AIIMS GI 2022

Ulcerative colitis Surgery in Young female

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Ulcerative Colitis Surgery Choice
#AIIMS 2022 April
Q) Which surgery would be preferred to be done in young unmarried female with steroid refractory Ulcerative colitis and 15 bloody bowel movements per day?
a) TPC with IPAA
b) TPC with EI (end ileostomy)
c) TAC with EI (end ileostomy)
d) TAC with IRA (Ileo rectal anastomosis)
Ans b

The risk of infertility following IPAA was estimated to be approximately 50% compared with 15% among medically treated patients.

Given these data, many surgeons advocate for a three-stage procedure in which subtotal colectomy with end ileostomy is performed and IPAA is deferred until childbearing is completed.
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Spontaneous Pneumothorax

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Q) 15 year old boy, with Spontaneous pneumothorax. He is dyspneic with increased RR

Next best step

a) Vats and pleurodesis

b) Needle aspiration

c) Tube thoracostomy

d) Any of the above

Ans c

Primary spontaneous pneumothorax occurs in young patients without significant lung disease, whereas secondary spontaneous pneumothorax occurs in patients with COPD.

The most common cause of primary spontaneous pneumothorax is rupture of small apical blebs. Tube thoracostomy with water seal drainage is the usual first-line treatment of a moderate-to-large pneumothorax in a patient with a first-time occurrence.

Fuel for colonocytes

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Q) The principal energy source for colonocytes is:

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A. Glucose
B. Lactate
C. Butyrate
D. Long-chain fatty acids

✅ Answer: C. Butyrate

Butyrate is the primary fuel for colonocytes. It is a short-chain fatty acid (SCFA) produced by the colonic flora when fermenting complex carbohydrates. The colonic epithelium and luminal bacteria form a crucial symbiotic relationship where bacteria produce butyrate, which provides essential nutrition to the colonocytes.

Antibiotics disrupt this balance by reducing bacteria, leading to less butyrate, which negatively affects colonocyte function, often causing diarrhea.

🧠 Key Point: Butyrate, not glucose or lactate, is the key fuel for colonocytes, and its production relies on gut bacteria.

Teaching Points

  • Short-chain fatty acids (SCFAs): butyrate, acetate, and propionate are produced by bacterial fermentation of dietary fiber.
  • Butyrate provides ~70% of the energy requirements of colonocytes.
  • It promotes mucosal integrity, anti-inflammatory effects, and epithelial repair.
  • Reduced butyrate production is implicated in:
    • Antibiotic-associated diarrhea
    • Diversion colitis
    • Inflammatory bowel disease
  • High-fiber diets increase SCFA production and improve colonic health.

Why other options are incorrect

  • A. Glucose — minimal utilization by colonocytes compared to SCFAs.
  • B. Lactate — intermediate metabolite; not the primary fuel.
  • D. Long-chain fatty acids — absorbed mainly in the small intestine.

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