HCC Cancer

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Q) Which of the following is true about screening in hepatocellular carcinoma (HCC Cancer)  a) Alpha feto protein should be done 6 monthly b) Ultrasound abdomen should be done 6 monthly c) Candidates for liver transplant should be screened every 3 months d) Nodules more than 2 cm should be followed up  more regularly Answer b Cirrhosis is prone for development of HCC. Screeing has to be stringrnt.  Earlier ultrasound of liver and alpha feto protein were both used for screening In 2009 Marrero et al demonstrated the suboptimal accuracy of AFP and after that it has been removed from the screening protocol and now only ultrasound is being done. The screening recommendation is not for those patients with severe associated conditions and with advanced liver disease who are already considered for  transplant. So there is no screening for those who are already listed. Nodules more than 1 cm are highly suspicious where as in nodules less than 1 cm only 40% will be malignant. Ref: blumgart 6th edition  

Gall Bladder Cancer in setting of APBDJ

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Q) Gall bladder cancer arising in the setting of APBDJ , all are true except a) It occurs in younger age b) Prevalent in Asian countries c) More common in males d) Less often associated with Gall stones Answer (free) c)  It is more common in females In APBDJ, pancreatic and biliary duct meet more than 15 mm away from the duodenal wall. APBDJ is seen more in asian countries and is associated as a cause of gall bladder cancer. It is seen in younger age group Most of the patients are females Ref article- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658122/

Recurrent Pyogenic Cholangitis

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Q) Not true about  recurrent pyogenic cholangitis : a) Mostly there are intrahepatic strictures with involvement of the left side duct b) It can present as choledochoduodenal fistula c) In it there is complete biliary obstruction which  leads to marked jaundice and pruritis d) MRCP and other other cholangiography can be diagnostic   Answer c In recurrent pyogenic cholangitis (RPC)  complete obstruction does not occur and jaundice and pruritis is not marked. RPC is a disease commonly seen in young Asians (also known as oriental cholangiohepatitis) which leads to multiple strictures in extra or intrahepatic ducts. Association with Ascaris lumbricoides and Clonorchis sinensis has been noted. It can present as choledocholithiasis  with stricture, choledochoduodenal fistula, acute pancreatitis, secondary biliary cirrhosis and can lead to cholangiocarcinoma. MRCP can be diagnostic and is preferred because of its non invasive nature.  

Beger Procedure for Chronic Pancreatitis

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Q) True about Beger procedure for chronic pancreatitis a) Posterior branch of gastro duodenal artery is preserved. b) Beger procedure is  a pancreatic head mass resection that can be done for small pancreatic tumors. c) Intra pancreatic, choledochal and ampullary structures are removed. d) Neck of the pancreas is not  transected

Roux en Y gastric bypass Surgery

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Q) Which  of the following statement about Roux en Y gastric bypass Surgery is not true? a) After weight loss it resolves symptoms of venous ulcers due to stasis b) Symptoms of pseudo tumor cerebri are resolved c) Heartburn is alleviated immediately d) Protein malnutrition is a very common problem