Q16 Which of the following is not true about reconstruction in caustic injuries to esophagus
a) Caustic injuries to esophagus have 1000 times more risk of developing malignancy
b) Right colon replacement is definately better than left colon
c) The only indication for elective surgery is refractory strictures and possibility of malignancy
d) Most of the surgeons prefer bypass over resection of esophagus
There are no trials which determine that use of right colon is better than the left.
Choice of conduit depends on vascularity and surgeon's preference.
Although the risk of developing malinancy is 1000 times high but in most large series involving 500-1000 patients only 1 or 2 patients developed cancer over a period of 20-30 years.
The risk of resecting the esophagus in badly adherent mediastinum is high so most of the surgeons opt for retro sternal bypass and not esophageal resection. The disadvantage of this approach is that it sometime converts the esophagus into a mucocele which can cause pain and mediastinal compression later on.
Ref Book- Shackelford's Surgery of Alimentary canal
Q17) CT Scan in Carcinoma Esophagus is least useful in describing
a) T staging
b) Nodal staging
c) Distant Metastasis
d) Omental involvement
CT is least sensitive in distinguishing T1-T3 lesions. It has better ability to define T4 lesions when there is involvemnt of trachea, pericardium or aorta.
In a known case of carcinoma esophagus a lymph node greater than 1 cm is mostly malignant. Contrast Enhanced Computed Tomography (CECT) has its best role in predicting distant metastasis by picking up secondaries in liver, omental or even adrenal involvement
Q18 . Barrett's esophagus is a premalignant condition. Which of the following statement is false regarding Barrett's esophagus
a) Barrett's mucosa predisposes to Squamous cell carcinoma of esophagus
b) Risk of Cancer is 0.5% per year
c) Prevalence of Barrett's esophagus in general population is 2-7%
d) Intestinal type of mucosa with goblet cells is the most common histopathological finding
Barrett's esophagus --- with adenocarcinoma and not squmaous cell carcinoma. Metaplasia occurs most commonly because of GERD and the normal esopheal lining is replaced by columnar cells
These columnar cells can be (i) Junctional cells (ii) Gastric cells and (iii) Intestinal Type of cells
Presence of intestinal type of cells with presence of goblet cells is the sine quo non of Barrett's esophagus
All other options are true.
Q19) Which of the following statement is true for epiphrenic diverticulum
a) Surgery or Endoscopic Intervention is required in almost all cases at detection
b) Most of these diverticulum of esophagus are primary
c) Most of the epiphrenic diverticula are on the right
d) These are also known as traction or mid esophageal divertcula
Epiphrenic diverticulum is a lower esophageal diverticulum with in 10 cm of gastro esopheal junction (GEJ)
it is and false due to associated motor disease such as Diffuse esophageal spasm (DES) or Achlasia. (Read more about Achlasia Cardia here) Unlike the middle esophageal divertula these are not traction diverticula. These are most commonly seen on the right side.
Most of these are asymptomatic and treatment is required only if they cause chest pain (due to DES) or regurgitaion or aspiration.
Q20 ) One of the following is not a criteria of malignancy in lymph node on EUS
a) Size more than 1 cm
b) Prominent intranodal vasculature
c) Sharp well defined borders
Prominent intravascular pattern in the lymph node is suggestive of benign pathology and other features of malignany include, size more than 1 cm, well defined sharp borders, lost nodal pattern and hypoechoic consistency