General Surgery

NEET, DNB questions from general surgery

Splenectomy

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Q) Which of the following is not an indication for splenectomy in Non Hodgkin Lymphoma?
 
a)  Massive splenomegaly
b) Signs of hypersplenism
c) Diagnosing and staging of isolated splenic disease

d) All are indications for splenectomy

The correct answer is: d) All are indications for splenectomy

Explanation:

In Non-Hodgkin Lymphoma (NHL), splenectomy may be considered in the following scenarios:

  • Massive splenomegaly causing symptoms or complications like infarction, pain, or risk of rupture.

  • Hypersplenism, which leads to cytopenias (low counts of blood cells) that are not responsive to medical therapy.

  • Diagnostic and staging purposes, especially in isolated splenic disease where biopsy is inconclusive or not feasible.

 

Radiation proctitis

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Q) In radiation proctitis surgery is needed in all except 

a) Pain Abdomen

b) Rectal stricture

c) Haemorrhage

d) Vesical Fistula

Free Question on management of raiation proctiitis 

Ans a, 

In radiation proctitis, surgery is typically indicated for complications that are severe or unmanageable through conservative measures. The options can be considered as follows:

  • A) Pain Abdomen: While abdominal pain can be a symptom associated with radiation proctitis, it is not an indication for surgery on its own. Pain management and other conservative treatments can be employed first.
  • B) Rectal stricture: This can cause significant obstruction and may require surgical intervention to restore normal bowel function.
  • C) Haemorrhage: Severe bleeding due to radiation proctitis may necessitate surgical intervention if it is not controlled by endoscopic or conservative measures.
  • D) Vesical Fistula: The formation of a fistula between the bladder and rectum (vesical fistula) is a serious complication that often requires surgical repair.

Acute Radiation proctitis - Occurs within 6 mths of starting the treatment

Chronic - After 6 mths, Most patients develop symptoms at a median of 8 to 12 months after completion of radiotherapy

Modified Radiation Therapy Oncology Group rectal toxicity scale

Grade 1 Mild and self-limiting Minimal, infrequent bleeding or clear mucus discharge, rectal discomfort not requiring analgesics, loose stools not requiring medications
Grade 2 Managed conservatively, lifestyle (performance status) not affected Intermittent rectal bleeding not requiring regular use of pads, erythema of rectal lining on proctoscopy, diarrhea requiring medications
Grade 3 Severe, alters patient lifestyle Rectal bleeding requiring regular use of pads and minor surgical intervention, rectal pain requiring narcotics, rectal ulceration
Grade 4 Life threatening and disabling Bowel obstruction, fistula formation, bleeding requiring hospitalization, surgical intervention required

Prevention

  1. Use of newer conformal radiation therapy techniques.
  2. Amifostine is a prodrug that is metabolized to a thiol metabolite that is thought to scavenge reactive oxygen species
  3. Placebo-controlled phase III trials have detected no benefit from either topical or oral sucralfate.

Treatment  of radiation proctitis 

Medical

  1. Butyrates
  2. ASA
  3. Sucralfate
  4. Metronidazole
  5. Short chain FA
  6. Topical formalin
  7. Hyperbaric o2

Endoscopic

  1. dilatation
  2. Heater and bipolar cautrey
  3. ND YAG
  4. APC
  5. RFA

Surgery

Diverting ostomies for severe stricture - Better for incontinence, stricture and limited benefit  for bleed

Reconstruction with Flaps -  rectourethral or rectovaginal fistula with a pedunculated gracilis or a Martius flap to facilitate healing by introducing well-vascularized healthy tissue,

Proctectomy  complicated fistulous disease, especially when accompanied by significant pain and incontinence, or in cases of severe and intractable bleeding

Amoebic Liver abscess

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Q) Not true about amoebic liver abscess

a) Most common liver enzyme elevated is ALT
b) Metronidazole and luminal amebicide needed in all cases
c) In peritonitis due to amoebiasis perforation of colon are less than perforation of liver
d) 5% to 15% of patients with ALA may be resistant to metronidazole

 

Answer
The cecum is the most common site of amebic colitis, and the right lobe of the liver is more commonly affected because of drainage
of the right portal branch from the right side of the colon. The condition usually starts as diffuse amebic hepatitis; liver cells
undergo liquefactive necrosis

Read on for answer - Need Premium Membership

GIST Stomach

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Q ) Antral GIST 1cm incidentally found on UGIE. True regarding its management

a) Surgical resection resection of GIST (More questions on GIST here) 

b) Endoscopic resection

c) Resection required if EUS suggests irregular border with cystic spaces

d) Endoscopic surveillance, if size >2cm then resect

Answer ( You need to be a premium member to see this) 

GIST are usually found in the stomach (40% to 60%), small intestine (30%), and colon (15%). Clinically they appear  in patients older than 50 years.

They generally have an equal male-to-female ratio or a slight male predominance.

They are rarely associated with familial syndromes such as GISTparaganglioma syndrome (Carney triad), neurofibromatosis 1, and von Hippel-Lindau disease, but most develop de novo. 

natural history breast cancer

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Q. True about breast cancer is?

a) Doubling time of breast tumor is 1 month

b) Skip metastasis in level iii lymph nodes is common

c) Lungs are commonly involved by direct invasion

d) Dimpling of skin is due to shortening of cooper's ligaments

Ans