Category: AIIMS GI 2020

Ileostomy vs IPAA in PSC

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Q)  All are true regarding ileostomy and IPAAA in PSC with UC except? ( # AIIMS GI, # colon) 

1) PSC UC end ileostomy have risk of peristomal varices

2) IPAA for UC nd PSC-UC have same long term results

3) IPAA for PSC-UC have high chronic pouchitis

Post gastrectomy syndrome

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Q)  False about post gastrectomy syndrome?
a) 30%incidence
b) Octreotide agonist prevent it's occurrence
c) Megaloblastic anemia due to partial gastrectomy
d) Calcium deficiency  in billroth 2

Crohn Disease Pathology

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Q) Which of the following is not characteristic of Crohn Disease  : * (From AIIMS 2020 November GI)  

a) Granular mucosa
b) Transmural involvement
c) Skip lesions
d) Giant cell granuloma

Ans a ) Granular Mucosa- This is a feature of ulcerative colitis ( Table 49-7 Sabiston 20) 

The typical gross appearance of ulcerative colitis is hyperemic mucosa. Friable and granular mucosa is common in more severe cases, and ulceration may not be readily evident. ( Saby 1340) 

IN Crohn disease - Microscopically, there are focal areas of chronic inflammation involving all layers of the intestinal wall with lymphoid
aggregates. Non-caseating giant cell granulomas are found in 60% of patients and when present clearly allow a confident diagnosis of CD.

( Bailey 1242) 

 

Carcinoid Syndrome

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Q) Carcinoid syndrome wrong statement is?
a) 40 % Right  heart dysfunction in carcinoid syndrome

 

Blood supply of bile duct

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Q)Blood supply of biliary tract? Which is false

a) 2% blood supply is  nonaxial
b) Downward 38% from RHA
c) GB venous drainage directly to Portal vein
d) Main artery supply to retro pancreatic CBD is retroduodenal artery

Alveolar Hydatid disease

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Q45)  All are true for alveolar hydatid disease except?

1) Caused by E. Multilocularis

2) Common in liver

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.

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 

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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Uncomplicated Diverticulitis

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Q). 45 yr old Known case of diverticular disease, presents with left lower abdominal pain , on CT sigmoid wall thickening with fat stranding. All of the following can be done except
a) Admit and iv antibiotic
b) Colonoscopy after resolution
c) Elective colectomy after resolution
d) Out patient oral antibiotic