Category: Jejunum

GIST

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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

Roux stasis

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Q) True about Roux stasis syndrome

a) Dilated Roux limb present

b) Can be prevented by inter positioning 20 cm jejunum between stomach n duodenum

c) Delayed gastric emptying of solids

d) It is not related to the size of gastric remnant

Answer

Acute mesenteric ischemia

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Q)  All are  findings in acute mesenteric ischemia findings except?

a) Slow filling intramural vein

b) Spasm of arterial arcade / distal vessels

c) String of sausages/beaded appearance

d) Dilated and ring enhancement of SMV in CT

Answer 

 

SMA syndrome

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Q True in SMA syndrome

  1. Causes Medial Arcuate Ligament syndrome
  2. Causes nut cracker syndrome
  3. Low AM distance and Narrow AM angle <25 degree is sensitive finding
  4. It can be treated by releasing the DJ and keeping duodenum to the right of the artery

Answer 

 

Vascular

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Q  Engorged dilated Riolan arc vessel with retrograde flow suggests

a) SMA occlusion

b) IMA occlusion

c) Normal flow

d) Iliac artery occlusion

Answer