Association with cancer

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Q) Obesity is least associated with which cancer ? ( AIIMS Onco exam 2020
A) Colon
B)Pancreas
C) Breast
D) Esophagus


Important Points : Obesity is also associated with 

  1. GB cancer

2. Obesity and increased BMI also has an increased risk of death from prostate cancer

 

Surgical safety checklist

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Q1) Surgical Safety Checklist aimed at decreasing the incidence of ___________

a) operative complications

b) Site error

c) Anesthesia complications

d) infective complications

 

Caustic Injuries of Esophagus

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Q . Caustic injury of esophagus pick up the  false statement
a) Steroid is used 
b) Carcinoma risk  is 30%
c) Contrast study has false negative of 25%
d Esophageal stent reduce leaks by 75%

Ans ) a

Points of esophagus caustic injuries

There is no proven benefit of starting steroids in early or intermediate phase of injury as there is no evidence to support prevention of stricture

  1. Endoscopy should be performed after initial stabilization
  2. Complete esophagus can be examined now with flexible endoscopes
  3. Available studies show no benefit of steroid use ( skf PAGE 521) 
  4. Cancer risk is 30% in injured and non injured portions

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Radial scar

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Q) Radial scar is seen on 
A. Mammography findings
B. MRI findings
C. Fracture of radius
D. Fracture of ulna

Ans a Mammography

Radial scar, or complex sclerosing lesion, is a rosette-like proliferative breast lesion. It is not related to surgical scarring.

A radial scar is a benign hyperplastic proliferative disease of the breast. Proposed possible causes include localized inflammatory reaction and chronic ischemia with subsequent slow infarction.

In approximately 30% of cases, a radial scar is associated with ductal carcinoma in situ and tubular carcinoma of the breast

Ref 

Oncology is an ever evolving field and for MCH entrance you need to have your concepts clear. This book helps you achieve that with brilliant explanations