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,

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. 

Highly selective vagotomy

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Q) False about highly selective vagotomy
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

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
Ref sab 2oth page 1206
Criminal Nerve of Grassi is 1st branch of posterior vagus
Criminal Nerve of Grassi is from posterior vagus
MOre 

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

Acute Gastric dilatation

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Q) Not true about acute gastric dilatation (AGD) 

a) AGD is encountered most often as a postoperative complication in abdominal surgery 

b)Also seen in other  disorders, such as anorexia and bulimia nervosa, psychogenic polyphagia, trauma, diabetes mellitus 

c) When intragastric pressure from gastric distension exceeds 20 cm H2O gastric necrosis starts

d)  clinical features are pain abdomen and effortless vomiting