Q16. Which of the following is not true for Dieulfoy's lesion of the stomach?
A) Wedge Resection of the stomach is a treatment modality
B) Endoscopy can diagnose all cases
C) Lesser curvature of the stomach is involved
D) It can cause massive bleeding
16)b
Dieulfoy's lesion is a submucosal arterial bleeding in the stomach.
Endoscopy can not diagnose all the cases because the arterial bleed is submucosal.
Endoscopic treatment is tried initially with sclerotherapy.
Other modalities are angiographic and surgcial wedge excicsion.
Q17. What is not included in the triad of zollinger ellison syndrome (ZES)
A) Hyperacidity
B) Intractable duodenal ulcer disease
C) Liver secondaries
D) Non beta islet cell tumor of pancreas
17) c
Zollinger Ellison syndrome is a non beta islet cell tumor of the pancreas. Read more about Endocrine tumors here.
Q18. Which is not a metabolic abnormality after gastrectomy
a) Weight loss
b) Hypokalemia
c) Anemia
d) Osteoporosis
18)b
Although all of these may occur but hypokalemia is the least common.
Metabolic abnormalities are seen after antrectomy/gastrectomy than vagotomy and drainage procedures.
Mostly after Billroth II gastrectomy.
Iron absorbtion from the proximal jejunum requires an acidic environment which is lost after gastrectomy leading to iron deficiency anemia.
B12 deficiency anemia also develops after gastrectomy.
These patients require cyanocobalalmine injections every 3-4 months.
Fat malabsorbtion leading to osteoporosis
Hypocalecemia is another metabolic problem.
Q19 ) True about gastric volvulus
a) Organoaxial rotation is less common than mesenteroaxial
b) Organoaxial rotation is associated with diaphragmatic defect
c) Symptoms are gradual and chronic
d) Most of the cases require resection of compromised stomach
19) b
Gastric volvulus is a rare emergency in stomach
Organoaxial is more common than mesenteroaxial roatation and is associated with diaphragmatic defect
In adults the diaphragmatic defects are traumatic or paraesophageal hernias and in children they are congenital
Symptoms are often sudden and acute and treatment requires reduction of stomach and fixation with closure of diaphragmatic defect.
In 5-28% some form of gastric resection is required.
Q20) Which of the following is true about dumping syndrome
a) Somatostatin analogues are effective in controlling symptoms
b) Symptoms always include flushing and tachycardia
c) Diarrhea is always part of dumping syndrome
d) Part of treatment includes combining solids with liquids in frequent small meals
20) a
Dumping Syndrome is caused when the pyloric sphincter is bypassed or removed occurring in 20% of cases after distal gastrectomy.
MOA- Rapid emptying of gastric contents (high in carbohydrates) in the duodenum. This leads to net fluid retention and release of VIP and serotonin.
Symptoms are GI related and neurological. GI symptoms are nausea vomiting diarrhea and cramps
Neurological symptoms are diaphoresis, flushing and palpitations.
Management
- Small frequent meals with separation of solids and liquids
- Octreotide effective in almost all cases
- Surgery is the last resort
