Bleeding on Clopidogrel

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Q)  Patient on Clopidogrel has  Intraop bleeding  Which component will you transfuse to control it? ( #NEET 2018)

a) Platelets
b) FFP
c) Cryoprecipitate

d) PRBC

Ans ) A, platelets

Patients on clopidogrel who are actively bleeding and undergoing major surgery may require almost continuous infusion of platelets during the course of the procedure. Arginine vasopressin or its analogues (DDAVP) have also been used in this patient group

Platelet shelf life is 5 days and stored at temp of -24

Bailey 27th 

 

Gastric pullup

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Q 35) Not a step in Gastric pull up mobilization?

a) Lesser sac entering

b) Posterior mobilization of the duodenum

c) dilatation of hiatus

d) ligation of lesser curve vessels
Answer 35

Stomach is the best esophageal substitute. It has a single anastomosis, consistent blood supply and is durable

Disadvantage is reflux in the long term.

Check the answer to the question on gastric pull up in the answer

Caustic Injury to esophagus

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Q ) False regarding Caustic injury to Esophagus

a) Gastric lavage not done as it increases the chances of more injury

b) Neutralising  agents not given as it produces more injury than preventing it

c) Milk and albumin not given as it causes more damage

d) Activated charcoal not given as it doesn’t effectively absorb alkali

Check one more question on caustic injuries to esophagus here

Answer 

In  caustic injuries to the esophagus, early decisions have to be taken. The involvement of surgeon should be done early and patient should be placed under close monitoring.

Blind nasogastric and orogastric tubes should not be inserted and initially CT of chest and abdomen with contrast should be done to guide the subsequent procedures. Read on

 

Bile duct injuries in cholecystectomy

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Q True about Bile duct injuries in cholecystectomy

a) Only 15% are recognized at the time of surgery

b)Routine  Operative cholangiography  definitely reduces the incidence of bile duct injury

c) In incomplete obstruction of bile duct,  jaundice occurs early

d) Surgical outcome depends on timing of surgery

Answer for premium members

After cholecystectomy complications can occur in 15%. Identification and management of bile duct injuries is very important. This question and subsequent discussion has been routinely asked in many exams

Siewert

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  1. Q) False regarding CA Esophagus

    a) Siewert I treated as Esophageal cancer

    b) Siewert III treated as Gastric cancer

    c) Siewert II treated as Esophageal cancer or Merindino surgery

    d) Proximal margin in Esophagus is determined routinely to alter the management

    Answer

FNH _ Focal Nodular hyperplasia

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Q) Which of the following statements about focal nodular hyperplasia (FNH) of the liver is true?

a) A central scar is present in all cases
b) Fine-needle aspiration cytology (FNAC) is usually diagnostic in doubtful cases
c) Resection is recommended due to risk of malignant transformation
d) Asymptomatic patients with typical radiologic features usually do not require treatment

d) Asymptomatic patients with typical radiologic features usually do not require treatment

  • Focal Nodular Hyperplasia (FNH) is a benign liver lesion, often found incidentally.

  • a) Central scar is present in all cases – Incorrect. While a central stellate scar is characteristic of FNH, it is not present in all cases (seen in ~50-70% on imaging).

  • b) FNAC is usually diagnostic – Incorrect. FNAC often provides inconclusive results in FNH. Histological diagnosis requires tissue architecture, which FNAC can't reliably provide.

  • c) Resection is recommended due to risk of malignant transformation – Incorrect. FNH has no malignant potential and rarely causes complications. Surgery is not routinely recommended unless symptomatic or diagnosis is uncertain.

  • d) Asymptomatic patients with typical radiologic features usually do not require treatment – Correct. FNH with typical imaging features (especially on MRI with hepatobiliary contrast agents) does not require biopsy or surgical intervention.