DNB 61-70

A 61

a

Spleneculi are accessory spleen that can be single or multiple

10-30% of people have them

50% near hilum

30% near splenic vessel or tail of pancreas

Others - Mesocolon, Ligaments of spleen

Applied anatomy- Have to be searched and removed during splenectomy for haematological diseases

REf Bailey 26th page 1089

62 ) a

Ref Sabiston 20 page 1240

63 ) a, Adenocarcinoma

Adenocarcinoma is the most common, (50%) followed by neuroendocrine tumors (30%) . Malignant neoplasms are mostly symptomatic

Benign lesions are common in distal small bowel and malignant in proximal

Ref Sabiston page 1268

64) A

Ileum

After laparotomy small bowel is the first to regain function. Gastric motility returns after 48 hours and colon after 72 hours

Sabiston page 306

65) b

Management of Carcinoma GB after lap cholecystectomy depends on the depth of invasion of disease

a) T1a - only serosa- Nothing is to be done

T1b- serosa - Cholecystectomy if margins are negative

T1 b if perineural, lymphatic or vascular invasion- Extended cholecystectomy

T2-Extended cholecystectomy

An excision of 2 cm of liver parenchyma is must adjacent to the GB bed.

Port site excision should be done in all cases as recurrence has been shown to occur even with in situ Ca GB

Ref Blumgart 799

66) b

Steroids have no role

Treatment options in Anal fissure are

1. Midline fissure - Medical management - Nitrates, Calcium channel blocker,  botulinum injections                                                          Surgery - Lateral sphincterotomy                                                                                                                                             Fails to heal a) Hypotonic sphincter- Excise and advancement flap                                                                                                         b) Hypertonic - Again sphincterotomy                                                                                 
2. Lateral fissure - consider Crohn, TB, HIV, Syphilis  

67) d

Albumin is not a part of MELD score

It includes Bilirubin, INR and serum creatinine

It was initially devised to assess liver transplant wait list mortality. A MELD score of 14 means a patient's chance of being alive in a year is about 86%. 

Higher the MELD Score, more urgent is the need for liver transplant

Ref Sabiston 20, page 640

68) c

Milan criteria 

It was devised by Mazzaferro in Italy to devise criteria 

Mazzaferro et al. reported that liver transplantation was an effective treatment for small, unresectable hepatocellular carcinoma (HCC) in patients with cirrhosis in 1996 .

It set criteria (single tumors ≤5 cm in diameter or no more than three tumors ≤3 cm in diameter) 

The 5 cm was the generally accepted cutoff for small intrahepatic tumors, which was used in patient selection for the studies before Mazzaferro’s report. In the report of Bismuth, patients with no more than three tumors and ≤3 cm in diameter were considered eligible for transplantation 

69) b

Barium Enema are limited and give information only about the luminal pathology. They cannot be used in cases of suspected perforation

CT abdomen is now the standard of management in acute colonic diverticulitis. It tells about the site, severity, extent and external structures involved. CT guided aspirations can also help in deciding further management options. The use of MRI and Ultrasound is not as reliable as CT 

Ref Sabiston 1331-1332

70) a

Most common congenital anomaly of intestine, seen in 2% of population. It is located at antimesenteric border of intestine. It is formed due to incomplete closure of vitelline duct.

It is seen in equal ratio in both sexes. It can harbour pancreatic and even colonic mucosa. Its a true diverticulum .

Ref sabiston page 1284