Q) Antral GIST 1cm incidentally found on UGIE. True regarding its management
a) Surgical resection
b) Endoscopic resection
c) Resection required if EUS suggests irregular border with cystic spaces
d) Endoscopic surveillance, if size >2cm then resect
Answer (Pemium members who are logged in can see explanation below)
Q . Wrong about post gastrectomy syndromes (AIIMS MCQ 2018 GI)
A. Early dumping syndrome occurs after 1 hour
B. Early dumping syndrome has less cardiac and more gastrointestinal symptoms
C. Anastomotic ulcer is more after billroth II
D. Post gastrectomy syndromes are common in billroth II than roux en Y anastomosis
Q ) Hereditary diffuse Gastric carcinoma is associated with which breast cancer
A. Ductal carcinoma NOS subtype
B. Lobular carcinoma
C. DCIS
D. Metaplastic carcinoma
Answer for Q 79
Majority of Gastric Cancers are sporadic,
1–3% of GCs arise as a result of inherited cancer predisposition syndromes.
Li-Fraumeni syndrome, Lynch syndrome, Peutz-Jeghers syndrome, hereditary breast and ovarian cancer,1MUTYH-associated adenomatous polyposis (MAP), familial adenomatous polyposis, juvenile polyposis syndrome and PTENhamartoma tumour syndrome (Cowden syndrome).
Q) True about retained antrum syndrome after gastrectomy are all except
a) It is a persistent hypergastrinemic state
b) It is only seen after Billroth II Gastrectomy
c) Technetium labelled food is not helpful in diagnosing this condition
d) Serum gastrin is usually less than 1000 pg/ml
Answer c
After billroth II gastrectomy, if a cuff of gastric mucosa remains with duodenum, this entity is called as retained antrum syndrome. This cuff of gastric mucosa is cut off from the proximal stomach and inhibitory effect of hormones such as VIP (Vasoactive Intestinal Peptide) leading to a persistent hypergastrinemic state. ALso this gastric mucosa is continuously bathed by the alkaline contents of duodenum , which further increases the acid formation.
Both Basal and maximal gastric acid outputs increase but it is not as high as seen in zollinger ellison syndrome. Typically less than 1000 pg/ml
This condition can present as recurrent and persistent ulcerations. Technetium scanning is the diagnostic modality of choice. Treatment is re do surgery and antral excision.
Technetium pertechnate imaging has a sensitivity of 73% and specificity of 100%
Diuelafoy lesion which is false? (AIIMS 2018)
A. Most of the bleed cannot be visualised due to small mucosal defect lies over large arterial
bleed.
B. Large 1-3 mm artery in the submucosa is the source
C. MC in the greater curvature
D. Found within 6 cm from GEJ
Q. Hyergastrinemia occurs in all except
a)Retained antrum
b)Excluded antrum
c)Brunner gland adenoma
d)GOO
Q) Late dumping syndrome is due to
a) Excessive release of insulin
b) Food bolus in jejunum
c) Release of serotonin
d) Local enteric reflexes
Answer
a, Excessive release of Insulin
Dumping syndrome are most common after billroth II gastrectomy followed by BI and Truncal vagotomy and gastro jejunostomy.
Dumping can occur 30 mins after food, (early dumping) or 2 hours after eating (late dumping). Early dumping has GI symptoms such as nausea, vomiting, epigastric fullness, diarrhea and abdominal pain.
Early dumping occurs due to rapid emptying of chyme in jejunum. This hyperosmolar fluid draws water from extracellular compartment to the lumen of small intestine causing intestinal distension and autonomic changes.Serotonin, bradykinin-like substances, neurotensin, and enteroglucagon are involved in early dumping.
Late dumping syndrome has more cardiovascular symptoms such as palpitations, light headedness, dizziness, tachycardia, diaphoresis, flushing and blurred vision.
It occurs due to delivery of carbohydrates into jejunum, their absorption causes hyperglycemia and insulin release. Excessive insulin release leads to development of symptoms.
Treatment
Ref Sabiston 1212
Q) According to Borrmann's Classification of Ca stomach Type II is
a) Fungating
b) Polypoid
c) Ulcerative
d) Infiltrative
Answer free
Ans a
Fungating
Borrmann’s classification is for advanced gastric tumors.
It is useful to distinguish between advanced and early gastric tumors because in advanced tumors neo adjuvant therapy improves over all survival.
The gross appearance of advanced gastric carcinomas can be divided into
Type I for polypoid growth
Type II for fungating growth,
Type III for ulcerating growth,
Type IV for diffusely infiltrating growth which is also referred to as linitisplastica
Q) Management of carcinoma body of stomach which on exploration is only invading the body of pancreas with no distant metastasis
a) feeding jejunostomy and closure
b) Palliative total gastrectomy
c) Total gastrectomy with ......