Q 36 ) What is not true regarding Sugiura's procedure for Portal Hypertension
a) It is a transesophageal variceal ligation
b) Splenectomy is done
Ans 36) a
Non shunt operations are done for bleeding esophageal varices in emergency for poor risk patients when sclerotherapy or other conservative methods fail.
Sugiura's is a devascularization procedure described in 1973, It has two parts
Thoracic and abdominal which may be simultaneous or staged. The Left posterolateral thoracotomy is done. The longitudinal periesophageal azygous collateral veins and thoracic vagus is preserved. The esophagus is transected at level of diaphragm. This completely devascularizes the esophagus. The cut mucosa and anterior muscle layer is approximated.
Then the abdominal approach is done and abdominal esophagus, cardia of stomach is devascularized. Short gastric vessels are ligated, selective vagatomy is done, pyloroplasty is done, splenectomy completes the procedure.
Transgastric varix ligation was done previous to this procedure as described by Tanner but not transesophageal. Hence 'a' is the answer.
Schakelford pancreas pg 383.
Q37. True about Hydatid cyst of liver is
a) Echinococcus multilocularis is more common than Echinococcus Granulosus
b) Extrahepatic location is 15% in lungs and 2% in brain
c) Adult worm infests carnivores
d) Indirect Heamagglutination (IHA) is the most specific serological test.
The larva of echinococcus causes hydatid cyst in man. In liver E.Granulosus is the commonest organism.
The adult worm lives in the intestine of carnivores (definitive host) and shed eggs
which are picked by herbivores. The embryos are responsible for hydatid of liver.
Immuno electrophoresis has a specificity of 90%. IHA and ELISA -85%
Schakelford pancreas pg 383.
Q38. Peritoneo-Venous shunt is contraindicated in
a) Uncorrectable coagulopathy
b) Spontaneous bacterial peritonitis
c) Hepatic encephalopathy
These shunts were used for intractable ascites in the past but due to high rate
of complications there is no role for these shunts in cirrhotic ascites. Bleeding occurs
due to DIC, with prolonged PT, aPTT.
DIC is caused by an activator in ascitc fluid. Bacterial Peritonitis is staph induced.
Failure of shunts is 50% in 1st year
Q39. False about cholecystectomy
a) In open cholecystectomy CBD injury rate is 0.1-0.2%
b) In Lap Cholecystectomy complication of CBD injury is double that of open
c) Abnormal GB, CBD, Cystic artery is seen in 1/3 cases
d) Open cholecystectomy is the treatment of choice for cholelithiasis
Still despite higher CBD injury rate Lap cholecystectomy is treatment of choice
Q40. Write True or false for the following statements for Extra Hepatic Biliary atresia
a)More in premature babies
b)Jaundice occurs after 1wk
c) surgery should be done after 1year
d) Most common operation is Kasai operation
e) Most common indication for liver transplant in children
f) only intrahepatic tree is involved
F Surgery should be done before 2mths or around it