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GI Bleed

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Q )  A 59 year old male alcoholic male presents with history of upper GI bleed of 1 day duration. During the day he has had three episodes of bleeding each time about 150 ml. Blood is fresh and not associated with retching. He has a history of long standing alcohol intake. What will be the most likely cause of GI bleed?

a) Mallory weiss tear

b) Esophageal varices

c) Gastric ulcer

d) Esophagitis

11 b

Long standing alcohol intake means some stigma of liver disease leading to chronic liver disease and consequently esophageal varices. 

Mallory Weiss tear occurs with retching and after episodes of binge drinking

Gastric and duodenal ulcers are related to alcohol but usually presents at 40 years 

Esophagitis will have associated symptoms of GERD and long standing history

Causes of Acalculus Cholecystitis

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Q) Which of the following is not a cause of acalculus cholecystitis? Questions on bile duct

a) Kinking of the neck of gall bladder

b) Acalculus cholecystitis Sphincter spasm

c) Thrombosis of cystic artery

d) Over eating

Ans d

Acalculus cholecystitis can be both acute and chronic in the absence of stones. Although it can present acutely, acalculous cholecystitis typically presents more insidiously.

Mostly the acute form is recognized and chronic form is called biliary dyskinesia.

The cause of acalculus cholecystitis are

  1. Kinking or fibrosis of neck of gall bladder.
  2. Thrombosis of cystic artery
  3. Sphincter of Oddi spasm
  4. Prolonged fasting
  5. Dehydration
  6. Sepsis
  7. Systemic diseases MODS

Ref: By Jarrell - NMS Surgery (National Medical Series for Independent) (Sixth Edition) (2015-07-30) [Paperback]

Jaundice in acalculus cholecystitis  is known to occur because of ischemia and inflammation cystic duct gets obstructed due to edema

Diagnosis

Chronic acalculus cholecystitis is a cholescintigraphy nuclear scan (HIDA) with the administration of cholecystokinin (CCK). After the . A calculated ejection fraction of 35% or less may be indicative of hypokinetic functioning of the gallbladder. An ultrasound of the gallbladder may also be useful. If this shows a thickened gallbladder wall of over 3.5 mm, this may be due to cholecystitis.

Acute acalculus cholecystitis - USG CT or HIDA

 

BEST BOOKSMCQ practise 

MRCS Part A: Essential Revision Notes: Book 1

MRCS Part A: Essential Revision Notes: Book 2

 

Omental cyst

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Q) True statement about omental cyst is ?

a) It is always unilocular

b) Commonly seen in old age group

c) Arise from acquired or congenital obstruction of the lymphtaic channels

d) Complications are more common in old age.

Answer c

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Duodenal obstruction

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Q) Duodenal obstruction is caused by all except (#duodenum)
a) Duodenal Diverticulum
b) Annular Pancreas
c) SMA syndrome
d) Malrotation of duodenum

EUS in pancreatic cancer

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Q) What is true about the role of EUS in Carcinoma head of pancreas.

  • a) It has a sensitivity of 50-60% in detecting lesions less than 3 cm in size
  • b) It has a  high negative predictive  value
  • c) Chronic pancreatitis can be easily differentiated from Carcinoma head of pancreas by EUS
  • d) Small caliber needles have low accuracy than high caliber needles in FNAC
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Lymph node stations in Carcinoma stomach

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Q) In gastric cancer, lymph node station 12 corresponds to 

a) Common hepatic

b) Hepatoduodenal

c) Retropancreatic

d) Superior Mesenteric

Ans b

In gastric cancer, lymph node station 12 corresponds to the hepatoduodenal ligament lymph nodes.  These nodes are specifically located along the hepatoduodenal ligament and are further subdivided into groups based on their anatomical relationship: along the hepatic artery (12a), along the bile duct (12b), and behind the portal vein (12p)

Altemeier procedure

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📘 Theme: Rectal Prolapse

True about the Altemeier procedure?

A. It is proctosigmoidectomy with posterior levatoroplasty
B. Done in left lateral position
C. Recurrence rate can be as high as 50%
D. Altemeier was the first person to do it

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✅ Answer: A. It is proctosigmoidectomy with posterior levatoroplasty

Explanation:
The Altemeier procedure is a perineal rectosigmoidectomy (proctosigmoidectomy) performed for complete rectal prolapse. It is commonly combined with posterior levatoroplasty, which restores pelvic floor support and helps reduce recurrence.

Why the other options are incorrect:

  • B. The procedure is usually performed in the lithotomy position, not the left lateral position.
  • C. Reported recurrence rates are generally 10–30%; a recurrence rate of 50% is not considered typical.
  • D. Although the procedure bears Altemeier's name, he popularized and refined the operation rather than being the first to perform it.

Take-home Message:
Altemeier = Perineal rectosigmoidectomy + posterior levatoroplasty; performed in the lithotomy position; preferred perineal operation for complete rectal prolapse in elderly or high-risk patients.

Reference: Sabiston Textbook of Surgery, 22nd Edition, p. 1394.

Hydatid liver

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Q) Not an indication of surgery in hydatid cyst liver

a) CE2 cyst with multiple daughter cysts

b) Large 10 cm cyst situated peripherally

c) Infected cyst

d) 6 cm asymptomatic cyst

All the following would be seen after splenectomy for hereditary spherocytosis except?

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a) Persistence of spherocytosis

b) Anemia

c) Same osmotic fragility

d) Normal life span of erythrocytes

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