Stomach Q1-5

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Q1. Ideal treatment of alkaline reflux gastritis after Billroth I and Billroth II gastrectomy is

 a) Conversion of Billroth I gastrectomy  to Billroth II surgery
b) Roux en Y gastrojejunostomy
c) Total gastrectomy
d) Conservative management

 1. b

After Billroth I and II, bile reflux gastritis is common. The amount of bile in stomach is not important and clear pathogenesis is not known.

Symptoms of bile reflux gastritis are

(i) Epigastric pain

(ii) Bilious vomiting

(iii) Weight loss

Diagnosis of Bile Reflux gastritis after surgery

HIDA scans show bile in stomach or esophagus

Surgery is recommended for those who have intractable symptoms.
The surgical procedure of choice is conversion of Billroth II to Roux-en Y Gastrojejunostomy in which the Roux limb is lengthened to 40 cm
Ref - Sabiston page 1213

 Q2. Surgical Treatment of bleeding Type I stomach ulcer is
 a) Wedge resection of the gastric ulcer
b) Oversewing the vessel at the ulcer base
c)  Distal gastrectomy
d)  Distal gastrectomy along with truncal vagotomy

 2. c

Treatment of choice for a bleeding gastric ulcer Type I is distal gastrectomy followed with a Billroth I gastrojejunostomy. 
For type II and type III ulcers vagotomy is done 
In sick and frail patients, figure of 8 suture at the base of vessel or wedge excision can be done
Ref Sab

 Q3.Helicobacter Pylori (H.Pylori) is a known  cause of peptic ulcer disease.It was discovered in Australia in 1987. Which of the following statements is not true regarding it?
a) Its infectivity is highest in developed world.
b) Person to person transmission is common
c) It is seen in populations with low socio economic status
d)H. Pylori is a gram negative microaerophilic bacteria

 3. a

H. Pylori was discovered by Warren and Marshall in 1987.
It is a disease associated with poor sanitation, over crowding and under developed countries.
Peptic ulcer associated with H. Pylori is rarely seen in the developed countries.

 Q4. Which of the following hormones are not released in duodenum?
a) Gastrin
b) Motilin
c) Somatostatin

d) Pancreatic YY

 4. d
Peptide YY is released from ileum.
Gastrin - G cells stomach
Motilin- M cells from duodenum and jejunum
Somatostatin - D cells in pancreas, stomach and duodenum

 Q5. Treatment for bleeding duodenal diverticulum is
a) Diverticulectomy
b) Diverticulopexy
c) Diverticulization

d) Subtotal diverticulectomy

 5. a

Treatment of choice in such cases is diverticulectomy.
Subtotal diverticulectomy is done if the diverticulum is very close to ampulla of vater
to safeguard the bilio- pancreatic ducts.

Q) What is the difference between Billroth I and Billroth ii gastrojejunostomy?
Ans -
In Billroth II gastrojejunostomy the duodenal stump is closed and a gastric continuity is established by anastomosing a loop of  jejunum to the body of stomach
In Billroth I  the Duodenum is anastomosed to the remaining part of stomach. It is a gastroduodenostomy and is more physiological for the body.
Billroth II is more commonly performed procedure because of its technical ease and low leak rates.
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