Timing of cholecystectomy in biliary pancreatitis

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Q) What is true regarding timing of cholecystectomy in biliary pancreatitis ?

a) Cholecystectomy should be done before discharge in severe pancreatitis to prevent recurrent attacks

b) Cholecystectomy should be done in same admission as pancreatitis when severe disease is excluded

c) Early cholecystectomy has been shown to have more complications than interval cholecystectomy

d) Early cholecystectomy increases technical complications

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Questions on Bile ducts?

 Ans b

"Poncho trial " answers this question of timing of cholecystectomy in biliary pancreatitis 

Early cholecystectomy (just before discharge, when the patient has recovered and severe disease excluded), compared to interval cholecystectomy, effectively reduces---

  1. The rate of recurrent gallstone-related complications in patients with mild biliary pancreatitis,
  2. low added risk of complications.

Evidence on the timing of cholecystectomy in severe pancreatitis is scarce. Cholecystectomy is recommended after all signs of pancreatic necrosis have been resolved or if they persist more than 6 weeks

  • Cholecystectomy during the same admission is recommended for patients with mild biliary pancreatitis to prevent recurrent attacks.
  • In cases of severe pancreatitis, surgery is generally delayed until the inflammation subsides.
  • Studies have shown that early cholecystectomy during the same admission for mild to moderate biliary pancreatitis does not increase complications compared to delayed or interval cholecystectomy.

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Pancreatic necrosis

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Q) Pancreatic necrosis all are true except
a) Sterile pancreatic necrosis may be managed conservatively in most of the cases
b) Infected Pancreatic Necrosis  is managed by surgery at 2 weeks
c) Minimal access techniques have given better results than open necrosectomy
d)WOPN may be drained by either a transgastric or, less commonly, a transdoudenal route.

Mucinous cystic neoplasm

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Q) Which of the following statements about Mucinous Cystic Neoplasms (MCNs) of the pancreas is incorrect?
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Management of biliary strictures

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Q) Which of the following is false about management of benign biliary stricture?

a) After HJ,success rate of 80-90% for benign biliary stricture is achieved

b) Recurrent stricture in 5 years is 30%

c) MOst important factor for recurrent stricture is the initial level of injury

d) Liver failure after stricture repair is around 20% 

Duodenal Diverticula

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Which of the following statements about duodenal diverticula is incorrect?

a) Extraluminal diverticula are more common than intraluminal ones
b) They are most commonly located within 2 cm of the ampulla
c) The majority are symptomatic, presenting with epigastric pain
d) Diverticulectomy is the standard surgical treatment

Afferent loop syndrome

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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. 

Indications of Small Bowel transplant

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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

 

 

Diverticular disease of colon

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Q) False about diverticular disease of colon is 

a) 10-20% of all diverticular disease of colon develop symptoms. Rest remain asymptomatic

b) Low fiber diet is implicated in etiology

c) Sigmoidoscopy is useful tool for evaluation of diverticulitis

d) Elective colectomy in uncomplicated diverticulitis is rare and forms only 1% of cases with diverticular disease

Cancer lower rectum

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Q) False statement about management of cancer rectum

a) Relative to ERUS, pelvic MRI is more accurate in its ability to detect lymph node involvement 

b) Rectal cancers located in the upper third of the rectum are exempt from neoadjuvant treatment.

c)  TME is typically performed 2-3 weeks after completion of CRT before fibrosis develop

d) ERAS  include early mobilization, transition to oral pain control, and resumption of oral food intake