Non obstructive mesenteric ischemia

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Q) Not true about Non Obstructive Mesenteric Ischeamia (NOMI)

a) Occurs due to treatment with vasopressors

b) Occurs in cardiac shock

c) Can occur in Burns

d) Hypercoagulable state maybe responsible for NOMI

Answer

Renal cell carcinoma

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Q) False about Renal cell carcinoma is

a) More common in males

b) Associated with von hippel lindau syndrome

c) Always require radical nephrectomy

d) Has paraneoplastic manifestaions

Answer

c

Renal cell carcinoma is more common in males

Genetic

loss of heterozygosity in chromosome 3p

B/l RCC is associated with VHL syndrome

Paraneoplastic of RCC

Anemia, hypettension, erythrocytosis.

Radical nephrectomy is the gold standard but not always necessary and partial nephrectomies in selected cases give good clearance

Annular pancreas

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Management of annular pancreas

Q) All are true about annular pancreas except ( AIIMS GI Surgery Question bank)

a) They are mostly asymptomatic

b) It has equal incidence in children and adults

c) Treatment of choice is duodenojejunostomy

d) Associated with Down's syndrome

Answer c

Annular pancreas is a congenital malformation but manifestations can appear in the adult life.

Annulus means a ring of pancreatic tissue around the duodenum. For annular pancreas to be diagnosed, this ring can be complete or incomplete.

Embryological basis

Normally the ventral buds of pancreas and  dorsal bud fuses together. Non rotation and fusion of these two leads to the formation of annular pancreas. It envelops the  2nd part of duodenum.

Age of presentation

Incidence is equal in both adults and children

Presentation in children is congenital anomalies and duodenal obstruction

Presents in adults as pancreatitis usually in 3rd or 4th decade

Association with other pancreatic conditions

1. Pancreas  divisum 35- 40%

2. Chronic pancreatitis 45- 50%

Other GI conditions

Annular pancreas is a possible etiology of congenital duodenal obstruction and is associated with other congenital anomalies such as Down syndrome, duodenal atresia, and imperforate anus.

Clinical Fetaures

Of those seen as adults, 75%were seen with pain

22% were diagnosed with pancreatitis

24%) had gastrointestinal (GI) symptoms that included vomiting,

11%had obstructive jaundice and/or abnormal liver function test results.

Treatment

It is duodenal bypass and not resection of duodenum as duodenum excision can lead to pancreatitis

in children its duodeno - duodenostomy

in adults duodenoduodenostomy which has now replaced duodenojejunostomy

Sabiston

Questions on Pancreas 

Pancreas annulare in radiology refers to the imaging findings of a rare congenital anomaly where a ring of pancreatic tissue encircles the duodenum. On imaging, such as CT, MRI, or endoscopic ultrasound, it may present as a characteristic encircling or constricting mass around the duodenum, often associated with symptoms like duodenal obstruction.

Budd chiari

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Q31) In Budd Chiari Syndrome best management for patients when all three hepatic veins are blocked with deranged LFT

a) Liver transplant

b) Side to side porto caval shunt

c) MEso atrial Shunt

d) TIPS

Answer

Roux en Y Gastric bypass

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Q 35) To prevent bile reflux gastritis in RYGB, false is

a) Jejunum divided at 45cm from the DJ

b) Roux loop length is 40 cm and above

c) Enteroenterostomy done at 45cm from the GJ


Answer q 35

Achalasia cardia with perforation

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Q) What is the management of achalasia cardia with perforation ?

a) Suture ligation of the perforation

b) Suture ligation with myotomy on opposite side with fundoplication

c) Suturing with fundoplication

d) esophagectomy

Answer 

Splenectomy

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Q) Which of the following is not an indication for splenectomy in Non Hodgkin Lymphoma?
 
a)  Massive splenomegaly
b) Signs of hypersplenism
c) Diagnosing and staging of isolated splenic disease

d) All are indications for splenectomy

The correct answer is: d) All are indications for splenectomy

Explanation:

In Non-Hodgkin Lymphoma (NHL), splenectomy may be considered in the following scenarios:

  • Massive splenomegaly causing symptoms or complications like infarction, pain, or risk of rupture.

  • Hypersplenism, which leads to cytopenias (low counts of blood cells) that are not responsive to medical therapy.

  • Diagnostic and staging purposes, especially in isolated splenic disease where biopsy is inconclusive or not feasible.

 

BISAP Score In Pancreatitis

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Q) All are components in BISAP score except?

a) Age more than 60 years

b) WBC more than 16000

c) GCS <15

d) BUN > 25 mg/dl

Ans )b

Correct Answer: b) WBC more than 16000

The BISAP score (Bedside Index for Severity in Acute Pancreatitis) is used to predict the severity of acute pancreatitis. It includes 5 components, one point each:

  1. Blood urea nitrogen (BUN) > 25 mg/dL

  2. Impaired mental status (GCS < 15)

  3. Systemic Inflammatory Response Syndrome (SIRS)

  4. Age > 60 years

  5. Pleural effusion on imaging

✅ WBC >16,000 is not directly part of the BISAP score, although it is a criterion within SIRS, which is part of BISAP.