Hemangioma Liver

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Q) A 38 year lady undergoes USG  abdomen for vague pain abdomen. ON USG she has a large 12 cm lesion in the right lobe of liver, which on CT turns out to be hemangioma.  True about management of hemangioma liver

a) All hemangioma more than 10 cm should be resected

b) OCPs and pregnancy should be avoided in young females as there is risk of rupture

c) Arterial embolization should be routinely done in large hemangiomas

d) If surgery is decided  hemangioma located at the periphery should be enucleated

Ans) d

Whatever the size there is no role of resection for asymptomatic hemangioma. Risk of rupture is very small and therefore there is no rationale for stopping OCPS, pregnancy or physical activities.

 Arterial embolization, which may be considered for temporary control of hemorrhage has limited success and is occasionally associated with morbidity

In symptomatic hemangioma liver resection is the treatment of choice, in peripheral tumors enucleation and in centrally placed tumors, formal resection should be done

REf  Blumgart Surgery of liver 7th  page 1184

Complications of Billroth II surgery

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Billroth 1 and 2
Complications of Billroth II Surgery – Free MCQ | mcqsurgery.com

Complications of Billroth II – Free MCQ (GI Surgery)

High-yield stomach surgery question for NEET SS & GI Surgery preparation. Use the Answer Free button to reveal the explanation.

Q) What is true regarding complications of Billroth II surgery?

a) It has less complications than Billroth I surgery
b) Recurrent ulceration is more common in the afferent limb as compared to efferent limb.
c) Afferent loop obstruction is more common after Billroth II  surgery
d) Billroth I  operation is preferred in scarred duodenum

Answer c -

In Billroth II surgery, afferent limb obstruction is more common

In Billroth I reconstruction The remnant is anastomosed  to the duodenum

In Billroth II duodenum stump is closed and stomach is anastomosed to the jejunum limb

Advantages of Billroth I

  • More Physiological as normal GI continuity is maintained
  • No problem of afferent and efferent limb
  • Future procedures like endoscopy and ERCP can be done
  • Reduced chance of gastric carcinoma in remnant stomach as compared to Billroth 2  ( SKF page 682) 

In surgery for benign gastric ulcers, Billroth I reconstruction is the preferred choice.

Billroth II surgery has problems of

  • Retained antrum syndrome
  • Afferent loop obstruction
  • Duodenal stump leak (1-3%

Billroth 2 surgery is done when there is

1. Inadequate mobility of the duodenum

2. Scarring of duodenum

Complications of gastric surgery
Complications of gastrectomy

  • Nutritional and weight loss - Iron deficiency, Copper deficiency, Vit B12 , Anemia
  • Delayed gastric emptying
  • Roux statsis- Seen in roux en y loops-  Pain, nausea, vomiting, abdominal bloating
  • Cholelithiasis-  Higher incidence in roux en y reconstruction as compared to B1 and B 2 gastrectomy
  • Recurrent ulceration

Complications of Billroth 2 surgery

  • Dumping syndrome Dumping symptoms have been reported in up to 70% of Billroth II patients and up to 75% of patients after RYGBP for obesity.
  • Afferent loop obstruction - It can be minimized by keeping the length of afferent loop less than 20 cm and using a retrocloic approach.
  • Bile reflux gastritis - More common with billroth I and billroth 2 surgery, incidence is decreasing after the use roux en y anastomosis
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Tags: Billroth I, Billroth II, Afferent loop obstruction, Stomach Surgery MCQ, NEET SS GI Surgery

Splenic artery aneurysm

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Q) Splenic artery aneurysm is seen in  ( #spleen1)

a) Proximal 1/3rd of splenic artery

b) Proximal 2/3 of splenic artery

c) Middle 1/3 of splenic artery

d) Distal 1/3 of splenic artery

Mass forming lesion Liver

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Q) A 55 year old male presents with obstructive jaundice. Ultrasound evaluation reveals a

hyperechoic 4 cm mass in segment VI of liver with peripheral duct dilatation.

CT abdomen shows a hypodense mass with delayed enhancement in portal pahse.

What is the most likely diagnosis

a) Hepatocellular carcinoma

b) Intrahepatic cholangiocarcinoma

c) Metastatic Adenocarcinoma

d) Carcinoid 

b) Intrahepatic cholangiocarcinoma (IHCC)

IHCC - Mass forming type- have gradual central enhancement and variable delayed enhancement on portal phase

Hepatocellular carcinoma present ....Premium content at Questions on Bile ducts Q16-20

Surgery Trauma MCQ

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Q ) A 25 year old male brought to the hospital  after being involved in a road traffic accident that occurred 50 minutes ago. His  initial BP at the scene of accident was  80/40 mm HG with a pulse rate of 120/min.

The paramedics administered 2 litres of normal saline in the ambulance and in the emergency department his BP is 110/70 with a pulse rate of 90/min.

He has tenderness in Left upper quadrant abdomen and USG reveals perisplenic fluid. Next step is to :  (#See more trauma MCQS) 

a) Take him for exploratory laparotomy

b) Shift him to ICU and observe

c) Do a CT scan of the abdomen

d) Put in a laparoscope and assess

Answer c

This Patient has a splenic injury due to blunt trauma abdomen. The  immediate management  depends on grade of splenic  injury  and response to IV Fluids. This patient is hemodynamically stable after IV fluids  and immediate laparotomy is not needed.

Direct shifting to ICU is also not the right choice because CT is required first and for more severe injuries patient can go to OT

Laparoscopy has no role in splenic injuries

Hirchsprung’s disease

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Q) False statement about Hirchsprung's disease is:

a) Male and Female have equal incidence

b) In approximately 8% of the patients entire colon is affected

c) After surgery constipation is the most common problem

d) Down syndrome can be seen in up to 3-5% patients 

HCC Cancer

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Q) Which of the following is true about screening in hepatocellular carcinoma (HCC Cancer) 

a) Alpha feto protein should be done 6 monthly

b) Ultrasound abdomen should be done 6 monthly

c) Candidates for liver transplant should be screened every 3 months

d) Nodules more than 2 cm should be followed up  more regularly

Answer b

Cirrhosis is prone for development of HCC. Screening has to be stringent.  Earlier ultrasound of liver and alpha feto protein were both used for screening

In 2009 Marrero et al demonstrated the suboptimal accuracy of AFP and after that it has been removed from the screening protocol and now only ultrasound is being done.

The screening recommendation is not for those patients with severe associated conditions and with advanced liver disease who are already considered for  transplant. So there is no screening for those who are already listed. Nodules more than 1 cm are highly suspicious where as in nodules less than 1 cm only 40% will be malignant.

Ref: blumgart 6th edition

 

 

Mass in Right lower quadrant

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Q) A 55 year old lady presents with vague pain in right lower abdomen. Physical examination reveals a well defined mass there which is non tender and freely mobile. It is non pulsatile as well. What is the most likely possibility?

a) Appendicular mass

b) Mesenteric cyst

c) Perforated tubo ovarian mass

d) Meckel's diverticulum

Answer

b

Mesenteric cysts are uncommon lesions found in this age group. It typically presents as a freely mobile mass  which moves perpendicular to small blwel axis. It is painless as well.

Appendicular mass will have a preceding history of pain abdomen

Similarly perforated  tubo ovarian mass will also have a history of pain 

Meckel's diverticulum does not present as this kind of mass

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