Small intestine

Intra Abdominal pressure

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Q) Which of the following is not true about Intra abdominal pressure (IAP) 

a) Normal Intra abdominal pressure in most people is less than 5 mmHg

b) After non complicated surgery  IAP remains less than 5mm Hg

c) IAH (Intra abdominal hypertension) is IAP more than 12 mmHG

d) ACS is IAP more than 20 mm Hg

Question on Management of Abdominal Compartment Syndrome

Small bowel syndrome

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Q) Drug combination not recommended for diarrhea in the early treatment of SBS

a) Loperamide and PPI

b) Loperamide and octreotide

c) Octreotide and PPI

d) Cholestyramine and Oxalate

Answer

Complications of Meckel’s diverticulum

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Q. Least common complication of Meckel's diverticulum (NEET 2018) 

a) Bleeding

b) Obstruction

c) Neoplasm

d) Obstruction

Answer is free 
7) c Neoplasm

The most common clinical presentation of Meckel’s diverticulum is gastrointestinal bleeding, which occurs in 25% to 50% of patients who present with complications

intestinal obstruction occur as a result of a volvulus of the small bowel around a diverticulum associated with a fibrotic band attached to the abdominal wall, intussusception, or, rarely, incarceration of the diverticulum in an inguinal hernia (Littre hernia)

Diverticulitis accounts for 10% to 20% of symptomatic presentations.

Neoplasms can also occur in a Meckel’s diverticulum, with NET as the most common malignant neoplasm (77%). Other histologic types include adenocarcinoma (11%), which generally originates from the gastric mucosa, and GIST (10%) and lymphoma (1%).

Sabiston -1285

Duplication of intestine

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Q) Duplication of the intestine associated with
A. Heterotopic mucosa 
B. Smooth muscle component 
C. Associated with spinal / vertebral defects
D. All are correct

Answer 

Obscure occult Gi bleed

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Q Not true about Obscure occult GI bleed

a) RBC scintigraphy scan has high accuracy

b) Capsule endoscopy can not be done in obstruction

c) Mesenteric Angiography is best for angiodysplasia

d) Intraoperative enteroscopy should be the last resort

 

Spontaneous fistula closure

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Q) Which of the following is an Adverse factor hindering  spontaneous fistula closure:

a) Tract <1cm

b)Transferrin > 200

c) Location in esophagus

d) First surgery done in the same institution

 

a) Tract less than 1 cm

Spontaneous fistula closure

Short-turnover  protein (prealbumin,  retinol-binding  protein,  transferrin)  levels should  be  measured  at  least  weekly  to  assess  the  adequacy of  protein  delivery. An  ongoing  catabolic  state  will adversely  affect  short-turnover  protein  levels,  even  with maximal  protein  delivery.

Failure  of  an  enterocutaneous  fistula  to  close  spontaneously  is associated with acronym FRIENDS): 

the  presence  of  a foreign  body  within  the  tract  or  adjacent  to  it,  previous radiation  exposure  of  the  site,  ongoing  inflammation (most  commonly  from  Crohn  disease)  or  infection  that contributes  to  a  catabolic  state,  epithelialization  of  the fistula  tract  (particularly  if  the  fistula  tract  is  less  than 2  cm  long),  neoplasm,  distal  intestinal  obstruction,  and  pharmacologic  doses  of  steroids. 

Fistulas  associated  with  a concurrent  pancreatic  fistula  also  have  a  low  rate  of  spontaneous  closure,  as  do  those  occurring  in  the  presence  of  malnutrition  or  adjacent  infection.

In general,  anatomic  locations  that  are  favorable  for  closure  are  the  oropharynx,  esophagus,  duodenal  stump,  pancreas,  biliary  tree,  and  jejunum.

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