Q11) Gastrointesinal stromal tumors false statement
is a) it is the most common primary non epithelial tumor of stomach and small bowel b) It occurs due to activation of KIT mutations c) Imatinab is a useful drug in GIST d) It is same as a smooth muscle tumor
Q12
Treatment of choice in megaesophagus with Achalasia Cardia is a) Botulinum toxin b) Pneumatic dilatation c) esophageal resection d) Myotomy
Q13 )
Belsey Mark IV surgery a) Is Done through abdominal approach b) It denotes the final technique that emerged as a seies of trials intended to restore a competent valvular mechanism to cardia c) Middle esophageal artery is preserved d) 360 degree fundoplication is done
Q14)
After Ileal Pouch Anal Anastomoses (IPAA) for ulcerative colitis the patient develops on the 7th day increased frequency od stools, fever, lower abdominal discomfort with joint pains. What is the treatment? a) 5ASA b) corticosteroids c) cipro d) metro
Q15)
Excision rather than bypass is preferred for surgical treatment of small intestinal Crohn's because:
a) Excision is safer. b) Bypass does not relieve symptoms. c) Excision cures the patient of Crohn's disease but bypass does not. d) Fewer early complications appear with excision. e)The risk of small intestine cancer is reduced. Answers
11) d These tumors are unique because they occur as a consequence of activating KIT mutations, express KIT proteins . Imatinab is a new therapy which has changed prognosis as it is directed against KIT protein KIT protein overexpression is detected by immunohistochemical staining for CD117 and this is its defining feature which differentiates it from smooth muscle tumors Smooth muscle tumor is Vimentin positive, Smooth muscle Actin (SMA) positive and Desmin positive, GIST can be Vimentin positive but Desmin negative GI Surgery Annual 9th edition page 102
12)c Read the account on this website http://www.bhcs.com/Proceedings/12_4/12_4_vanderpool.html
13)b it is done through the 6th left intercostals space, the esophagus is mobilized first, the middle esophageal artery is divided, then cardia is mobilized. Now a posterior buttress is created using the two halves of right crus of diaphragm. 240 degree fundoplication is done Stomach is sutured to the esophagus. Only the seromusculae layer is taken, the stitch should not take the mucosa. There is no gas bloat as seen in nissen It is an effective antireflux adjunct to myotomy done for achalasia or DES
14) d this is consistent with pouchitis, It is diagnosed by PDAI (Pouchitis Disease Severity Index) if more than 7 treatment is metronidazole 750-1500mg/day for 1-2 weeks Schakelford 98
15) e Bypass of segments of small bowel affected with Crohn's disease is a safe operation with few complications, and one that usually relieves symptoms promptly. It leaves diseased bowel behind, however, which can flare in the future and can develop carcinoma. Excision, though it does not cure the Crohn's disease, removes the areas of severe involvement and so eliminates the risk of developing cancers in these segments.