Q16. Why does cholestasis occur in sepsis?
a) There is functional defect in bile formation at the level of hepatocyte (Reduced Expression and function of transport systems)
b) Due to impairment of bile secretion and flow at bile duct level
c) Both mechanisms play a role
d) None of these
Q17. Which of the following is not a complication of massive small bowel resection?
c) Vitamin and Calcium deficiency
Q18 Most common site for carcinoid tumor is
Q19 . True about ileostomy output is
a) Sodium excretion is two to three times that of normal stool
b) Contents of ileostomy are alkaline
c) Usually it starts functioning in 24 hours
d) Uric Acid renal calculus formation is more common than cholelithiasis
Q20. Which of the following is not true regarding strictureplasty in small bowel disease
a) contraindications of strictureplasty are sepsis, perforation, malnutrition
b) Strictureplasty technique for stricture less than 10 is Finney's
c) Heineke-mikulicz is the preferred technique for strictures less than 10 cm
d) Stricureplasty was advocated for single small or multiple small strictures
Most information about hepatocellular transporter expression is derived from animal studies. Decreased bile acid secretion and bile flow during endotoxemia is caused by a concomitant reduction in the expression of the export pumps BSEP and MRP2, respectively
In addition to hepatocellular changes, sepsis is also known to frequently cause bile duct changes . TNF-?, IL-1ß, IL-6, and nitric oxide all impair cAMP-dependent ductal chloride and bicarbonate secretion . Interferon-also stimulates nitric oxide production by cholangiocytes and promotes lymphocytic infiltration of the biliary epithelium. Beyond representing a target for inflammatory mediators, the biliary epithelium actively participates in liver inflammation by secreting proinflammatory and chemotactic cytokines and growth factors that are not produced under physiologic conditions.
The after effects of small bowel resection are many. Small segments of small bowel removal are met with minimal electrolyte and fluid disturbances but massive small bowel resection is complicated by the formation of
a) Gall stones
b) Renal stones
c) Metabolic disturbances
d) Vitamin deficiencies
18. d Carcinoid tumors are those which are derived from enterochromaffin cells which belong to APUD system.Gastrointestinal carcinoids are distributed via embryologic origins: foregut, midgut, and hindgut. Foregut carcinoids account for approximately 7% of all carcinoids, whereas midgut and hindgut carcinoids represent 62% and 30% of all carcinoids, respectively. Because of the preponderance of APUD cells within the ileum and appendix, the most common sites are the appendix (35%) and small intestine (23%), followed by the rectosigmoid (12%) and colon (6%).
Carcinoid tumors have five histologic patterns: insular, trabecular, glandular, undifferentiated, and mixed
Clinical features of Carcinoid tumor in foregut
Gastric carcinoids arise from enterochromaffin-like cells and are classified into three groups. Type I consists of gastric carcinoids associated with chronic atrophic gastritis type A. This group represents 75% of all gastric carcinoids and is marked by a lack of parietal cells, achlorhydria, and hypergastrinemia. The tumors are often less than 1 cm in diameter, diffusely involve the stomach, and metastasize in 10% of all cases, with an overall 5-year survival rate approaching 100%
Patients with type I gastric carcinoid are often 70 to 80 years of age and female with symptoms of abdominal pain. Carcinoid syndrome is not seen, and these tumors usually follow an indolent course.
Type II gastric carcinoid tumors are associated with Zollinger-Ellison syndrome and familial multiple endocrine neoplasia type I syndrome. Patients in this group, 5% of those with gastric carcinoids, are younger (in their sixth decade of life), exhibit no evidence of carcinoid syndrome, and have a tumor size less than 1.5 cm with an equal gender distribution. Although metastases develop in up to 25%, the clinical course is usually indolent.
(type III) consists of sporadic carcinoid tumors. Patients in this group have larger tumors, and hepatic metastases develop in more than 65%. This group of patients (15% to 25% of those with gastric carcinoids) is associated with the development of an atypical carcinoid syndrome and have a 5-year survival rate near 50%. Indicators of tumor aggressiveness include angiolymphatic invasion, clinicopathologic type, mitotic index, Ki-67 grade, and tumor size.
An ileostomy starts to function 48 to 72 hours after construction. A mature ileostomy produces between 400 and 700 mL of effluent per day. This volume remains relatively constant for an individual. The contents are weakly acidic (pH 6.1 to 6.5). Sodium excretion is 60 to 120 mEq/day, which is two to three times higher than in normal feces.
Cholelithiasis occurs in 30% and Renal stones in 10%
Stricturoplasty techniques were initially applied for tubecular strictures and then their use was extended for strictures of Crohn's disease.
Contraindications are Sepsis, fistula, perforation, malnutrition, stricture near segment to be resected.
For bowel length less than 10 cm - Heineke-Mikulicz
upto 90 cm technique by Michelassi