Carcinoid Syndrome

Q) Carcinoid syndrome wrong statement is?
a) 40 % have Right  heart dysfunction in carcinoid syndrome

b) >1cm in appendix is  indication for Right  hemi colectomy
c) 30 %  jejunoileal carcinoid are metastatic
d) Resection of primary is done in presence of metastatic disease

 

Crohn Disease of Duodenum

Q) In Crohns  disease of duodenum , patient has a duodenal abscess which is  drained. He develops a fistula with  ileal communication. Surgery with the least chance of success would be

a. Ileal reaction and duodenal bypass

b. Ileal resection an dudodenal HMplasty
c. Ileal freshen and closure
d. Duodenum vertical closure

Small Intestine diverticulum

Q) Small intestine diverticula true statement is 
a. Meckel is Most common and jejuno ileal is least common but most symptomatic
b. Meckel is true and congenital and rest are false and acquired
c. 1-5 % Duodenal ones require endoscopic or surgical treatment
d. All Meckel’s resected unless strong Contraindication is there

 

Intestinal TB

Q) False about intestinal TB? # Gen surgery infections
1. Hyperplastic variety has colonic strictures
2. Raised markers,anaemia,positive sputum culture point towards diagnosis
3. BMFT shows pulled up cecum
4. IFN gamma assay is diagnostic 

Ans A) STRICTURES ARE OF SMALL BOWEL

There are two types Of Intestinal TB

Ulcerative type - Transverse ulcers with undermined edges, Serosa of bowel is studded with tubercles. It is a severe form of disease

Hyperplastic - Hyperplasia and thickening of terminal ileum. Narrowing of lumen., Stricture and fibrosis occues of terminal ileum

There are raised inflamatory markers and anemia

Interferon gamma is for subclinical infection

BMFT shows subhepatic caecum

Bailey page 80

Enteropathy in T cell lymphoma

Q. Not true about enteropathy in T cell lymphoma
a) It is an  variant of intestinal lymphoma mainly in jejunum and ileum
b) Associated with coeliac disease
c) Perforation is frequently seen with ETL (Enteropathy T cell lymphoma)
d) This type of lymphoma is commonly seen
Ans. d
Enteropathy T cell lymphoma is an unusual variant of intestinal lymphoma. It is associated with celiac disease and responds to gluten free diet. It has a higher rate of perforations because of circumferential ulcers. It is commonly seen in jejunum and ileum
Ref- Schakelford Surgery of Alimentary canal  pg 1205
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Indications of Small Bowel transplant

Q ) One of the following is not an indication for small bowel transplant?

a)  Impending liver failure by PNALD

b) Multiple thromboses of central veins 

c)  Single episode of catheter-related infection requiring hospitalization in any year

d) single episode of fungal line infection

 

 

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