MCH 2021 ( Jan 22) GI Surgery Similar Questions and explanations
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Q) Lymph node not removed in whipple's?
a) Retropancreatic
b) Celiac
c) Suprapyloric
d) Inferior pancreatico duodenal
Ans b
The extent of standard lymphadenectomy of pancreatic head carcinomas includes the LNs station involved in two main routes of LN metastases: from the head of the pancreas to the common hepatic artery (CHA) then celiac axis and from the head of the pancreas to the superior mesenteric artery (SMA)
Standard lymphadenectomy.
No. 5 Supra pyloric lymph nodes;
No. 6 infra pyloric lymph nodes
No. 8a lymph nodes in the anterosuperior group along the common hepatic artery
No. 12b lymph nodes along the bile duct; No. 12c (located next to 12b), lymph nodes around the cystic duct;
No. 13a lymph nodes on the posterior aspect of the superior portion of the head of the pancreas;
No. 13b lymph nodes on the posterior aspect of the inferior portion of the head of the pancreas;
No. 14a-b lymph nodes along right side of superior mesenteric artery
No. 17a lymph nodes on the anterior surface of the superior portion of the head of the pancreas;
No. 17b lymph nodes on the anterior surface of the inferior portion of the head of the pancreas.
Extended lymphadenectomy.
No. 8p lymph nodes in the posterior group along the common hepatic artery;
No. 12a lymph nodes along the hepatic artery;
No. 12p lymph nodes along the portal vein;
No. 14c-d lymph nodes along the left side of superior mesenteric artery;
No. 16 lymph nodes around the abdominal aorta besides standard range of lymph node dissection.
Q) Young Male around 20 with severe chest pain and dysphagia with small hiatus hernia most probable diagnosis?
a) Achalasia cardia
b) Hypertensive LES
c) Nutcracker esophagus
d) DES
Ans b
Hypertensive lower esophageal sphincter (LES) is an uncommon manometric abnormality found in patients with dysphagia and chest pain, and is sometimes associated with gastroesophageal reflux disease (GERD)
Achalasia does not have chest pain
DES has chest pain but seen in older females preferably
Nutcracker esophagus is seen in patients of all ages, with equal gender predilection and is the most
common of all esophageal hypermotility disorders. Like DES patients have chest pain and dysphagia.
Q3) 45 year old lady asymptomatic, routine USG check up detected to have 5X 6 cm cystic lesion in segment V of liver. CT Scan picture
a) Biliary cystadenoma
b) Hydatid cyst liver
c) Amoebic liver abscess
d) Cystic degeneration of Malignancy
Ans a
Biliary cyst adenoma are mostly seen in the age group asked in the question. Most of them are asymptomatic
While 10% of reported BCT originate in the extrahepatic biliary tree, the overwhelming majority arises from the intrahepatic biliary system
CT of Biliary cyst adenoma At CT, BCAs are a fluid attenuating cystic mass with a soft tissue attenuating rim, internal septa, and possibly capsular calcifications and mural nodularity.
D/d is
Hydatid cyst - In this question age and sex is pointer to biliary cyst adenoma
Simple cyst
Liver abscess ( excluded in this question ) as patient is asymptomatic
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