Stomach Surgery MCQS- Q 16-20

Stomach Surgery MCQs 

 

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) Mostly seen in lesser curvature

D) It can cause massive bleeding

16 b

  1. Wedge resection of the stomach is a treatment modality.
    • True: Wedge resection can be a treatment option for Dieulafoy's lesion, especially if the lesion is large or there is significant bleeding. The goal is to remove the lesion and any surrounding tissue that may be involved.
  2. b) Endoscopy can diagnose all cases.
    • Not True: While endoscopy is a valuable tool for diagnosing Dieulafoy's lesion, it cannot diagnose all cases. Dieulafoy's lesions are often submucosal, making them difficult to visualize during endoscopy. In some cases, the lesion may not be detected during the procedure, and further imaging or surgical intervention may be needed for a definitive diagnosis.
  3. c) Lesser curvature of the stomach is involved.
    • True: Dieulafoy's lesions are typically found on the lesser curvature of the stomach. This is the most common site for these vascular lesions, where a small artery can erode through the gastric mucosa, leading to bleeding.
  4. d) It can cause massive bleeding.
    • True: Dieulafoy's lesion can indeed cause massive bleeding. The lesion is characterized by a large, eroded artery, which can lead to significant hemorrhage if it ruptures.

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

The correct answer is c) liver secondaries, as it is not part of the classical triad of Zollinger-Ellison Syndrome. The triad focuses on hyperacidity, intractable duodenal ulcers, and the presence of gastrin-secreting tumors.

  1. a) Hyperacidity:
    • True: Hyperacidity is a hallmark of ZES. The excessive gastrin production leads to increased gastric acid secretion, resulting in hyperacidity.
  2. b) Intractable duodenal ulcer disease:
    • True: Patients with ZES often suffer from recurrent or intractable duodenal ulcers due to the high levels of gastric acid. This is a key feature of the syndrome.
  3. c) Liver secondaries:
    • Not Included: While gastrinomas can metastasize to the liver, liver secondaries are not part of the classic triad of ZES. The triad primarily focuses on hyperacidity, ulcer disease, and the presence of a gastrin-secreting tumor.
  4. d) Non-beta islet cell tumor of the pancreas:
    • True: Gastrinomas are non-beta islet cell tumors (specifically gastrin-secreting tumors) of the pancreas, which are central to the diagnosis of ZES.

 Q18. Which is not a metabolic abnormality after gastrectomy
a) Weight loss
b) Hypokalemia
c) Anemia
d) Osteoporosis

 18)b

The correct answer is b) hypokalemia, as it is not a standard metabolic abnormality specifically associated with gastrectomy compared to the other options.

  • Weight Loss:
    • weight loss is common due to reduced stomach capacity and changes in dietary intake.
  • Anemia:
    • This can result from:
      • Iron deficiency: Due to reduced gastric acid secretion and changes in diet.
      • Vitamin B12 deficiency: Often caused by the absence of intrinsic factor, which is produced in the stomach and is necessary for B12 absorption.
  • Osteoporosis:
    • Due to malabsorption of calcium and vitamin D, leading to decreased bone density over time.
  • Hypocalcemia:
    • Low calcium levels can occur because of impaired absorption and may lead to bone-related complications.
  • Hypomagnesemia:
    • Low magnesium levels may result from malabsorption and can contribute to muscle cramps, weakness, and other neurological symptoms.
  • Dumping Syndrome:
    • Characterized by rapid gastric emptying, leading to symptoms such as nausea, diarrhea, and hypoglycemia shortly after eating.
  • Fat Malabsorption:
    • This can occur due to reduced production of digestive enzymes and bile salts, leading to steatorrhea (fatty stools).
  • Hyperglycemia:
    • Some patients may experience postprandial hypoglycemia followed by reactive hyperglycemia due to rapid gastric emptying.
  • Dehydration:
    • Due to changes in diet, increased stool output, or vomiting, leading to inadequate fluid intake.
  • Metabolic Acidosis:
    • Rarely, patients may develop metabolic acidosis due to increased production of lactic acid from dumping syndrome or other underlying conditions.

 Q19 ) Which of the following statements about gastric volvulus is true?

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  stomach

 19) b

The correct answer is b), as organoaxial rotation is indeed associated with diaphragmatic defects. The other statements are incorrect in the context of gastric volvulus.

  • a) Organoaxial rotation is less common than mesenteroaxial:
    • False:
    • Organoaxial is seen in 75%
  • b) Organoaxial rotation is associated with diaphragmatic defect:
    • True: Organoaxial rotation can be associated with a diaphragmatic defect, such as a congenital eventration of the diaphragm or other anatomical abnormalities that can predispose the stomach to this type of rotation.
  • c) Symptoms are gradual and chronic:
    • False: Symptoms of gastric volvulus often present acutely, including severe abdominal pain, vomiting, and signs of gastrointestinal obstruction. While some cases can have chronic presentations, most are acute and require prompt medical attention.
  • d) Most of the cases require resection of compromised stomach:
    • False: While some cases of gastric volvulus may require resection (5-30%) especially if there is significant ischemia or necrosis of the stomach, many cases can be treated with detorsion and fixation (gastropexy) without the need for resection.

Gastric volvulus  is a rare emergency in stomach

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 occurs when the pyloric sphincter is bypassed or removed, affecting approximately 20% of patients after distal gastrectomy.

Mechanism of Action:
This condition results from the rapid emptying of gastric contents, particularly those high in carbohydrates, into the duodenum. This leads to net fluid retention in the intestines and stimulates the release of vasoactive intestinal peptide (VIP) and serotonin.

Symptoms:

  • Gastrointestinal Symptoms:
    • Nausea
    • Vomiting
    • Diarrhea
    • Abdominal cramps
  • Neurological Symptoms:
    • Diaphoresis (sweating)
    • Flushing
    • Palpitations

Management:

  • Dietary Changes: Small, frequent meals that separate solids and liquids can help minimize symptoms.
  • Medications: Octreotide is effective in nearly all cases, as it slows gastric emptying and reduces symptoms.
  • Surgical Intervention: Surgery is considered a last resort if conservative measures are ineffective.

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