Q) DES esophagus False in the management of this patient
a) Treatment is primarily medical management
b) Long myotomy necessary if surgery indicated
c) Dor's Fundoplication is recommended to prevent reflux
d) Endoscopic dilatation.
Answer Q 30
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Technique of CME
Q) All are true regarding complete mesorectal excision except
a) Introduced by Hobeninger
b) It is based on ligation of central artery
c) Increases yield of lymph nodes and has decreased recurrence
d) Line of resection is below Toldt's fasica
Bile duct injury
Q. All are poor prognostic factors in managing bile duct injury except? ( From AIIMS 2018 nov)
a) Complete ligation
b) Advanced age
c) Internal/External fistula
d) Type III/IV stricture
Radiation proctitis
Q) In radiation proctitis surgery is needed in all except
a) Pain Abdomen
b) Rectal stricture
c) Haemorrhage
d) Vesical Fistula
Answer: a) Pain Abdomen
In radiation proctitis, surgery is typically indicated for complications that are severe or unmanageable through conservative measures.
A) Pain Abdomen: While abdominal pain can be a symptom associated with radiation proctitis, it is not an indication for surgery on its own. Pain management and other conservative treatments can be employed first.
B) Rectal stricture: This can cause significant obstruction and may require surgical intervention to restore normal bowel function.
C) Haemorrhage: Severe bleeding may necessitate surgical intervention if not controlled by endoscopic or conservative measures.
D) Vesical Fistula: A serious complication that often requires surgical repair.
Classification:
- Acute: Within 6 months of starting radiation
- Chronic: After 6 months (usually 8–12 months post therapy)
Radiation Proctitis Severity (RTOG):
- Grade 1: Mild, self-limiting
- Grade 2: Conservative management required
- Grade 3: Severe, affects lifestyle
- Grade 4: Life-threatening → Surgery needed
Prevention:
- Conformal radiation techniques
- Amifostine (free radical scavenger)
- Sucralfate not beneficial in trials
Treatment:
Medical:
- Butyrates
- 5-ASA
- Sucralfate
- Metronidazole
- Short chain fatty acids
- Topical formalin
- Hyperbaric oxygen
Endoscopic:
- Dilatation
- Heater probe / bipolar cautery
- Nd:YAG laser
- APC
- RFA
Surgery:
- Diverting ostomy – for stricture/incontinence
- Flap reconstruction – gracilis/Martius flap for fistula
- Proctectomy – severe fistula, pain, intractable bleeding
Colorectal Liver metastasis
Q) All are negative prognostic factors in liver metastasis due to colorectal cancers except
a) Size more than 4.5 cm
b) Number of tumors more than 2
c) CEA more than 200
d) Tumor recurrence within 8 mths of primary surgery
Blood supply of CBD
Q) Supraduodenal CBD is supplied by all except (AIIMS NOV 18)
a Cystic art
b RHA
c LHA
d Anterosuperior pancreaticoduodenal artery
Complications of Meckel’s diverticulum
Q. Least common complication of Meckel's diverticulum is
a) Bleeding
b) Obstruction
c) Neoplasm
d) Obstruction
While many individuals remain asymptomatic, complications of Meckel's diverticulum can lead to significant clinical issues requiring medical intervention.
Answer is free
Ans ) c Neoplasm
The most common clinical presentation of Meckel’s diverticulum is gastrointestinal bleeding, which occurs in 25% to 50% of patients who present with complications.
Bleeding is often due to ulceration of the diverticulum. This bleeding can manifest as painless rectal bleeding
Another potential complication is intestinal obstruction, which can occur if the diverticulum becomes incarcerated or twisted. This situation may lead to bowel ischemia and perforation if not managed quickly.
Intestinal obstruction occur as a result of a volvulus of the small bowel around a diverticulum associated with a fibrotic band attached to the abdominal wall, intussusception, or, rarely, incarceration of the diverticulum in an inguinal hernia (Littre hernia)
Diverticulitis accounts for 10% to 20% of symptomatic presentations.
Neoplasms can also occur in a Meckel’s diverticulum, with NET as the most common malignant neoplasm (77%). Other histologic types include adenocarcinoma (11%), which generally originates from the gastric mucosa, and GIST (10%) and lymphoma (1%).
Complications of Meckel's diverticulum can be recognised and managed early if there is high index of suspicion
Rectal Prolapse with constipation
Q) . Management of Rectal Prolapse with constipation
a) Ripstein's repair
b) Resection rectopexy
c) Altemeier procedure.
d) Thiersch
Answer to
Choledochal cyst and malignancy
Q) Choledochal cyst and malignancy false statement is (AIIMS 2018 nov)
a) Highest risk of malignancy in Type 3
b) Malignancy can occur even after removal of choledochal cyst
c) Malignancy can occur anywhere in the biliary tract
d) It can take upto 15 years for malignancy to develop after excision of choledochal cyst