GIT Surgery

Question 1

State an examples of prokinetic agents

Answer 1

Metoclopramide
Domeperidone
Erythromycin

Question 2

Mucosal protection agents such as …………… help to protect against other non-acidic agents in the refluxate however it can cause……………….

Answer 2

-Sucralfate
-unpleasant taste and constipation

Question 3

Causes of functional obstruction

Answer 3

• vascular occlusion ileus: acute or chronic ischemia
• Adynamic or inhibition:
  *Post operative paralytic ileus (most *common)
  *Metabolic causes (DKA, hyponatremia, hypokalemia, hypomagnesaemia)
  *Drugs (morphine, TCA, antacid, anticonvulsants)
  *intra abdominal inflammation
  *sepsis or occult wound infection
  *pneumonia
  *renal stones
  *retroperitoneal hematoma
  *fracture spine and ribs
• spastic ileus: (intestine remains contracted not propulsive)
  *mesentric vascular occlusion (MVO)
  *pseudo-obstruction
  *uremia
  *prophyria
  *heavy metal poison

Question 4

Treatment of recurrent adhesive intestinal obstruction

Answer 4

-Repeat adhesiolysis alone (open/laproscopic)
-adhesiolysis with seprafilm(decrease fibrin formation)
-noble’s intestinal plication
-child phillips transmesenteric plication
-baker intestinal intubation

Question 5

Causes of paralytic ileus

Answer 5

-post operative
-infection:
Intra abdominal sepsis
Abscess
Peritonitis
-reflex ileus:
Following fractures of the spine or ribs
Retroperitoneal hemorrhage
-metabolic:
Uremia
Hypokalemia
Hypothyroidism
-medications:
Anticholinergics
Opiates
Calcium channel blockers

Question 6

The teat of choice in paralytic ileus is ………..

Answer 6

CT scan

Question 7

Treatment of ogilvie syndrome

Answer 7

Colonic decompression
Neostigmine

Question 8

………….. is the most common neoplasm of the small intestine

Answer 8

Adenoma

Question 9

…………… is the treatment of choice for tubular adenoma and brunner’s gland hyperplasia

Answer 9

Endoscopic polypectomy

Question 10

Common primary malignancies that can give small intestinal metastasis includes…………….

Answer 10

Malignant melanoma (the most common)
Ovarian cancer
Bladder cancer
Breast cancer
Lung cancer

Question 11

Gardner’s syndrome is a triad of ……….

Answer 11

Gastrointestinal polyps
Skin and soft tissue tumors
Multiple osteoma

Question 12

Carcinoid tumors arise from………..

Answer 12

Kulchitsky cells in the crypts of lieberkuhn (ECL cells)
Neuroendocrine cells (APUD system)

Question 13

Causes of diffuse (generalized) abdominal pain

Answer 13

Gut perforation
Mesenteric ischemia
AAA
acute pancreatitis
DM

Question 14

Pharyngeoesophageal ligament is an extension of …………

Answer 14

The inferior diaphragmatic fascia

Question 15

The left gastric artery is from ………..

Answer 15

Coeliac artery

Question 16

Pyrosis is ………..

Answer 16

Heartburn

Question 17

Barrett’s esophagus is ……….. above GEJ

Answer 17

2 cm

Question 18

…………. Is the gold standard of quantifying the degree of reflux

Answer 18

Ambulatory 24 hours pH monitoring

Question 19

Esomeprazole is the ……………

Answer 19

S-isomer of omeperazole

Question 20

………….. surgery is used in patients in whom the GEJ can’t be reduced below the diaphragm

Answer 20

Collis-gastroplasty

Question 21

Endoscopic GERD therapy

Answer 21

-radiofrequency energy deliveredto the LES (Stretta procedure)
-suture ligation of the cardia (Endoscopic plication “bard Endo Cinch”)
-submucosal implantation of inert material in the region of the LES (Enteryx)
-Linx system

Question 22

What are the ulcerogenic drugs which inhibit synthesis of protective PG

Answer 22

NSAIDs
Corticosteroids
Erythromycin
Iron
KCL
Cyclophosphamide
Methotrexate
Azathioprine

Question 23

What can cause hourglass stomach

Answer 23

Long standing gastric ulcer

Question 24

What is moynhan’s sign?

Answer 24

It’s perforation of peptic ulcer with pain in the right iliac fossa because fluid may track along the right paracolic gutter to the right iliac fossa causing pain in the right iliac fossa

Question 25

Heartburn is also called………

Answer 25

Pyrosis

Question 26

Treatment of Achalasia

Answer 26

Early cases: nitrate and CCBs Late cases: Endoscopic “balloon/botulinum toxin injection “ Laparoscopic Heller myotomy (the best)

Question 27

PH reaches 2:3 after mixing with food at which……..

Answer 27

pepsinogen is activated to pepsin

Question 28

Hourglass stomach is a complication of ……….

Answer 28

PUD complication

Question 29

Zollinger Ellison syndrome is also called …………

Answer 29

Gastrinoma

Question 31

Most common cause of acute abdomen is……….

Answer 31

Acute appendicitis

Question 33

The most common affected sites in volvulus are …………..

Answer 33

The most is sigmoid The second most is cecum

Question 34

Treatment of volvulus

Answer 34

-endoscopic relieved by decompression per anum -surgery to prevent ischemia

Question 35

What is abdomino-perineal resection (APR)?

Answer 35

Excision of the rectum Anal canal Anus (With a permanent colostomy)

Question 36

Secondary causes of small intestinal pseudo obstruction

Answer 36

Scleroderma Muscular trophy Spinal cord injury Viral infections

Question 38

Direction of growth of the spleen is towards the right fossa because of………….

Answer 38

Phrenicocolic ligament

Question 39

……… are the most common type of precancerous cyst of pancreas

Answer 39

Intraductal papillary mucinous neoplasms (IPMNs)

Question 40

Masses that may appear and disappear

Answer 40

-Pseudocyst of pancreas (communicating) -hydronephrosis (intermittent) -choledochal cyst -intussusception