Q51) 45 year old male with 2 cm Jejunal Neuroendocrine tumor ( NET). Dota Scan Shows no metastasis What would be the best management in him?
a) Octreotide
b) Resection & Anastomoses of jejunum
c) Resection and Anastomoses with mesenteric excision
d) Radiotherapy
Ans 51 c
The treatment of patients with small bowel NETs is based on tumor size, location, and presence of metastatic disease.
Smaller than 1 cm in diameter without evidence of regional lymph node metastasis, a segmental intestinal resection is adequate.
For patients with lesions larger than 1 cm, with multiple tumors, or with regional lymph node metastasis, regardless of the size of the primary tumor, wide excision of bowel and mesentery is required.
Lesions of the terminal ileum are best treated by right hemicolectomy
Sabiston page 1280
Q 52) 12 year old girl undergoes massive small bowel resection and develops small bowel syndrome. Identify the wrong statement regarding this condition
a) Acute phase lasts till 4 weeks
b) Adaptation phase begins after 6 months
c) Maintenance phase is life long
d)All are wrong
Ans 52 ) b
Adaptive process begins within 24 hours of significant intestinal resection and continues over a
2-year period.
The degree or success of intestinal adaptation depends on anatomic factors, such as the extent and site of intestinal resections, the patient’s health and existent
underlying disease processes, the mechanism of nutritional support, and regaining the endocrine regulatory mechanisms of the GI tract.
three phases of intestinal adaptation:
• Acute phase—postresection to 4 weeks. The goal is stabilization of the patient’s sequelae of diarrhea, malabsorption, and dysmotility.
• Adaptive phase—1 to 2 years. The goal is achieving
aximal intestinal adaptation with a gradual increase f nutritional exposure.
• Maintenance phase—long term. Optimizing fluid
balance and individualized dietary regimen. Management of acute exacerbations.
SKF 8th edition 923
Q 53 ) Permanent parenteral nutrition is avoided in type III SBS if less than _______ cm of jejunum is preserved ?
a) 100
b) 150
c) 200
d) 250
Ans a
Type III SBS
End jejunostomy ----Some jejunum retained. Ileum, ICV colon removed. End jejunal ostomy
Deficiencies in vitamin B12, bile salts, magnesium. Fluid
and nutrient malabsorption
REF SKF 8th Table 79.2
Q 54) The measurement of serum CgA is a useful test in patients with suspected NETs. In which benign condition it can be elevated
a) Impaired liver function
b) Reflux esophagitis
c) Anal fistula
d) Intussusception
Ans 54 a
The measurement of serum CgA is a useful test in patients with suspected NETs.
This can be elevated in both functional and nonfunctional tumors
This test is particularly sensitive to the assay technique, and it is
advised that serial measurements be performed.
In addition, there are many nonneoplastic causes of elevated CgA that should be considered, including impaired renal and hepatic function, hypergastrinemia secondary to proton pump inhibitors or atrophic gastritis, and inflammatory bowel disease
SKF 8th page 943
Q 55 ) Which of the following is not true regarding metabolic diagnosis of neuroendocrine tumors?
a. Aspirin use can cause false low urinary 5HIAA
b. Urinary 5HIAA has sensitivity of -75% specificity of -85%
c. Most specific for NET is 24 hour urinary 5HIAA
d. Hindgut NET have increased urinary 5HIAA than midgut
Ans d
Measurement of urine 5-HIAA is useful mainly for midgut tumors and is much
less helpful for tumors from the foregut and hindgut.
All others are true
SKF 943
Q 56 ) When will you not do stricturoplasty in Crohn disease of small intestine?
a) Large phlegmon
b) Malignancy
c) Active inflamation
d) All the above
Ans d
Stricturoplasty is generally considered the preferred approach to a Crohn stricture but is inappropriate in the setting of active inflammation/infection, large phlegmon,
when the length or number of strictures within a given segment makes resection a better option, or when there is concern about carcinoma
