Survival after pancreatic resection in Ca head of Pancreas

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Q) Median survival after surgery and chemotherapy in Ca Head of Pancreas

a) 12 months

b) 22 months

c) 32 months

d) 44 months

Answer for premium members

This is an interesting question because this is one tumor in which breakthrough has not been achieved in the last 70 years. Pancreatic cancer remains one of the deadliest cancers of the GI tract and whipple's surgery continues to have high morbidity.

We discuss the role and response of chemotherapy also

Dumping Syndrome

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Q) Late dumping syndrome is due to 

a) Excessive release of insulin

b) Food bolus in jejunum

c) Release of serotonin

d) Local enteric reflexes

Answer

a, Excessive release of Insulin 

Dumping syndrome are most common after billroth II gastrectomy followed by BI and Truncal vagotomy and gastro jejunostomy.

Dumping can occur 30 mins after food, (early dumping) or 2 hours after eating (late dumping). Early dumping has GI symptoms such as nausea, vomiting, epigastric fullness, diarrhea and abdominal pain.

Early dumping occurs due to rapid emptying of chyme in jejunum. This hyperosmolar fluid draws water from extracellular compartment to the lumen of small intestine causing intestinal distension and autonomic changes.Serotonin, bradykinin-like substances, neurotensin, and enteroglucagon are involved in early dumping.

Late dumping syndrome  has more cardiovascular symptoms such as palpitations, light headedness, dizziness, tachycardia, diaphoresis, flushing and blurred vision.

It occurs due to delivery of carbohydrates into jejunum, their absorption causes hyperglycemia and insulin release. Excessive insulin release leads to development of symptoms.

Treatment 

  1. Diet - Avoid carbohydrates, frequent small meals of protein and fat and separate liquids from solids
  2. surgery Conversion to Roux en Y

Ref Sabiston 1212

 

Clinical question

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Q) A 68-year-old woman complains of  Intestinal obstruction. Xrays reveal fluid levels and air in the biliary tree. What is the likely cause?
(A) Choledochal cyst
(B) Gallstone ileus
(C) Obstructed hernia
(D) Previous choledochoduodenostomy

Premium Answer

Siewert classification for GE junction tumors

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Q) According to Siewert classification tumors at GE junction are

a) Type I

b) Type II

c) Type III

d) Type IV

Answer b

Type I   Lower  (center located within between 1-5cm above the anatomic OGJ)

Type II Real GE junction  (within 1cm above and 2cm below the OGJ)

Type III  (2-5cm below OGJ)

This classification has only 3 subtypes

According to the Siewert-Stein classification,

Type I tumour 25% approx

Type II - Most common 49%

Type III was present in 25%

This classification helps in deciding the operative management and unified pre op classification

Types of Surgery

Type I cancer--depending of the size of the tumour--distal 2/3 oesophagectomy with the resection of the proximal lesser curve of the stomach or total gastrectomy  or THE

In patients with types II and III cancers total gastrectomy

More ref 

  1. Radiopedia
  2. Reviews Article

 

Choledochal cyst

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Q) Which of the following statement is false about classification of choledochal cyst ?

a) Type IV is also known as Caroli's disease

b) Type I choledochal cyst is the most common type

c) Type III is also called as choledochocele

d) Type II choledochal cyst is diverticular disease

NEET  MCH 2018 Questions Q no. 71-75

Ans ) a

Original classification of choledochal cysts was given by Alonso Lej and later modified by Todani. 

Type I most common and and is fusiform dilatation

Type II saccular diverticulum

Type III dilatation in the intramural duodenum also called choledochocele

Type IV 

IVa Both intrahepatic and extrahepatic biliary tree

IV b Multiple extrahepatic biliary

Type V - Caroli disease

Intrahepatic ducts only can be single or multiple

Ref Sabiston page 1510

Carbon Monoxide poisoning

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Q. Carbon monoxide poisoning true is 

a)  It is having 10 times more affinity than oxygen
b) 60 percent is not deadly.
c) . Concentration above 10% are dangerous and need observation
d)  Concentration above 10% are dangerous and need treatment with pure oxygen for more than 24 hours

d

Option A: Affinity of CO for Hb is 200-250 times that of oxygen. It causes a conformational change in Hb molecule and reduces affinity of Hb for O2, shifting the oxyhemoglobin dissociation curve to the left.

Option B: Concentrations less than 10% are usually asymptomatic. Concentrations >60% are fatal. Arterial carboxyhemoglobin level must be obtained because pulse oximetry can be falsely elevated.

Option C: Concentrations above 10 per cent are dangerous and need treatment with pure oxygen for more than 24 hours. Administration of 100% O2 reduces the half-life of CO from 250 minutes in room air to 40 to 60 minutes on 100% oxygen.