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Steroid Refractory Ulcerative colitis

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Q) Not used in steroid refractory severe Ulcerative Colitis ( AIIMS 2020 Nov) 

a) Infliximab
b) Azathioprine
c) Cyclosporine
d) Surgery

Ans b- Azathioprine

Cyclosporine is  immunomodulator indicated for second-line therapy in the case of severe, steroid refractory ulcerative colitis. Treatment is usually initiated after 3 to 5 days of failed steroid response

Tacrolimus is appropriate as second-line therapy in patients with severely active ulcerative colitis unresponsive to steroids.

The use of various anti–tumor necrosis factor-α  (TNF-α) monoclonal antibodies ( infliximab)  is well supported in the case of
severe ulcerative colitis refractory to steroids. 

Indication Surgery crohn disease

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Q. Most common indication of surgery in Crohn's disease (#AIIMS GI )    (# Jejunum MCQS) 
a) Fistula
b) intractability
c) abscess
d) obstruction

Ans d Obstruction

Confusion between failure of medical therapy or obstruction as the ans. I have checked Bailey sabiston and Shackelford

2 books mention obstruction on top whereas one mentions failure of medical therapy. However with the improvement of medical management in the past decade, obstruction can be the ans

Crohn’s disease will require surgery at some time durin the course of their illness. Approximately 70% of patients will
require surgical resection within 15 years after diagnosis.

Indications for surgery include failure of medical treatment, bowel obstruction, and fistula or abscess formation. Most patients can
be treated with elective surgery,

CDH 1 gene

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Q) CDH 1 gene is associated with which cancer

a) Breast

b) Colon

c) Prostate

d) Renal

ANs a

CDH 1 is with gastric and lobular breast cancer

The CDH1 gene is responsible for  making a protein called epithelial cadherin or E-cadherin.

Germline mutation in the CDH1 gene encoding E-cadherin is  shown to be associated with hereditary diffuse gastric cancer. Also RHOA gene is also associated with Ca stomach

Prophylactic total gastrectomy should be considered in patients with these mutations

Renal cancer is mainly associated with VHL gene

Gene mutation associated with CDH 

E Cadherin is involved in

a) Cell Adhesion

b) Cell maturation

c) Managing intracellular chemical signals

d) It acts as a tumor suppressor protein

Amylase in pancreatitis

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Q) In  acute pancreatitis all are true except :

1) Amylase is more sensitive for first 5 days than lipase

2) S. lipase remains elevated for a longer time

3) Amylase levels not included in definitive diagnostic criteria of acute pancreatitis

4) Amylase levels may not be elevated in 19 % of patients

 

Colon Lymphoma

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Q) True about lymphoma of the colon?

a) More common in females

b) Most common in 3rd and 4th decade

c) Most common site is caecum

d) T cells are most commonly involved

Surgery Questions on Colon

MCQs in Rectum

Ans c

Lymphoma is uncommon in the colon/rectum occurring in 0.4% of patients; intestinal lymphoma and can present anywhere between the
second and eighth decades of life.

Most of these lesions are intermediate to high-grade B-cell lymphomas.

Affected men outnumber women about 1.5:1 

The majority of colorectal lymphomas are found in the cecum or ascending colon. More than 70% of colorectal lymphomas are proximal to the hepatic flexure. 

Colon Lymphoma Pathology Outlines 

Extranodal Marginal Zone B-Cell Lymphoma

ENMZL, formerly known as marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma)

Low-grade lymphoma involving cells that arise from the marginal zone surrounding lymphoid follicles.

23%–48% of all primary GI NHLs, second only to DLBCL in most series

ENMZLs are heterogeneous lymphomas, often containing monocytoid-like cells, plasma cells, and scattered large cells intermixed with marginal zone cells.

There are small cells with irregular cleaved nuclei and a moderate amount of clear cytoplasm

DLBCL

Microscopic Appearance  diffuse sheets of large lymphoid cells infiltrate the lamina propria and submucosa, with frequent obliteration of the muscularis propria and ulceration of the overlying mucosa.

Irregular nuclei, prominent nucleoli, and basophilic cytoplasm and are more than twice as large as normal lymphocytes.

Other less common type is  Mantle cell lymphoma

Our Recommendations

BEST TEXTBOOKS FOR GENERAL SURGERY

Bailey & Love’s Short Practice of Surgery, 27th Edition

Sabiston’s Textbook of Surgery

Schwartz’s Principles Of Surgery

SRB’S Manual Of Surgery

BEST BOOKS FOR OPERATIVE SURGERY

Operative Techniques in Surgery by Michael W. Mulholland et al

Chassin’s Operative Strategy in General Surgery

Farquharson’s Textbook of Operative General Surgery, 10th Edition