Important Points

Anal malformation

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MCQ on Newborn with Abdominal Distension
Q) Newborn with abdominal distension on day 2, not passed meconium. There is absent anal orifice. What is the next step? # NEET SS 22
✅ Answer: A. Cross table X ray

🔍 Explanation:
The first step in such cases is to rule out congenital abnormalities of the spine, sacrum, kidneys, and heart.

- The second step is a Cross-table X-ray. If the X-ray shows perineal fistula, perform Anoplasty.
- If the X-ray shows rectal gas below the coccyx, perform a PSARP (Posterior Sagittal Anorectoplasty) with or without a colostomy.
- If the X-ray shows gas above the coccyx with associated defects, perform a colostomy.

🧠 Key Point: Cross-table X-ray is crucial to determine the presence of rectal gas and other associated defects, guiding the next step in management.

📘 Reference: Table 67.14 Sabiston

Paclitaxel group drugs

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MCQ on Group of Drug Paclitaxel Belongs To
Q) Which group of drug paclitaxel belongs to?
✅ Answer: A. Drugs which interfere with mitosis

🔍 Explanation:
Paclitaxel is a drug that interferes with mitosis. It belongs to the class of drugs that interfere with mitosis.

- Paclitaxel works by stabilizing microtubules and preventing their disassembly, thereby inhibiting cell division.
- Vincristine is also in the same group but it interferes with the formation of microtubules (spindle poison).

- Antimetabolites include drugs like 5-FU, Methotrexate, and Gemcitabine, which interfere with DNA synthesis.
- Drugs that directly damage DNA include Mitomycin, Cisplatin, Oxaliplatin, and Doxorubicin.
- Receptor tyrosine kinase inhibitors include drugs like Imatinib and Gefitinib.

🧠 Key Point: Paclitaxel is primarily classified as a drug that interferes with mitosis, making it a mitotic inhibitor.

📘 Reference: SRB’s Manual of Surgery

Chicago classification of Achalasia

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Here I am discussing the Chicago classification and its clinical significance

 

This is based on high resolution manometry (HRM) 

Manometry evaluates the swallowing response, and weather the LES sphincter relaxation is absent or incomplete.

There are three types of Achalasia and all have incomplete LES relaxation

Type I - Body - Aperistalsis  and no pressurization

Type II Body - aperistalsis and panesophageal pressurization 

Type III - Spastic contractions and distal contractility integral (DCI) over 450 mm HG

 Type 2 achalasia had the best positive response to treatment, and type 3 the least favorable response to treatment.

The best initial treatment option for types 1 and 2 are conservative measures such as pneumatic dilatation and surgical myotomy,

while type 3 achalasia appears to respond better to initial treatment with peroral endoscopic myomectomy

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