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Pancreas
Q) In acute pancreatitis all are true except :
1) Amylase is more sensitive for first 5 days than lipase
2) S. lipase remains elevated for a longer time
3) Amylase levels not included in definitive diagnostic criteria of acute pancreatitis
4) Amylase levels may not be elevated in 19 % of patients
Ans 1) Amylase is not more sensitive than lipase
Serum amylase concentrations generally rise within a few hours after symptom onset and return to normal within approximately 5 days Amylase levels may not be elevated in as many as 19% of AP patients on admission.
Furthermore, amylase levels may also be elevated in the absence of pancreatitis in patients with renal impairment, salivary gland diseases, and other extrapancreatic abdominal conditions (e.g., acute appendicitis, perforated viscus, intestinal obstruction, mesenteric ischemia). Serum lipase levels have the added advantage f remaining elevated during a longer period and have a higher specificity versus amylase.
BG page 891
2. Most common indication of surgery in Crohn's disease a) Fistula b) intractability c) abscess d) obstruction
Ans d Obstruction
Confusion between failure of medical therapy or obstruction as the ans. I have checked Bailey sabiston and Shackelford
2 books mention obstruction on top whereas one mentions failure of medical therapy. However with the improvement of medical management in the past decade, obstruction can be the ans
Crohn’s disease will require surgery at some time durin the course of their illness. Approximately 70% of patients will require surgical resection within 15 years after diagnosis.
Indications for surgery include failure of medical treatment, bowel obstruction, and fistula or abscess formation. Most patients can be treated with elective surgery,
3. Not used in steroid refractory severe Ulcerative Colitis
a) Infliximab b) Azathioprine c) Cyclosporine d) Surgery
Ans 3 b- Azathioprine
Cyclosporine is immunomodulator indicated for second-line therapy in the case of severe, steroid refractory ulcerative colitis. Treatment is usually initiated after 3 to 5 days of failed steroid response
Tacrolimus is appropriate as second-line therapy in patients with severely active ulcerative colitis unresponsive to steroids.
The use of various anti–tumor necrosis factor-α (TNF-α) monoclonal antibodies ( infliximab) is well supported in the case of severe ulcerative colitis refractory to steroids.
4. All the following Tumor marker prognostic in unresectable colorectal cancer except ?
1. Kras 2. MSI 3. Braf 4. Tymps
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