Crohn Disease of Duodenum

Q) In Crohns  disease of duodenum , patient has a duodenal abscess which is  drained. He develops a fistula with  ileal communication. Surgery with the least chance of success would be

a. Ileal reaction and duodenal bypass

b. Ileal resection an dudodenal HMplasty
c. Ileal freshen and closure
d. Duodenum vertical closure

Hormones released from duodenum

 Q. Which of the following hormones are not released in duodenum?
a) Gastrin
b) Motilin
c) Somatostatin

d) Pancreatic YY

4. d
Peptide YY is released from ileum.

Gastrin - G cells stomach
Motilin- M cells from duodenum and jejunum
Somatostatin - D cells in pancreas, stomach and duodenum

Somatostain is an inhibitory hormone and inhibits most of the things

Secretin is released by acid in the duodenum and stimulates pancreatic fluid and bicarbonate secretion, leading to neutralization of acidic chyme in the intestine. Secretin also inhibits gastric acid secretion  and intestinal motility. LES pressure is decreased by Secretin, CCK, Somatostatin and VIP

 

Duodenal Adenocarcinoma

Q) Which of the following is not true about duodenal adenocarcinoma

a) Adenocarcinoma is the most common malignancy affecting duodenum

b) Most of the patients with duodenal adenoacarcinoma have a palpable mass

c) Surgery is the main stay of management

d) GOO is the most common presentation

Duodenal Diverticula

Which of the following statements about duodenal diverticula is incorrect?

a) Extraluminal diverticula are more common than intraluminal ones
b) They are most commonly located within 2 cm of the ampulla
c) The majority are symptomatic, presenting with epigastric pain
d) Diverticulectomy is the standard surgical treatment

Duodenal adenoma in FAP

Q) What is the Surgery in FAP patient after colectomy for ampullary adenoma Stage IV

a)Classic Whipple
b) Pancreas preserving duodenectomy
c) Transduodenal excision
d) endoscopic excision


Answer is free for all

b) 

Duodenal cancers are the third most common (10%) cause of death in FAP after CRC and desmoid disease.

Duodenal adenomas  100% incidence

 tendency to progress to cancer.

The severity of duodenal adenomatosis predicts the chances of duodenal cancer,  Spigelman staging system that is based on

adenoma number, size, and histology

Patients with stage 0 disease (no adenomas) can be surveyed again in 5 years.

Stage I patients can be surveyed in 3 years;

stage II in 1 year;

stage III in 6 months

and stage IV is an indication to consider surgery. 36 % progress to cancer- Surgery is pancreas preserving duodenectomy

A Whipple is indicated for a duodenal cancer that is definitively operable

Duodenal adenomas can be treated by snare polypectomy or by transduodenal polypectomy. Ampullary adenomas can be treated by endoscopic mucosal resection or surgical ampullectomy

Ref schakelford page 1968

Duodenal injury

Q . Duodenal injury management false? (# Duodenum free page )

a) Circumferential skeletonization is required

b) All duodenal repairs require some form of drainage

c) All hematomas near the pancreas requires exploration to check for serosal integrity

d) Most common location is the second portion

Duodenal injury

Q) Duodenal injury management false

a ) Circumferential skeletonization is required

b ) All duodenal repairs require some form of drainage

c) All hematomas near the pancreas requires exploration to check for serosal integrity

d) Most common location is the second portion

 

Duodenal obstruction

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

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