Surgery for Gastric volvulus

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Q)   Which is not an operative approach in  in gastric volvulus? ( Click for  more Questions on Stomach) 

a) Tanner

b) Opolzsr

c) Grey Ghimmenton

d) Gavrilu

Ans  d ) Gavrilu

Gavrilu is  trans-abdominal myotomy and antireflux procedure using a flap of greater curvature of stomach to be sutured over esophageal mucosa through a left subcostal incision

Division of gastro colic ligament and gastropexy is tanner

Splitting the meso colon and doing a gastropexy is grey ghimelton

Fundo antral gastrogastrostomy - opolzsr
Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice

Post gastrectomy syndrome

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Q)  False about post gastrectomy syndrome?
a) 30%incidence
b) Octreotide agonist prevent it's occurrence
c) Megaloblastic anemia due to partial gastrectomy
d) Calcium deficiency  in billroth 2

Endoscopic Resection of Stomach cancer

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Q.  Not an Extended Criteria for Endoscopic resection of gastric cancer?

a) Less than 3 cm irrespective of ulceration
b) Limited Sm1 leison
c) Submucosal invasion 2 cm in size

d) submucosal invasion 3.5 cm in size

Peptic Ulcer Location

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Q) False statement about location of peptic ulcer?

a) Type 1 is on greater curvature

b) Type 2 is gastric body and duodenal

c) Pauchet procedure is for type IV

d) Type Iv is high on lesser curvature

Ans 16) a

TYPE             LOCATION                             ACID LEVEL
I                   Lesser curve at incisura         Low to normal
II               Gastric body with duodenal ulcer Increased
III                      Prepyloric                           Increased
IV                   High on lesser curve               Normal
V                        Anywhere                            Normal,

D 2 gastrectomy

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Q) D2 gastrectomy false (AIIMS 2020 GI) ( AIIMS 2021) 
a. No benefit in OS

b. Better DFS
c. Recommended to take stomach, omentum, retro peritoneum en masse
d. Can remove spleen or pancreas if involved

Maltoma Stomach

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Q) False about maltoma of stomach

a Rituximab based therapy is useful in  resistant cases

b) Most respond to anti H pylori

c) T (11, 18) respond to h pylori eradication


Gastric Lymphadenopathy

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Q ) which is one of the  criteria for diagnosis of gastric lymphadenopathy
a. mesenteric lymphoadenopathy
b. hepatic involvement

c. general lymph adenopathy
d . blood count within normal limt

Ans d

Dawson criteria

(1) absence of peripheral lymphadenopathy at the time of presentation;

(2) lack of enlarged mediastinal lymph nodes;

(3) normal total and differential white blood cell count

(4) predominance of bowel lesion at the time of laparotomy with only lymph nodes obviously affected in the immediate vicinity; and

(5) no lymphomatous involvement of liver and spleen


Afferent loop syndrome

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Q) Not true about afferent loop syndrome

a) It can  occur after either partial or total gastrectomy with Billroth ii reconstruction or roux en y gastrojejunostomy

b) Acute obstruction is more common than chronic

c)  Weight loss and anemia are common. 

d) Bacterial overgrowth in  afferent limb causes  malabsorption of fat and other nutrients, such as vitamin B12 or iron. 

Role Of PET Scan in CA Stomach

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Q) What is not true about the role of PET Scan in staging of Ca Stomach?

a) 50% of Carcinoma stomach are PET avid

b) Response to Neoadjuvant therapy is  usually seen on PET in 2 weeks

c) PET response correlates with survival 

d) Sensitivity of PET is same for all kinds of histopath tumors

Highly selective vagotomy

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Q) False about highly selective vagotomy? ( # Gastric Surgery MCQS(# Questions on Esophagus) 
a) Highly selective vagotomy divides the vagus nerves supplying the acid-producing portion of the stomach
b) Incidence of postoperative complications is lower.
c) The criminal nerve of Grassi should be severed

d) Crow's feet nerves are severed till below the GE junction

This Question discusses the concept of criminal nerve of Grassi and features of HSV

Ans -d

Highly Selective Vagotomy (HSV)  only divides the last part of the nerves which supply the part of stomach which produces acid.
Anterior  and posterior  nerves of Latarjet are found and their terminal branches are severed from 7 cm proximal to the pylorus to 5 cm above the GE junction
Motor function of the stomach is not affected
Criminal nerve of Grassi is branch of posterior Vagus. It should be sought and cut. This nerve derives its name from the common mistake done during vagotomy. This nerve is often missed and responsible for recurrence of symptoms of Peptic ulcer disease.
Ref sab 2oth page 1206


Criminal Nerve of Grassi is 1st branch of posterior vagus
Criminal Nerve of Grassi is from posterior vagus

Vagus Nerve branches 

  • Anterior trunk: Gives
Branch to liver GB and Bile duct and goes along the lesser curvature as the anterior nerve of Latarjet
  • Posterior Trunk:

    Sends branches to the celiac plexus and continues along the posterior aspect of the lesser curvature as the posterior nerve of Latarjet.
    • Criminal Nerve of Grassi: The first branch of the posterior trunk, innervates the gastric fundus. Failure to divide this nerve during an acid-reducing surgery can lead to recurrent ulcers
    • Crows Foot: The most distal branches of the anterior and posterior trunks and provides innervation to the antro-pyloric region. These branches are spared in a highly selective vagotomy (HSV)
    • Parasympathetics are vagally mediated using acetylcholine as the primary neurotransmitter

Question on Dumping Syndrome