Bleeding Peptic ulcer

Q) In a patient with a bleeding peptic ulcer, endoscopy is done. Which of the following findings on endoscopy predicts the highest rate of re bleed?

a) Non bleeding vessel

b) Adherent clot

c) Flat pigmented spot

d) Clean base ulcer

Free Answer . Click here for stomach MCQs

a) Non bleeding vessel IIA - Out of the choices given

Bleeding peptic ulcer is mostly from the posterior surface of the lesion and can be sometimes lethal

Forrest classification is used to grade the risk of re bleeding in peptic ulcers.

According to the stigmata of recent bleed, the chances of re bleed increase.

Forrest Classification

Ia - Active Spurting

Ib-  Active oozing

IIa Non bleeding vessel             50% chance of rebleed

IIB Adherent clot

IIC Flat Pigmented spot

III Clean based ulcer

Sabiston 12o3 20th edition

 

 

Parenteral nutrition

Q) IV fluid of choice to increases calories to provide parenteral nutrition  by peripheral route is:

a) DNS

b) Lipid Emulsions

c) Arginine in DNS

d) 25% dextrose

Answer (FREE)  b

Lipid Emulsions can be given by peripheral route. They are the highest source of energy and calories.  25% dextrose, although a good source of energy has high concentration of glucose which can cause thrombophelebitis.

DNS will provide just basic calories and will not cause any increase in calorie intake.

Addition of arginine, which is an amino acid will not increase the energy intake.

 

Electrolytes

Q) A 50 year old male undergoes pancreatectomy for Carcinoma head of pancreas. His pre op Hb was 9.2g% and during surgery he received 5 units of PRBC. In the post op period on the 2nd day he develops ECG changes. Work up is done for Myocardial Ischemia which is negative. What is the most common  cause of ECG changes here

a) Hyponatremia

b) Hyperkalemia

 

Gastrinoma

Q) Regarding gastrinoma what is true?

a) All gastrinomas express SRS receptors

b) In 30 % of cases gastrinomas are not localized intra operatively

c) Levels of serum  gastrin more than 100pg/ml are strongly suggestive of gastrinoma

d) Angiography with secretin stimulation is required in all cases for localization of gastrinoma

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Median arcuate syndrome

Q) Median arcuate syndrome is due to compression of 

a) Coeliac artery

b) Superior mesenteric artery

c) Phrenic artery

d) Inferior mesenteric artery

Free Answer for MCH GI Surgery Questions

A) a

Median arcuate syndrome is also known as coeliac artery compression syndrome. Median arcuate

ligament connects the diaphragm with the spine. In some individuals this median arcuate compresses the coeliac artery and produes abdominal pain. Read More ...

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