Q) Which of the following statement is true about appendicitis in pregnancy?
a) Typical symptoms of appendicitis are seen in more than 90% of patients.
b) 50% cases of appendicitis occur in 2nd trimester
c) Rate of negative explorations remain low based on clinical presentation alone
d) The sensitivity and specificity of ultrasound diagnosis remain the same in appendicitis in pregnancy
Answer b
Appendicitis the most common non obstetric emergency in pregnancy. The diagnosis is difficult because the symptoms of pain abdomen, nausea, vomiting, anorexia, raised TLC are common in pregnancy. Appendicitis has a typical presentation in only 50% to 60% cases.
If untreated preterm labor and even fetal loss can occur due to the complications.
Based on clinical presentation alone, the incidence of negative exploration is as high as 25-50%
Ultrasound with graded compression is still a good imaging option but has lower sensitivity and specificity than in normal clinical situation. If ultrasound is equivocal the next best option is MRI which is safe.
Q) True statement regarding complications of duodenal diverticulum is
a) Perforation is the commonest complication
b) Obstruction is caused by extra luminal duodenal diverticulum
c) Bleeding is the most common complication of duodenal diverticulum.
d) Diverticulitis is common and easily diagnosed.
Answer
c
Complications of duodenal diverticulum are rare with a reported incidence of 5-10% in those with duodenal diverticulum. Operative intervention is required in about 1% cases
Perforation is the rarest but the most severe complication of duodenum diverticulum. The most common cause of perforated duodenal diverticulum is diverticulitis. They perforate in the retroperitoneum, adding to diagnostic uncertainty. Ct Scans are most diagnostic to help in this diagnosis.
Q ) A 59 year old male alcoholic male presents with history of upper GI bleed of 1 day duration. During the day he has had three episodes of bleeding each time about 150 ml. Blood is fresh and not associated with retching. He has a history of long standing alcohol intake. What will be the most likely cause of GI bleed?
a) Mallory weiss tear
b) Esophageal varices
c) Gastric ulcer
d) Esophagitis
11 b
Long standing alcohol intake means some stigma of liver disease leading to chronic liver disease and consequently esophageal varices.
Mallory Weiss tear occurs with retching and after episodes of binge drinking
Gastric and duodenal ulcers are related to alcohol but usually presents at 40 years
Esophagitis will have associated symptoms of GERD and long standing history
Acalculus cholecystitis can be both acute and chronic in the absence of stones. Although it can present acutely, acalculous cholecystitis typically presents more insidiously.
Mostly the acute form is recognized and chronic form is called biliary dyskinesia.
Jaundice in acalculus cholecystitis is known to occur because of ischemia and inflammation cystic duct gets obstructed due to edema
Diagnosis
Chronic acalculus cholecystitis is a cholescintigraphy nuclear scan (HIDA) with the administration of cholecystokinin (CCK). After the . A calculated ejection fraction of 35% or less may be indicative of hypokinetic functioning of the gallbladder. An ultrasound of the gallbladder may also be useful. If this shows a thickened gallbladder wall of over 3.5 mm, this may be due to cholecystitis.
Q) In gastric cancer, lymph node station 12 corresponds to
a) Common hepatic
b) Hepatoduodenal
c) Retropancreatic
d) Superior Mesenteric
Ans b
In gastric cancer, lymph node station 12 corresponds to the hepatoduodenal ligament lymph nodes. These nodes are specifically located along the hepatoduodenal ligament and are further subdivided into groups based on their anatomical relationship: along the hepatic artery (12a), along the bile duct (12b), and behind the portal vein (12p)