Intestinal TB

Q) False about intestinal TB? # Gen surgery infections
1. Hyperplastic variety has colonic strictures
2. Raised markers,anaemia,positive sputum culture point towards diagnosis
3. BMFT shows pulled up cecum
4. IFN gamma assay is diagnostic 

Ans A) STRICTURES ARE OF SMALL BOWEL

There are two types Of Intestinal TB

Ulcerative type - Transverse ulcers with undermined edges, Serosa of bowel is studded with tubercles. It is a severe form of disease

Hyperplastic - Hyperplasia and thickening of terminal ileum. Narrowing of lumen., Stricture and fibrosis occues of terminal ileum

There are raised inflamatory markers and anemia

Interferon gamma is for subclinical infection

BMFT shows subhepatic caecum

Bailey page 80

Enteropathy in T cell lymphoma

Q. Not true about enteropathy in T cell lymphoma
a) It is an  variant of intestinal lymphoma mainly in jejunum and ileum
b) Associated with coeliac disease
c) Perforation is frequently seen with ETL (Enteropathy T cell lymphoma)
d) This type of lymphoma is common
Ans. d
Enteropathy T cell lymphoma is an unusual variant of intestinal lymphoma. It is associated with celiac disease and responds to gluten free diet. It has a higher rate of perforations because of circumferential ulcers. It is commonly seen in jejunum and ileum
Ref- Schakelford Surgery of Alimentary canal  pg 1205
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Indications of Small Bowel transplant

Q ) One of the following is not an indication for small bowel transplant

a)  Impensing liver failure by PNALD

b) Multiple thromboses of central veins 

c)  Single episode of catheter-related infection requiring hospitalization in any year

d) single episode of fungal line infection

 

 

Ingested foreign bodies

Q) False statement about ingested foreign bodies is 

a) Conservative management in most patients

b)  Cathartic agents are part of conservative management

c) Sharp objects can cause perforation

d) Laparotom  is  indicated for  obstruction

 

Contra Indication of stricturoplasty

Q) All are contraindications of stricturoplasty in crohn's disease of small intestine except?

a) Perforation of intestine

b) Fistula or abscess at stricturoplasty site

c) Multiple strictures in long  segment

d) Albumin < 2 g/dl

 

Intussusception in childhood

Q) Most common intussusception in children is

a) Ileocolic

b) Ileoileal

c) Ileoileocolic

d) Colocolic

Answer for premium 

GIST

Q) True statement regarding GIST is  (AIIMS 2019)

a) 80% of GIST arise from stomach

b) ILeal GIST is resistant to Imatinab

c) Leiomyosarcomas do not express CD 117

d) Prognosis of GIST does not depend on the site of lesion 

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c
 They can appear anywhere within the GI tract, although they are usually found in the stomach (40% to 60%), small intestine (30%), and colon (15%).
 Development of imatinib mesylate has significantly altered previous treatment strategies. Imatinib mesylate is a tyrosine kinase inhibitor that blocks the unregulated mutant c-kit tyrosine kinase and inhibits the BCR-ABL and PDGF tyrosine kinases.
Current guidelines suggest that patients with high-risk disease should receive 3 years of adjuvant  therapy at all sites
Sabiston page 1280
Ileal GIST are more malignant than stomach GIST

Leiomyosarcomas

Among the gastric tumors, there were no examples of true leiomyosarcomas, whereas there were four small intestinal, four colonic, and two rectal tumors that histologically showed features of differentiated smooth muscle cells with blunt-ended nuclei and eosinophilic, sometimes granular, cytoplasm. These tumors were, by definition, all positive for SMA, and seven also were positive for desmin. Although all leiomyosarcomas were generally negative for CD117, scattered large neoplastic spindle cells (less than 1% of tumor cells) in two intestinal leiomyosarcomas showed strong cytoplasmic positivity; these four tumors were negative for CD34.

Ref https://www.nature.com/articles/3880210

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