Q16. Which of the following is not true for Dieulfoy's lesion of the stomach?
Answer
16 b
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.
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.
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.
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)?
Answer
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.
a) Hyperacidity: True: Hyperacidity is a hallmark of ZES. The excessive gastrin production leads to increased gastric acid secretion, resulting in hyperacidity.
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.
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.
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?
Answer
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 due to absence of intrinsic factor necessary for absorption.
Osteoporosis: Due to malabsorption of calcium and vitamin D, leading to decreased bone density over time.
Additional: Hypocalcemia, Hypomagnesemia, Dumping Syndrome, Fat Malabsorption, Hyperglycemia, Dehydration, Metabolic Acidosis may also occur.
Q19. Which of the following statements about gastric volvulus is true?
Answer
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 congenital eventration or other abnormalities.
c) Symptoms are gradual and chronic: False, most cases present acutely.
d) Most cases require resection: False, many cases treated with detorsion and gastropexy; resection needed only if ischemia/necrosis.
Q20. Which of the following is true about dumping syndrome?
Answer
20 a
Dumping Syndrome occurs when the pyloric sphincter is bypassed or removed, affecting approximately 20% of patients after distal gastrectomy.
Mechanism: Rapid emptying of gastric contents, especially carbohydrates, into the duodenum, causing fluid retention and VIP/serotonin release.
Symptoms: Nausea, vomiting, diarrhea, abdominal cramps, sweating, flushing, palpitations.
Management: Small, frequent meals that separate solids and liquids; Octreotide (somatostatin analogue) effective; Surgery only if conservative treatment fails.