Q) What is type III esophageal hernia?
a) Paraesophageal hiatus hernia
b) Sliding hiatus hernia
c) Both sliding and paraesophageal hernia
d) Large part of stomach in the mediastinum with pylorus near the esophageal hiatus
Hiatal hernias are protrusion of stomach through a defect in the esophageal hiatus into the mediastinum.
They are of four types of hiatus hernia
Sliding - GE junction migrates to the mediastinum and rests superior to the diaphragm.
Paraesophgaeal - Part of stomach migrates through the esophageal hiatus into the mediastinum with GE junction remaining at its normal position.
There are IV types of hiatal hernia
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a) Ureteral obstruction
b) Entero vesical fistula
d) Recto uretheral fistula
Q) True about management of hemangioma liver
a) All hemangioma more than 10 cm should be resected
b) OCPs and pregnancy should be avoided in young females as there is risk of rupture
c) Arterial embolization should be routinely done in large hemangiomas
d) If surgery is decided hemangioma located at the periphery should be enucleated
Q) What is true regarding complications of billroth 2 surgery?
a) It has less complications than billroth 1 surgery
b) Recurrent ulceration is more common in the afferent limb as compared to efferent limb.
c) Afferent loop obstruction is more common after billroth 2 surgery
d) Billroth I operation is preferred in scarred duodenum
Answer c -
In billroth 2 surgery, afferent limb obstruction is more common
I n surgery for benign gastric ulcers, billroth I reconstruction is the preferred choice. Billroth II surgery has problems of
Retained antrum syndrome
Afferent loop obstruction
Duodenal stump leak (1-3%)
Billroth 2 surgery is done when there is
1. Inadequate mobility of the duodenum
2. Scarring of duodenum
Complications of gastric surgery
Complications of gastrectomy
Nutritional and weight loss - Iron deficiency, Copper deficiency, Vit B12 , Anemia
Delayed gastric emptying
Roux statsis- Seen in roux en y loops- Pain, nausea, vomiting, abdominal bloating
Cholelithiasis- Higher incidence in roux en y reconstruction as compared to B1 and B 2 gastrectomy
Complications of Billroth 2 surgery
Afferent loop obstruction - It can be minimized by keeping the length of afferent loop less than 20 cm and using a retrocloic approach.
Bile reflux gastritis - More common with billroth I and billroth 2 surgery, incidence is decreasing after the use roux en y anastomosis
Q) Splenic artery aneurysm is seen in ( #spleen1)
a) Proximal 1/3rd of splenic artery
b) Proximal 2/3 of splenic artery
c) Middle 1/3 of splenic artery
d) Distal 1/3 of splenic artery
Answer is free
Q) A 55 year old male presents with obstructive jaundice. Ultrasound evaluation reveals a
hyperechoic 4 cm mass in segment VI of liver with peripheral duct dilatation.
CT abdomen shows a hypodense mass with delayed enhancement in portal pahse.
What is the most likely diagnosis
a) Hepatocellular carcinoma
b) Intrahepatic cholangiocarcinoma
c) Metastatic Adenocarcinoma
Answer is free
Q) Which of the following histological varieties of IPMN is associated with low grade dysplasia
a) Intestinal type
b) Oncocytic type
c) Pancreaticobiliary type
Answer Premium member
Q) All of the following are seen in both ulcerative colitis and crohn's disease except
a) Aphthous ulcer
b) Pseudo polyp
c) Rectal disease
d) Obstructive symptoms
Ans for Premium Members
Q ) A 25 year old male brought to the hospital after being involved in a road traffic accident that occurred 50 minutes ago. His initial BP at the scene of accident was 80/40 mm HG with a pulse rate of 120/min.
The paramedics administered 2 litres of normal saline in the ambulance and in the emergency department his BP is 110/70 with a pulse rate of 90/min.
He has tenderness in Left upper quadrant abdomen and USG reveals perisplenic fluid. Next step is to :
a) Take him for exploratory laparotomy
b) Shift him to ICU and observe
c) Do a CT scan of the abdomen
d) Put in a laparoscope and assess
This Patient has a splenic injury due to blunt trauma abdomen.The immediate management depends on grade of splenic injury and response to IV Fluids. This patient is hemodynamically stable after IV fluids and immediate laparotomy is not needed.
Direct shifting to ICU is also not the right choice because CT is required first and for more severe injuries patient can go to OT
Laparoscopy has no role in splenic injuries