AIIMS Nov 22, GI Surgery Questions Discussions

Q 1 Not true about POEM procedure 

1a) Circular muscle only removed

b  Good results for Type I Achalasia

c)  GA not required

d)  Fundoplication not needed usually


C , GA is required 

POEM is performed endoscopically using a standard flexible gastroscope.

A small (approximately 1 to 2 cm) incision is made in the mucosa of the distal esophagus, and then a
submucosal tunnel in the wall of the esophagus is created, extending caudally from this point across the EGJ and onto the stomach. A controlled myotomy across the EGJ high-pressure zone is then performed using an endoscopic electrocautery knife, and the entry mucosotomy is closed
with clips.

Q2) Carcinoid tumors true statement  is
a) Multiple sites are not present
b) Most common peptide is histamine
c) Only seen in  small bowel  colon and rectum

Multiple sites can be present and it is also seen in organs such as pancreas, liver etc



Q) 40 years old patient of liver disease due to alcohol now present after episode profuse hematemsis/ Most appropriate management for his condition --
a) sengstaken Blackmore tube
b) iv octretide
c) endoscopic sclerotheraphy
d) tips

Ans c

Q) Lap cholecystectomy Critical view of safety true is
a) Seg 4b should be seen
b) Cystic duct ligated first
c) Cystic duct cbd junction traced

Q3 What is appleby procedure
A) Celiac axis excision
B ) Ca + gda
) Ca + proper hepatic a

Ans a

locally advanced pancreatic neck or body PDAC, aggressive surgical resection of the neck, body, and tail of the pancreas with en bloc resection of the celiac artery can be pursued for curative intent.

This intervention, known as the Appleby procedure, or distal pancreatectomy (DP) with celiac artery resection (CAR), has been increasingly performed at select centers of excellence. Such an approach mandates that the gastroduodenal artery (GDA) is uninvolved and large enough for retrograde hepatic artery perfusion through the SMA.


Q) What is true regarding uncinate first ( medial uncinate )  approach? 

a) It does not allow complete lymphadenectomy

b) Allows identification of replaced RHA

c) More chances of bleed from pancreas head

d) All are true

Ans  b

In 2003, Pessaux et al  presented a modification of the dissection of the retroportal pancreatic lamina which prioritized the dissection of the origin of the SMA, allowing complete lymphadenectomy, safe dissection of the SMA and accurate identification of anatomic variations such as a HA originating in the SMA.

The front aspect of the SMA is dissected from the mesouncinate, at which point the invasion of the SMA can be identified and the surgery finished

The origin of the superior and inferior pancreaticoduodenal arteries (IPDA) can be identified and ligated when they enter the pancreatic head and the uncinate process respectively, reducing congestion and bleeding from the pancreatic head\

Q) Embryology of pancreas . What is true

a) Duct of Wirsung  is mainly formed by entire ventral pancreatic duct

b) Duct of Santorini is the main duct



Q) Reverse gastric tube is based on which artery?

a) Right gastroepiploic

b) right gastric

c) Left gastric

d) left gastroepiploic

Ans d

It preserves part of the stomach and related gastric function and that it has the ability to reach
the pharynx

Used for benign diseases. For malignant diseases it is rarely used nowadays.

The blood supply is based on the left gastroepiploic artery, which arises from the splenic artery and from the short gastric vessels

SKF 445


Q) As per Chicago classification, IRP is raised but failed peristalsis

a) type I Achalasia

b) DES

c) Achalasia in evolution

d) Nutcracker Esophagus

Ans a

Type I achalasia (classic) Median IRP >15 mm Hg, 100% failed peristalsis (DCI <100 mm Hg·s·cm);

Distal esophageal spasm -Normal median IRP; ≥20% premature contractions with DCI >450 mm Hg·s·cm
Hypercontractile esophagus (nutcracker or jackhammer) -----At least 2 swallows with DCI >8000 mm Hg·s·cm

Sabiston 28th 1024



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