Questions similar to NEET SS and DNB
Q41) Simple nipple inversion is seen in
a) Duct ectasia
c) Peri ductal fibrosis
d) Carcinoma breast
Q 42) Radiofrequency ablation used in treatment of GERD is
c) Esophy X
d) None of these
Q43) PGDFR mutation is seen in which disease
d) Carcinoma esophagus
Q44) Most common complication after Whipple's operation is
a) Delayed gastric emptying
c) Pancreaticojejunostomy leak
d) Wound infection
Q45) Pulmonary tractotomy is used for
b) Bleeding control in lung injury
c) Pneumothorax decompression
d) Hemothorax drainage
Inversion of nipples can be seen in a lot of conditions, both benign and malignant. Common causes are
- Duct ectasia
- After breast Surgery
- Fat necrosis
- Mondor disease
- Chronic peri ductal mastitis
- Carcinoma breast
Rapid unilateral development of inversion of nipple is a dangerous sign and warrants further diagnosis. Further circumferential retraction is also sign of carcinoma.
Simple nipple inversion occurring at puberty or retracted nipple is of unknown cause and is bilateral in 25%. No treatment is required for this.
Ref - Bailey 801
Grading of benign nipple inversions for management
In grade I, the nipple is easily pulled out manually and maintains its projection quite well. It has minimal fibrosis thus, manual traction and a single, buried purse-string suture are enough for the correction.
Grade II (majority) the nipples can be pulled out but cannot maintain projection and tend to go back again. These nipples are thought to have moderate fibrosis beneath the nipple.
In grade III, to which the least number of inverted-nipple cases belong, the nipple can hardly be pulled out manually. Severe fibrosis made it impossible to reach optimal release of the fibrotic band with the preservation of the ducts.
Radiofrequency ablation works on the principle of inducing injury to the muscle layer of esophagus and inducing fibrotic reaction. This technique spares the mucosa and fibrotic reaction produced at the cardia reinforces the GE junction.
Stretta is the radio frequency device that does it. Thermal applications are given in 0.5 cm areas above and below the GE junction. Most common symptoms that get relieved with this treatment are heartburn and cough. Regurgitation is often not relieved or partially relieved.
EndoCinch is Transoral plication technique
Esophy X same transoral plication
Linx system augments sphincter competence using titanium beads with magnets
Ref: schakelford page 270-274
GIST shows two main mutations-
1st is CD117 seen in 95% and 2nd is PGDFR mutation seen in 5%
Delayed gastric emptying is seen in 20% of cases. Most of the times it resolves but it indicates some intra abdominal collection or deviation from normal course of recovery.
PJ leak is seen in 12% and can be fatal. Depending on the amount of leak, it may be managed with prolonged drainage alone or re exploration and drainage.
Wound infection is 7%
Respiratory complications are rare
Others include Intra abdominal abscess and cardiac events
Ref: Sabiston 1548
It is a surgical technique in which bleeding from through and through lung injuries is controlled. Technique involves laying open of the tract and individually ligating the bronchi and blood vessels.
It prevents a lobectomy and has similar results to it
Wall MJ Jr, Hirshberg A, Mattox KL. Pulmonary tractotomy with selective vascular ligation for penetrating injuries to the lung. Am J Surg. 1994;168:665-9
Asensio JA, Demetriades D, Berne JD et al. Stapled pulmonary tractotomy: a rapid way to control hemorrhage in penetrating pulmonary injuries. J Am Coll Surg. 1997;185:486-7