Contraindication of Left lobe liver transplant

Q) Absolute contraindication for left lobe LDLT is
A. Trifurcation of the portal vein
B. Bifurcation of portal vein in the right lobe of the liver
C. Aberrant right hepatic artery
D. Right Posterior duct draining into left hepatic duct

ANSWER d

Trifurcation of portal vein is not a contraindication of  left lobe liver transplant  as we will get a single portal vein on the left side

Portal vein trifurcation
Portal vein

Bifurcation of portal vein in right lobe does not matter because we are leaving the right lobe behind

Again right aberrant artery does not matter because that segment is left behind

Right post duct draining into left duct gives rise to two ducts on the left or a single duct which is quite high.

Right posterior duct to left

 

 

 

 

Severe Acute Pancreatitis

Q)  Ideal time for CECT in severe acute pancreatitis is
A. After 72 hours
B. After 48 hours
C. 24 hours
D. At admission

Answer for premium members

Mild acute pancreatitis 

  1. enlargement of the pancreas with loss of definition of the borders of the pancreas. 
  2.  Thickening of the right or left anterior pararenal fascia 

Severe Acute pancreatitis 

 Main determinant of clinical outcome is the degree of systemic organ disturbance, particularly during the early hours and days after admission to hospital

More than half of all deaths in AP occur within the first 2 weeks of illness  and are usually a consequence
of multiple organ failure

The revised Atlanta Classification 
3  grades of severity of pancreatitis:

Mild AP—characterized by the absence of organ failure or local
complications

Moderately severe AP—defined by...................read on 

 

Cholangiocarcinoma

Q) Cholangiocarcinoma type IIIB bismuth Corlette bilirubin 10, left portal vein and hepatic artery
involved. Best approach is
A. Preoperative left biliary drainage followed by resection
B. Preoperative right biliary drainage followed by resection
C. Left portal vein embolisation followed by resection
D. Palliative drainage

Answer 

Retained antrum syndrome

Q) True about retained antrum syndrome after gastrectomy  are all except? ( # MCQ in  Stomach 11-15) 

a) It is a persistent hypergastrinemic state

b) It is only seen after Billroth II Gastrectomy

c) Technetium labelled food is not helpful in diagnosing this condition

d) Serum gastrin is usually less than 1000 pg/ml


Answer c

 After billroth II gastrectomy, if a cuff of gastric mucosa remains with duodenum, this entity is called as retained antrum syndrome. This cuff of gastric mucosa is cut off from the proximal stomach and inhibitory effect of hormones such as VIP (Vasoactive Intestinal Peptide)  leading to a persistent hypergastrinemic state. ALso this gastric mucosa is continuously bathed by the alkaline contents of duodenum , which further increases the acid formation.

Both Basal and maximal gastric acid outputs increase but it is not as high as seen in zollinger ellison syndrome. Typically less than 1000 pg/ml

This condition can present as recurrent and persistent ulcerations. Technetium scanning is the diagnostic modality of choice. Treatment is re do surgery and antral excision.

Technetium pertechnate imaging has a sensitivity of 73% and specificity of 100%

More about retained antrum syndrome