Q) What is true regarding timing of cholecystectomy in biliary pancreatitis
a) Cholecystectomy should be done before discharge in severe pancreatitis to prevent recurrent attacks
b) Cholecystectomy should be done in same admission as pancreatitis when severe disease is excluded
c) Early cholecystectomy has been shown to have more complications than interval choelcystectomy
d) Early cholecystectomy increases technical complications
"Poncho trial " answers this question
Early cholecystectomy (just before discharge, when the patient has recovered and severe disease excluded), compared to interval cholecystectomy, effectively reduces
The rate of recurrent gallstone-related complications in patients with mild biliary pancreatitis,
low added risk of complications.
Evidence on the timing of cholecystectomy in severe pancreatitis is scarce. Cholecystectomy is recommended after all signs of pancreatic necrosis have been resolved or if they persist more than 6 weeks
Q)In preop evaluation before placing skin graft over wounded area…bacterial colony count must be less than a) 10000 b) 100000 c) 1000000 d) 10000000
ans b) 10 raise to the power 5
Prerequisites for skin grafting: The recipient site should be assessed for potential bacterial load, blood supply, presence of devitalized tissue, and exposed vital structures. Donor site availability Perform recipient site tissue culture if history or concern for infection (counts <105 CFU/g tissue for most pathogens required before grafting). Presence of group a beta heamolytic streptococci is absolute contraindication for skin grafting [/bg_collapse]
Q) Post whipples on pod4 patient presented with fever, tachycardia and pain, usg showed collection, which was drained percutaneously. on pod 10 there is frank blood of 100ml in drain, next line of management
a. Ct angiography
b. Emergency laparotomy
c. flush the drain with noradrenaline d. Observe
This is extraluminal bleed on 10th POD following most likely a pancreatic fistula. Clinical condition is mentioned for day 4 which is because of pancreatic leak. A pancreatic fistula can cause vascular pseudo aneurysm so answer is A CT angiography
Early extraluminal PPH requires reexploration.
Intraluminal bleeding may manifest as extraluminal if there is associated anastomotic breakdown,and this may be amenable to angiographic intervention when involving the pancreaticojejunostomy.
Patients present with septic complications and/or a sentinel bleed. Radiographic embolization has become a more successful modality, with up to 80% success,13 but is limited by the initially intermittent nature of the bleeding
Exploration - if patient is not stable Ref SKF page 1241
Q) Which has no part in management of corrosive injury of esophagus?
a) Repeated Endoscopies routinely
b) Esophagectomy in some cases
c) Early emergency surgery routinely
d) Steroid use routinely
Other than the need for emergency surgery for bleeding or perforation, elective oesophageal resection should be deferred for at least 3 months until the fibrotic phase has been established.
Oesophageal replacement is usually required for very long or multiple strictures. Resection can be difficult because of perioesophageal inflammation in these patients.
Regular endoscopic examinations are the best way to assess stricture development (Figure 62.12). Significant stricture formation occurs in about 50% of patients with extensive mucosal damageo Corrosives can cause significant pharyngolaryngeal oedema
In unusual circumstances, e.g. with extensive necrosis after corrosive ingestion, emergency oesophagectomy may be necessary.