Q. Not an Extended Criteria for Endoscopic resection of gastric cancer?
a) Less than 3 cm irrespective of ulceration
b) Limited Sm1 leison
c) Submucosal invasion 2 cm in size
d) submucosal invasion 3.5 cm in size
stomach
Peptic Ulcer Location
Q) False statement about location of peptic ulcer?
a) Type 1 is on greater curvature
b) Type 2 is gastric body and duodenal
c) Pauchet procedure is for type IV
d) Type Iv is high on lesser curvature
D 2 gastrectomy
Q) D2 gastrectomy false statement is ? ( AIIMS 2021)
a. No benefit in Overall Survival ( OS)
b. Better Disease free Survival ( DFS)
c. Recommended to take stomach, omentum, retro peritoneum en masse
d. Can remove spleen or pancreas if involved
Maltoma Stomach
Q) False about Maltoma of stomach
a Rituximab based therapy is useful in resistant cases
b) Most respond to anti H pylori eradication
c) T (11, 18) respond to h pylori eradication
d)
Gastric Lymphadenopathy
Q ) which is one of the criteria for diagnosis of gastric lymphadenopathy
a. mesenteric lymphoadenopathy
b. hepatic involvement
c. general lymph adenopathy
d . blood count within normal limt
Ans d
Dawson criteria
(1) absence of peripheral lymphadenopathy at the time of presentation;
(2) lack of enlarged mediastinal lymph nodes;
(3) normal total and differential white blood cell count
(4) predominance of bowel lesion at the time of laparotomy with only lymph nodes obviously affected in the immediate vicinity; and
(5) no lymphomatous involvement of liver and spleen
Afferent loop syndrome
Q) Not true about afferent loop syndrome
a) It can occur after either partial or total gastrectomy with Billroth ii reconstruction or roux en y gastrojejunostomy
b) Acute obstruction is more common than chronic
c) Weight loss and anemia are common.
d) Bacterial overgrowth in afferent limb causes malabsorption of fat and other nutrients, such as vitamin B12 or iron.
Role Of PET Scan in CA Stomach
Q) What is not true about the role of PET Scan in staging of Ca Stomach?
a) 50% of Carcinoma stomach are PET avid
b) Response to Neoadjuvant therapy is usually seen on PET in 2 weeks
c) PET response correlates with survival
d) Sensitivity of PET is same for all kinds of histopath tumors
Highly selective vagotomy
Q) False about highly selective vagotomy? (# Gastric Surgery MCQS) (# Questions on Esophagus)
a) Highly selective vagotomy divides the vagus nerves supplying the acid-producing portion of the stomach
b) Incidence of postoperative complications is lower.
c) The criminal nerve of Grassi should be severed
d) Crow's feet nerves are severed till below the GE junction
Ans - d
Highly Selective Vagotomy (HSV) only divides the last part of the nerves which supply the part of stomach which produces acid.
Anterior and posterior nerves of Latarjet are found and their terminal branches are severed from 7 cm proximal to the pylorus to 5 cm above the GE junction
Motor function of the stomach is not affected
Criminal nerve of Grassi is branch of posterior Vagus. It should be sought and cut. This nerve derives its name from the common mistake done during vagotomy. This nerve is often missed and responsible for recurrence of symptoms of Peptic ulcer disease. MOre
Vagus Nerve branches
- Anterior trunk: Gives branch to liver GB and bile duct and goes along the lesser curvature as the anterior nerve of Latarjet
- Posterior trunk: Sends branches to the celiac plexus and continues along the posterior aspect of the lesser curvature as the posterior nerve of Latarjet.
- Criminal Nerve of Grassi: The first branch of the posterior trunk, innervates the gastric fundus. Failure to divide this nerve during an acid-reducing surgery can lead to recurrent ulcers
- Crows Foot: The most distal branches of the anterior and posterior trunks and provides innervation to the antro-pyloric region. These branches are spared in a highly selective vagotomy (HSV)
Parasympathetics are vagally mediated using acetylcholine as the primary neurotransmitter.