Bleeding Peptic ulcer

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Q) In a 55 year old male  with a bleeding peptic ulcer, endoscopy is done. Which of the following findings on endoscopy predicts the highest rate of re bleed?

a) Non bleeding vessel

b) Adherent clot

c) Flat pigmented spot

d) Clean base ulcer

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Free Answer 

Answer a

a) Non bleeding vessel IIA - Out of the choices given

Bleeding peptic ulcer is mostly from the posterior surface of the lesion and can be sometimes lethal

Forrest classification is used to grade the risk of re bleeding in peptic ulcers.

According to the stigmata of recent bleed, the chances of re bleed increase.

Endoscopic appearance of bleeding peptic ulcer classification

 Forrest Classification

Ia - Active Spurting                   Highest 90% chance of acute bleeding peptic ulcer ICD 10

Ib-  Active oozing

IIa Non bleeding vessel             50% chance of re bleed

IIB Adherent clot

IIC Flat Pigmented spot

III Clean based ulcer

Sabiston 1154 21th edition

Q) How to treat a bleeding peptic ulcer? Bleeding gastric ulcer management?

Steps to manage a bleeding peptic ulcer

  1. Secure two large bore IV lines for fluid and blood products. Evaluate for coagulopathy
  2. Simultaneous evaluation for source of bleeding and history. Important causes to rule out are chronic liver disease, NSAID use etc
  3.  Simultaneous IV PPI infusion
  4. Endoscopic control  of bleeding peptic ulcer- Thermal coagulation, hemoclips, Adrenaline injections etc
  5. Operative procedure For  Duodenum bleed - Longitudanally opening the anterior wall of duodenum and 3 point suture ligation
  6. For Gatric ulcer bleeding - depends on the site of ulcer and might require Antrectomy/Partial gastrectomy

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Bailey & Love’s Short Practice of Surgery, 27th Edition

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SRB’S Manual Of Surgery

 

Primary Thyroid Lymphoma

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Q) Which of the following statement is true regarding primary thyroid lymphoma?

a) Goiter grows at a slow pace

b) Hashimoto thyroiditis is a pre existing condition for thyroid lymphoma

c) "B" symptoms are common

d) MALT lymphoma is the commonest

Meckel’s diverticulum

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Q) Which is a true statement regarding diagnosis of Meckel's diverticulum?

a) CT and Ultrasonography are the modality of choice 

b) Technetium pertechnetate scan is the investigation of choice in children

c) Technetium Pertechnetate scan has more utility  in adults

d) None of the above

Electrolytes

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Q) A 50 year old male undergoes pancreatectomy for Carcinoma head of pancreas. His pre op Hb was 9.2g% and during surgery he received 5 units of PRBC. In the post op period on the 2nd day he develops ECG changes. Work up is done for Myocardial Ischemia which is negative. What is the most common  cause of ECG changes here

a) Hyponatremia

b) Hyperkalemia

 

Gastrinoma

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Q) Regarding gastrinoma what is true? ( # Questions on Endocrine Surgery) 

a) All gastrinomas express SRS receptors

b) In 30 % of cases gastrinomas are not localized intra operatively

c) Levels of serum  gastrin more than 100pg/ml are strongly suggestive of gastrinoma

d) Angiography with secretin stimulation is required in all cases for localization of gastrinoma

 

Amoebic Liver abscess

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Q) True about presentation of amoebic liver abscess?

a) 60-70% patients with amoebic liver abscess have diarrhoea

b) Jaundice is seen in 50% of these patients

c) Rupture of liver abscess in the peritoneum is seen in 10% cases

d) More complications of amoebic liver abscess occurs in acute presentation

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Carcinoid Appendix

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 A 40 year old male is  undergoing appendicectomy for acute appendictis.  During surgery a 3 cm mass is found in the body of appendix. Frozen section of the mass reveals carcinoid tumor. Which of the following is true

a) Appendicectomy should be completed followed by radiotherapy to the bed

b) Right hemicolectomy should be done

c) There is 50% chance of developing carcinoid syndrome in this case

d)  Carcinoid syndrome occurs only if there is liver metastasis

Answer for basic members (Register Free) 

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Q. A 45 year old male has severe coughing followed by sudden Bilateral pain in lower abdomen. At the same time he develops a swelling in the mid line, lower abdomen which does not change in size on raising the leg muscles. What has really happened?

a) Ruptured aortic aneurysm

b) Obturator hernia

c) Spigelian Hernia

d) Rectus sheath hematoma

Answer