Complications of Billroth 2 surgery

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

In surgery for benign gastric ulcers, billroth I reconstruction is the preferred choice. Billroth II surgery has problems of

  1. Retained antrum syndrome
  2. Afferent loop obstruction
  3. 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

  1. Nutritional and weight loss - Iron deficiency, Copper deficiency, Vit B12 , Anemia
  2. Delayed gastric emptying
  3. Roux statsis- Seen in roux en y loops-  Pain, nausea, vomiting, abdominal bloating
  4. Cholelithiasis-  Higher incidence in roux en y reconstruction as compared to B1 and B 2 gastrectomy
  5. Recurrent ulceration

Complications of Billroth 2 surgery

  1. Dumping syndrome
  2. Afferent loop obstruction - It can be minimized by keeping the length of afferent loop less than 20 cm and using a retrocloic approach.
  3. Bile reflux gastritis - More common with billroth I and billroth 2 surgery, incidence is decreasing after the use roux en y anastomosis

 

USMLE Trauma

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

Answer c

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

EUS criteria of malignant lymph node

Q) One of the following is not a criteria of malignancy in lymph node on EUS

a) Size more than 1 cm

b) Prominent intranodal vasculature

c) Sharp well defined  borders

d) Hypoechoic