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Sugiura Procedure

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Q)   What is not true regarding Sugiura's procedure for Portal Hypertension ?

a)  It is a transesophageal variceal ligation

b) Splenectomy is done

c) Vagotomy is done 
d) Pyloroplasty is done
Sugiura procedure is the non shunting procedure for EV bleeding, which was first proposed by Sugiura and Futagawa in 1973 []. However, because of its complexity and high postoperative morbidity and mortality, this procedure has not been widely accepted in Western countries 

a

Non shunt operations are done for bleeding esophageal varices in emergency for poor risk patients when sclerotherapy or other conservative methods fail.
Sugiura's is a devascularization procedure described in 1973
It has two parts
Thoracic and abdominal which may be simultaneous or staged.
The Left posterolateral thoracotomy is done.
The longitudinal periesophageal azygous collateral veins and thoracic vagus is preserved. 
The esophagus is transected at level of diaphragm. This completely  devascularizes the esophagus.
The cut mucosa and anterior muscle layer is approximated.
Then the abdominal approach is done and abdominal esophagus, cardia of stomach is devascularized. Short gastric vessels are ligated, selective vagotomy is done, pyloroplasty is done, splenectomy completes the procedure.
Transgastric varix ligation was done previous to this procedure as described by Tanner  but not transesophageal. Hence 'a' is the answer.
The modified Sugiura procedure can be performed through a one-stage transabdominal approach via the midline incision or extension of a left subcostal incision with the exposure of an L shape.
The procedure starts with splenectomy for improvement of the exposure followed by gastric and esophageal devascularization and finally the esophageal transaction using a mechanical stapler through a short gastrotomy.
The Sugiura operation contains five componential procedures and esophagogastric devascularization is the only remaining part in the many different versions of the modified Sugiura operation.
Schakelford pancreas pg 383.

Prognostic factor for carcinoma esophagus

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Most Important Prognostic Factor in Carcinoma Esophagus - MCQsurgery.com

Most Important Prognostic Factor for Carcinoma Esophagus

Q. Most important prognostic factor for carcinoma esophagus is

a) Cellular differentiation
b) Depth of esophagus involvement
c) Length of esophagus involvement
d) Age of the patient

Hormones released from duodenum

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Q. Which of the following hormones are not released in the duodenum?
a) Gastrin
b) Motilin
c) Somatostatin
d) Pancreatic YY
Correct Answer: d) Pancreatic YY

  • Gastrin – secreted mainly by G-cells in the stomach, and in small amounts from the duodenum.
  • Motilin – secreted by M cells in the duodenum and jejunum.
  • Somatostatin – secreted by D-cells throughout the GI tract, including the duodenum.
  • Pancreatic YY (PYY) – secreted by L-cells in the ileum and colon, not in the duodenum.
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Bevacizumab

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Bevacizumab MCQ
Q) Not true about use of Bevacizumab
a) It is a humanized monoclonal antibody against VEGF A
b) Bevacizumab is a first-line treatment in metastatic nonsquamous non-small cell lung cancer.
c) Bevacizumab is a first-line or second-line therapy for metastatic colorectal cancer
d) Its major advantage is that it has replaced combination chemotherapy
Correct Answer: d) Its major advantage is that it has replaced combination chemotherapy
Explanation: a) True – Bevacizumab is a humanized monoclonal antibody targeting vascular endothelial growth factor A (VEGF-A), thereby inhibiting angiogenesis. b) True – Bevacizumab is used as first-line treatment in combination with chemotherapy for metastatic nonsquamous non-small cell lung cancer (NSCLC). c) True – Bevacizumab is used as first-line and second-line therapy in combination with chemotherapy for metastatic colorectal cancer. d) Not true – Bevacizumab is not a replacement for combination chemotherapy. Instead, it is used in combination with standard chemotherapy regimens to improve efficacy. It is not used as a monotherapy in most settings.

Staging Anal Cancer

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Anal Cancer Staging MCQ
Q) In anal carcinoma, involvement of the external iliac lymph nodes indicates which stage of disease according to the AJCC staging system?
a) Stage II
b) Stage IIIA
c) Stage IIIB
d) Stage IV (M1)
Correct Answer: c) Stage IIIB
Explanation: Primary tumor (T) TX: primary tumor cannot be assessed T0: no evidence of primary tumor Tis: carcinoma in situ (Bowen disease, high-grade squamous intraepithelial lesion [HSIL], anal intraepithelial neoplasia II-III [AIN II-III]) T1: tumor 2 cm or less in greatest dimension T2: tumor >2 cm but <5 cm in greatest dimension T3: tumor >5 cm in greatest dimension T4: tumor of any size invades adjacent organ(s), e.g. vagina, urethra, bladder (Note: direct invasion of the rectal wall, perirectal skin, subcutaneous tissue, or the sphincter muscle(s) is not classified as T4) Regional lymph nodes (N) Nx: regional lymph nodes cannot be assessed N0: no regional lymph node metastasis N1: metastasis in regional lymph nodes N1a: metastases in inguinal, mesorectal, and/or internal iliac lymph nodes N1b: metastases in external iliac lymph nodes N1c: metastases in external iliac and in inguinal, mesorectal, and/or internal iliac lymph nodes Distant metastasis (M) Mx: distant metastasis cannot be assessed M0: no distant metastasis M1: distant metastasis (Note: involvement of para-aortic or more distant lymph nodes is considered M1) AJCC Staging: Stage 0: Tis N0 M0 Stage I: T1 N0 M0 Stage II: T2, T3 N0 M0 Stage IIIA: T1, T2, T3 N1 M0 Stage IIIB: T4 N0/N1 OR T1, T2, T3 with N1b or N1c Stage IV: Any T, any N, M1

Healing by Primary Intention

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Q)What is  false regarding the healing by  primary intention? ( # Gen surgery Wound Healing) 

A)Wound edges opposed.

B)Normal healing.

C)Usually done for dirty wounds

D)Minimal scar.

Answer-C

Primary intention,

Healing by primary intention is also known as healing by the first intention this occurs when there is an opposition of the wound edges

Secondary Intention

Healing occurs when the wound edges are not opposed immediately, which may be necessary for contaminated or untidy wounds.

Primary intention,

  • Would edges opposed
  • Normal healing.
  • Minimal scar.

Secondary intention,

  • Would leave open.
  • Heals by granulation, contraction and epithelialisation.
  • Increased inflammation and proliferation.
  • Poor scar.

Intestinal Tuberculosis

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False about Intestinal TB - MCQ

Q) Which of the following statements about intestinal tuberculosis is false?

1. Hyperplastic type commonly causes colonic strictures
2. Raised inflammatory markers, anemia, and positive sputum culture support the diagnosis
3. Barium meal follow-through may show a pulled-up cecum
4. Interferon-gamma release assay is diagnostic

Answer: A) Strictures are of the small bowel, not the colon

Explanation:

Intestinal tuberculosis occurs in two main forms:

1. Ulcerative type – Characterized by transverse ulcers with undermined edges, and the serosa is studded with tubercles. This represents a more severe form of the disease.

2. Hyperplastic type – Involves hyperplasia and thickening of the terminal ileum. It leads to narrowing of the lumen, stricture formation, and fibrosis of the terminal ileum, not the colon.

Other key points:

  • Raised inflammatory markers and anemia are commonly seen.
  • Interferon-gamma release assays help in detecting subclinical infection but are not diagnostic.
  • Barium meal follow-through typically shows a pulled-up or subhepatic cecum.
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INactive hydatid cyst

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Q According to WHO-IWGE ultrasonographic classification for Hydatid cyst, inactive cysts belong to which group
a) Group I
b)  Group 2
c) Group 3
d) Group 4

More question at www.mcqsurgery.com/hydatid

Answer: C

WHO Informal Working Group on Echinococcosis (WHO-IWGE) classification

Group 1: Active group – cysts larger than 2 cm and often fertile.
Group 2: Transition group – cysts starting to degenerate and entering a transitional stage because of host resistance or treatment, but may contain viable protoscolices.
Group 3: Inactive group – degenerated, partially or totally calcified cysts; unlikely to contain viable protoscolices.

Primary Hyperparathyroidism

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Primary Hyperparathyroidism MCQ - Free Question
Q) Which is not a feature of primary hyperparathyroidism?
a) Increase Parathormone
b) Increase Calcium
c) Decreased phosphate
d) Dystrophic calcification
Answer – Free

Answer: d) Dystrophic calcification

Explanation: Clinical features of primary hyperparathyroidism include subperiosteal bone resorption, increased serum calcium, decreased phosphate levels, and elevated PTH. Dystrophic calcification is not typically seen in this condition.

Primary hyperparathyroidism is most commonly caused by parathyroid adenoma (75%) and can be localized using sestamibi scan. Kidney stones are the most frequent symptomatic manifestation. It is defined by hypercalcemia with inappropriately normal or elevated PTH.

Associated disorders: peptic ulcers, pancreatitis, bone disease, and CNS symptoms.

Indications for surgery in asymptomatic patients include:

  • Age < 50 years
  • High urinary calcium excretion
  • Low creatinine clearance
  • Kidney stones
  • Very high serum calcium

Reference: Bailey and Love, 27th Edition, Page 826

#FreeQuestion #Hyperparathyroidism #BaileyAndLove

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Paraneoplastic syndrome in HCC

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Q) Paraneoplastic Syndrome in HCC which also occurs in End stage liver disease ?

a) Hypercholesteremia

b) Hypoglycemia

c) Hypercalcemia

d) Carcinoid

Ans -  b

Hypoglycemia (also seen in end stage liver disease) 

Erythrocytosis

Hypercalcemia

Dysfibrogenimea

Carcinoid Syndrome

Thyroxin binding globulinincreases

Porphyria cutanea tarda

Gynecomastia, testicular atrophy, early puberty