Q) In a patient with a bleeding peptic ulcer, endoscopy is done. Which of the following findings on endoscopy predicts the highest rate of re bleed?
a) Non bleeding vessel
b) Adherent clot
c) Flat pigmented spot
d) Clean base ulcer
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a) Non bleeding vessel IIA - Out of the choices given
Bleeding peptic ulcer is mostly from the posterior surface of the lesion and can be sometimes lethal
Forrest classification is used to grade the risk of re bleeding in peptic ulcers.
According to the stigmata of recent bleed, the chances of re bleed increase.
Ia - Active Spurting
Ib- Active oozing
IIa Non bleeding vessel 50% chance of rebleed
IIB Adherent clot
IIC Flat Pigmented spot
III Clean based ulcer
Sabiston 12o3 20th edition
Q) Regarding gastrinoma what is true?
a) All gastrinomas express SRS receptors
b) In 30 % of cases gastrinomas are not localized intra operatively
c) Levels of serum gastrin more than 100pg/ml are strongly suggestive of gastrinoma
d) Angiography with secretin stimulation is required in all cases for localization of gastrinoma
Answer for premium members
Q) In gastric cancer, lymph node station 12 corresponds to
a) Common hepatic
d) Superior Mesenteric
Q) What is true regarding complications of billroth 2 surgery?
a) It has less complications than billroth 1 surgery
b) Recurrent ulceration is more common in the afferent limb as compared to efferent limb.
c) Afferent loop obstruction is more common after billroth 2 surgery
d) Billroth I operation is preferred in scarred duodenum
Answer c -
In billroth 2 surgery, afferent limb obstruction is more common
In surgery for benign gastric ulcers, billroth I reconstruction is the preferred choice. Billroth II surgery has problems of
- Retained antrum syndrome
- Afferent loop obstruction
- Duodenal stump leak (1-3%)
Billroth 2 surgery is done when there is
1. Inadequate mobility of the duodenum
2. Scarring of duodenum
Complications of gastric surgery
Complications of gastrectomy
- Nutritional and weight loss - Iron deficiency, Copper deficiency, Vit B12 , Anemia
- Delayed gastric emptying
- Roux statsis- Seen in roux en y loops- Pain, nausea, vomiting, abdominal bloating
- Cholelithiasis- Higher incidence in roux en y reconstruction as compared to B1 and B 2 gastrectomy
- Recurrent ulceration
Complications of Billroth 2 surgery
- Dumping syndrome
- Afferent loop obstruction - It can be minimized by keeping the length of afferent loop less than 20 cm and using a retrocloic approach.
- Bile reflux gastritis - More common with billroth I and billroth 2 surgery, incidence is decreasing after the use roux en y anastomosis