Q. Hyergastrinemia occurs in all except
a)Retained antrum
b)Excluded antrum
c)Brunner gland adenoma
d)GOO
stomach
Dumping Syndrome
Q) Late dumping syndrome is due to
a) Excessive release of insulin
b) Food bolus in jejunum
c) Release of serotonin
d) Local enteric reflexes
Answer
a, Excessive release of Insulin
Dumping syndrome are most common after billroth II gastrectomy followed by BI and Truncal vagotomy and gastro jejunostomy.
Dumping can occur 30 mins after food, (early dumping) or 2 hours after eating (late dumping). Early dumping has GI symptoms such as nausea, vomiting, epigastric fullness, diarrhea and abdominal pain.
Early dumping occurs due to rapid emptying of chyme in jejunum. This hyperosmolar fluid draws water from extracellular compartment to the lumen of small intestine causing intestinal distension and autonomic changes.Serotonin, bradykinin-like substances, neurotensin, and enteroglucagon are involved in early dumping.
Late dumping syndrome has more cardiovascular symptoms such as palpitations, light headedness, dizziness, tachycardia, diaphoresis, flushing and blurred vision.
It occurs due to delivery of carbohydrates into jejunum, their absorption causes hyperglycemia and insulin release. Excessive insulin release leads to development of symptoms.
Treatment
- Diet - Avoid carbohydrates, frequent small meals of protein and fat and separate liquids from solids
- surgery Conversion to Roux en Y
Ref Sabiston 1212
Bleeding peptic ulcer
Q) In a patient with a bleeding peptic ulcer, endoscopy is done. Which of the following findings on endoscopy predicts the highest rate of re bleed?
a) Non bleeding vessel
b) Adherent clot
c) Flat pigmented spot
d) Clean base ulcer
Borrmann’s classification for ca stomach
Q) According to Borrmann's Classification of Ca stomach Type II is?
a) Fungating
b) Polypoid
c) Ulcerative
d) Infiltrative
Borrmann’s pathologic classification of gastric cancer is based on gross appearance.
Developed in 1926
Gastric carcinoma is divided into 5 types according to this classification
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Advanced ca Stomach
Q) Management of carcinoma body of stomach which on exploration is only invading the body of pancreas with no distant metastasis
a) feeding jejunostomy and closure
b) Palliative total gastrectomy
c) Total gastrectomy with ......
Surgical Gastro NEET type Exam Questions
Q) Type II gastric ulcer as described by Johnson is
a) Pre pyloric
b) Ulcer on body of stomach combined with duodenum
c) High on lesser curvature
d) Ulcer near the antrum
Answer b
Type II gastric ulcers, as described by Johnson, refer to:
b) Ulcer on body of stomach combined with duodenum
Type II ulcers are characterized by the presence of both gastric ulcers and duodenal ulcers.
In Johnson’s classification of peptic ulcers, Type II gastric ulcers are those that occur in both the stomach and the duodenum simultaneously. Here are the details:
- Location: The gastric ulcer typically occurs in the body of the stomach, usually on the lesser curvature, while the duodenal ulcer is found in the first part of the duodenum.
- Pathophysiology: This type of ulcer is associated with increased gastric acid secretion, which contributes to the development of both gastric and duodenal ulcers. The co-occurrence is often due to the same underlying factors like Helicobacter pylori infection or hyperacidity.
Giant Gastric ulcer
Q) Which of the following is true about giant gastric ulcer?
a) 70-80% of these ulcers are malignant
b) By definition giant gastric ulcer is more than 1.5 cm in size
c) Medical therapy can heal 80% of such ulcers
d) They are more common on the greater curvature and invade surrounding organs like spleen, liver etc
Answer for premium members
Bleeding Peptic ulcer
Q) In a 55 year old male with a bleeding peptic ulcer, endoscopy is done. Which of the following findings on endoscopy predicts the highest rate of re bleed?
a) Non bleeding vessel
b) Adherent clot
c) Flat pigmented spot
d) Clean base ulcer
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Free Answer
Answer a
a) Non bleeding vessel IIA - Out of the choices given
Bleeding peptic ulcer is mostly from the posterior surface of the lesion and can be sometimes lethal
Forrest classification is used to grade the risk of re bleeding in peptic ulcers.
According to the stigmata of recent bleed, the chances of re bleed increase.
Endoscopic appearance of bleeding peptic ulcer classification
Ia - Active Spurting Highest 90% chance of acute bleeding peptic ulcer ICD 10
Ib- Active oozing
IIa Non bleeding vessel 50% chance of re bleed
IIB Adherent clot
IIC Flat Pigmented spot
III Clean based ulcer
Sabiston 1154 21th edition
Q) How to treat a bleeding peptic ulcer? Bleeding gastric ulcer management?
Steps to manage a bleeding peptic ulcer
- Secure two large bore IV lines for fluid and blood products. Evaluate for coagulopathy
- Simultaneous evaluation for source of bleeding and history. Important causes to rule out are chronic liver disease, NSAID use etc
- Simultaneous IV PPI infusion
- Endoscopic control of bleeding peptic ulcer- Thermal coagulation, hemoclips, Adrenaline injections etc
- Operative procedure For Duodenum bleed - Longitudanally opening the anterior wall of duodenum and 3 point suture ligation
- For Gatric ulcer bleeding - depends on the site of ulcer and might require Antrectomy/Partial gastrectomy
Our Recommendations
BEST TEXTBOOKS FOR GENERAL SURGERY
Bailey & Love’s Short Practice of Surgery, 27th Edition
Sabiston’s Textbook of Surgery
Schwartz’s Principles Of Surgery