AIIMS MCQ

GI SUrgery MCQs from AIIMS over the years

Esophagus

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Q ) Patient with normal swallowing but progressive poor peristalsis in lower 2/3rds of esophagus and reflux episodes.

a) Scleroderma

b) Achalasia

c) GERD
Answer

Colonoscopic stenting in Colon cancer

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Q) . Not a risk factor in colonoscopic stenting in colonic cancer causing obstruction
A. Short stricture of length <10 cm
B. Extrinsic compression
C. Treatment with bevacizumab
D. Strictures and obstructions at multiple levels

Answer

Gastric pullup

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Q 35) Not a step in Gastric pull up mobilization?

a) Lesser sac entering

b) Posterior mobilization of the duodenum

c) dilatation of hiatus

d) ligation of lesser curve vessels
Answer 35

Stomach is the best esophageal substitute. It has a single anastomosis, consistent blood supply and is durable

Disadvantage is reflux in the long term.

Check the answer to the question on gastric pull up in the answer

Caustic Injury to esophagus

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Q ) False regarding Caustic injury to Esophagus

a) Gastric lavage not done as it increases the chances of more injury

b) Neutralising  agents not given as it produces more injury than preventing it

c) Milk and albumin not given as it causes more damage

d) Activated charcoal not given as it doesn’t effectively absorb alkali

Check one more question on caustic injuries to esophagus here

Answer 

In  caustic injuries to the esophagus, early decisions have to be taken. The involvement of surgeon should be done early and patient should be placed under close monitoring.

Blind nasogastric and orogastric tubes should not be inserted and initially CT of chest and abdomen with contrast should be done to guide the subsequent procedures. Read on

 

Siewert

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  1. Q) False regarding CA Esophagus

    a) Siewert I treated as Esophageal cancer

    b) Siewert III treated as Gastric cancer

    c) Siewert II treated as Esophageal cancer or Merindino surgery

    d) Proximal margin in Esophagus is determined routinely to alter the management

    Answer

Bariatric Surgery

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Q) Which of the following statements regarding bariatric surgery is false?

a) Vertical banded gastroplasty (VBG) produces less weight loss compared to Roux-en-Y gastric bypass (RYGB)
b) Jejunoileal bypass is no longer commonly performed
c) Dumping syndrome occurs primarily due to non-compliance with dietary advice
d) Laparoscopic adjustable gastric banding (LAGB) requires follow-up only once every 4–6 weeks

c
Dumping is due to the surgery and unrelated to diet
Calorie restriction is responsible for long term weight loss and its beneficial effects such as control of diabetes, dyslipidemia, hypertension and other metabolic abnormalities.
Restrictive procedures are LSG and  LAGB  which decrease the appetite and induce early satiety.           
The RYGB (ROUX en Y  gastric bypass ) is  a malabsorptive procedure  with long term sustained weight loss.
Mechanism of weight loss after bariatric surgery
Ghrelin is orexigenic gut hormone, which increases appetite. After food intake ghrelin levels fall and appetite decreases.

After restrictive surgery such as LYGB and LSG, ghrelin levels fall and appetite decreases.

Vertical Banded Gastroplasty (VBG)
 This procedure has been abandoned in favor of other operations because of poor long-term weight loss, a high rate of late stenosis of the gastric outlet, and a tendency for patients to adopt a highcalorie liquid diet, thereby leading to regain of weight. Choice a is correct

Jejuno ileal bypass has many side effects because of malabsorbtion and liver cirrhosis ( See above)  Choice b is true

Visit -  evaluate oral intake, food tolerance, and wound healing and to determine whether appropriate restriction has resulted from placement of the non inflated band.
Subsequent visits, usually scheduled monthly to bimonthly in the beginning and then less frequently, involve counseling with a nutritionist and evaluation of weight loss and the need for band adjustment.
A goal of 1 to 2 lb/wk is ideal
d is correct
Dumping is both late and early and unrelated to dietary advise

Roux stasis

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Q) True about Roux stasis syndrome

a) Dilated Roux limb present

b) Can be prevented by inter positioning 20 cm jejunum between stomach n duodenum

c) Delayed gastric emptying of solids

d) It is not related to the size of gastric remnant

Answer