Caustic Injury to esophagus

Q ) False regarding Caustic injury to Esophagus

a) Gastric lavage not done as it increases the chances of more injury

b) Neutralising  agents not given as it produces more injury than preventing it

c) Milk and albumin not given as it causes more damage

d) Activated charcoal not given as it doesn’t effectively absorb alkali

Check one more question on caustic injuries to esophagus here


Answer 

In  caustic injuries to the esophagus, early decisions have to be taken. The involvement of surgeon should be done early and patient should be placed under close monitoring.

Blind nasogastric and orogastric tubes should not be inserted and initially CT of chest and abdomen with contrast should be done to guide the subsequent procedures. Read on

 

Bariatric Surgery

Q)  False regarding Bariatric surgery

a) VBG produces less weight loss when compared to RYGB

b) Jejuno-ileal by-pass not done nowadays.

c) Dumping is due to non- compliance of dietary advice

d) LAGB requires once a 4-6wk follow up

Answer (free)

c
Calorie restriction is responsible for long term weight loss and its beneficial effects such as control of diabetes, dyslipidemia, hypertension and other metabolic abnormalities.
Restrictive procedures are LSG and  LAGB  which decrease the appetite and induce early satiety.           
The RYGB (ROUX en Y  gastric bypass ) is  a malabsorptive procedure  with long term sustained weight loss.
Mechanism of weight loss after bariatric surgery
Ghrelin is orexigenic gut hormone, which increases appetite. After food intake ghrelin levels fall and appetite decreases.
After restrictive surgery such as LYGB and LSG, ghrelin levels fall and appetite decreases.
Vertical Banded Gastroplasty (VBG) This procedure has been abandoned in favor of other operations because of poor long-term weight loss, a high rate of late stenosis of the gastric outlet, and a tendency for patients to adopt a highcalorie liquid diet, thereby leading to regain of weight. Choice a is correct

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Roux stasis

Q) True about Roux stasis syndrome

a) Dilated Roux limb present

b) can be prevented by inter positioning 20 cm jejunum between stomach n duodenum

c) Delayed gastric emptying of solids

d) It is not related to the size of gastric remnant

Answer

In Roux stasis syndrome there is abnormal peristalsis in the roux limb and propulsion  is proximal. Read on 

Annular pancreas

Q) All are true about annular pancreas except ( AIIMS GI Surgery Question bank)

a) They are mostly asymptomatic

b) It has equal incidence in children and adults

c) Treatment of choice is duodenojejunostomy

d) Associated with Down's syndrome


 Answer c

Annular pancreas is a congenital malformation but manifestations can appear in the adult life.

Annulus means a ring of pancreatic tissue around the duodenum. For annular pancreas to be diagnosed, this ring can be complete or incomplete.

Embryological basis

Normally the ventral buds of pancreas and  dorsal bud fuses together. Non rotation and fusion of these two leads to the formation of annular pancreas. It envelops the  2nd part of duodenum.

Age of presentation

Incidence is equal in both adults and children

Presentation in children is congenital anomalies and duodenal obstruction

Presents in adults as pancreatitis usually in 3rd or 4th decade

Association with other pancreatic conditions

1. Pancreas  divisum 35- 40%

2. Chronic pancreatitis 45- 50%

Other GI conditions

Annular pancreas is a possible etiology of congenital duodenal obstruction and is associated with other congenital anomalies such as Down syndrome, duodenal atresia, and imperforate anus.

Clinical Fetaures

Of those seen as adults, 75%were seen with pain

22% were diagnosed with pancreatitis

24%) had gastrointestinal (GI) symptoms that included vomiting,

11%had obstructive jaundice and/or abnormal liver function test results.

Ref BG page 869

Treatment

It is duodenal bypass and not resection of duodenum as duodenum excision can lead to pancreatitis

in children its duodeno - duodenostomy

in adults duodenoduodenostomy which has now replaced duodenojejunostomy

Sabiston