Q) Carcinoid syndrome wrong statement is?
a) 40 % have Right heart dysfunction in carcinoid syndrome
b) >1cm in appendix is indication for Right hemi colectomy
c) 30 % jejunoileal carcinoid are metastatic
d) Resection of primary is done in presence of metastatic disease
a) 2% blood supply is nonaxial b) Downward 38% from RHA c) GB venous drainage directly to Portal vein d) Main artery supply to retro pancreatic CBD is retroduodenal artery
Q) Gastrinoma false is (AIIMS GI 2020) a) Fasting serum gastrin levels are 1000 g/ml b) Duodenotomy should be done in all cases c) Diarrhea most common symptom d) SRS can localize 80% cases
Ans ) c -
Duodenotomy detects 25% to 30% of tumors not seen on preoperative imaging.
Gastrin levels higher than 1000 pg/mL are strongly suggestive of gastrinoma, provided that the patient demonstrated increased gastric acid secretion ( gastric secretion ph should be less than 2)
Most common is abdominal pain ( 75%) In 10% to 20% of patients, diarrhea is the only symptom
Saby page 954)
SRS should be performed because almost all gastrinomas express somatostatin receptors.
Q) . False about subvesical duct a) Embedded in cystic plate b) Communicate with CHD c) Communicate with GB d) Does not drain any specific segment of liver
Q . Caustic injury of esophagus. Which statement is not true ( # All Questions of esophagus) a) Steroid is used as a treatment b) Carcinoma risk is 30% c) Contrast study has false negative of 25% d Esophageal stent reduce leaks by 75%
Ans ) a
Points of esophagus caustic injuries
There is no proven benefit of starting steroids in early or intermediate phase of injury as there is no evidence to support prevention of stricture
Endoscopy should be performed after initial stabilization
Complete esophagus can be examined now with flexible endoscopes
Available studies show no benefit of steroid use ( skf PAGE 521)
Cancer risk is 30% in injured and non injured portions
Q). 45 yr old Known case of diverticular disease, presents with left lower abdominal pain , on CT sigmoid wall thickening with fat stranding. All of the following can be done except a) Admit and iv antibiotic b) Colonoscopy after resolution c) Elective colectomy after resolution d) Out patient oral antibiotic
a) It corelates with cirrhosis b)Range of sodium value is 125-137 c)It relates to vasoconstriction d) Used for allocation in DDLT patients
Ans c
MELD was originally developed to predict three-month mortality following transjugular intrahepatic portosystemic shunt (TIPS) placement and was derived using data from a population of 231 patients with cirrhosis who underwent elective TIPS placement.
Range of MELD score is 6-40
MELD Score = 10 x (0.957 x Ln(serum creatinine mg/dL) + 0.378 x Ln(serum bilirubin mg/dL) + 1.120 x Ln(INR) + 0.643 )
For candidates with an initial MELD score greater than 11, the MELD score is then re-calculated as follows: MELDNa = MELD(i) + 1.32*(137-Na) - [0.033*MELD(i)*(137-Na)]
Sodium values less than 125 mmol/L will be set to 125, and values greater than 137 mmol/L will be set to 137.
It is used for allocation in DDLT to assess wait list mortality
MELD score has also proved to be an effective predictor of outcome in other situations, such as
Patients with cirrhosis going for surgery and patients with fulminant hepatic failure or alcoholic hepatitis.
The MELD score does have limitations in situations where the INR or creatinine may be elevated due to reasons other than liver disease, and its implementation for organ allocation purposes does not take into consideration several conditions that benefit from liver transplantation.
Q) Regarding ICG clearance rate . Which is false.. a) It assess total liver function
b) Heterogenous uptake in liver may lead to false negative result c) Measures blood supply d) ICG clearance Measured non invasively via spectrophotometry