Surgery

Front 1

Length of oesophagus in adult

Back 1

25cm

Front 2

Vertebral extent of oesophagus in adult

Back 2

C6 - T11

Front 3

Constrictions of oesophagus

Back 3

pic

Front 4

Oesophageal hiatus of diaphragm

Back 4

Lies in muscular part of diaphragm. Level is T10. Transmits oesophagus, anterior and posterior trunks of vagus

Front 5

Killian's dehiscence

Back 5

Area between thyropharyngeus and cricopharyngeus which has no constrictor support

Front 6

Zenker's diverticulum

Back 6

Protrusion of mucosa through Killian's dehiscence because of the failure of cricopharyngeus to relax during deglutition

Front 7

Characteristic c/f of zenker's

Back 7

Regurgitation of putrified, undigested foof

Intermittent dysphagia

Front 8

Causes of intermittent dysphagia

Back 8

Diffuse oesophageal spasm

Zenker's

eosinophilic oesophagus

Front 9

First symptom in zenker's

Back 9

regurgitation

Front 10

IOC zenker's

Back 10

Ba swallow

Front 11

Rx in zenker's`

Back 11

pic

Front 12

Types of TEF

Back 12

A - Pure atresia

B - Proximal fistula (distal atresia)

C - Proximal atresia (distal fistula)

D - Proximal oesophageal termination into lower trachea. Distal oesophagus arises from carina

E - H type

Front 13

MC type of TEF

Back 13

C - proximal atresia - Vogt's type - type 3b

2nd MC - Pure atresia

Front 14

Some common GI conditions with Down's

Back 14

TEF

Duodenal atresia

Jejunal atresia

Hirschsprung disease

Annular pancreas

Front 15

MC amongst VACTERL

Back 15

Cardiac.

2nd MC is anorectal

Front 16

Commonest among Limb defects in VACTERL is

Back 16

Radial hypoplasia

Front 17

Characteristic c/f s of TEF

Back 17

-Continuous drooling of frothy saliva

-Choking spell with each attempted feed

Front 18

IOC TEF

Back 18

X ray after passing nasogastric tube

Front 19

Sx in TEF

Back 19

R posterolateral thoracotomy through 4th ICS with ligation of the fistula and oesophageal anastomosis

Front 20

Criteria for operability in TEF ?

Rx of inoperable child

Back 20

Criteria for operability - birth wt > 5.5 pounds and no pneumonia

Rx of inoperable child - feeding gastrostomy followed eventually by surgery when fit

Front 21

T/F : pH value below 4 is pathological for oesophagus

Back 21

True

Front 22

List the protective mechanisms against reflux

Back 22

?

Front 23

Most important protective mechanism against oesophageal reflux?

Back 23

Intra-abdominal length of oesophagus - 3 to 5 cm

Front 24

Feature of complicated reflux?

Back 24

Laryngeal spillover

Front 25

Commonest oesophageal ca in white males

Back 25

adenocarcinoma (lower oeso)

Front 26

Commonest oeso ca all over the world, in all races except white males

Back 26

Squamous

Front 27

1st investigation for GERD

Back 27

endoscopy

Front 28

Best inv for GERD

Back 28

endoscopy

Front 29

Gold std inv for GERD

Back 29

24 hr pH monitoring

Front 30

Name of criteria in 24 hr pH monitoring

Back 30

De Maester criteria

Front 31

MC type of hiatus hernia

Back 31

Sliding

Front 32

Part thar herniates in sliding hiatus hernia

Back 32

Cardia only

Front 33

Part that herniates in rolling hiatus hernia

Back 33

Fundus also

Front 34

Which hiatus hernia is completely covered by peritoneum?

Back 34

Rolling

Front 35

c/f in hiatus hernia

Back 35

Reflux in sliding

Dysphagia in rolling

Front 36

Ischaemic ulcers in rolling hiatus hernia are called?

Back 36

Cameron's ulcers

Front 37

IOC hiatus hernia

Back 37

Barium meal

Front 38

X ray finding of hiatus hernia

Back 38

retro cardiac air fluid level

Front 39

Which hiatus hernia is prone to volvulus?

Back 39

Rolling

Front 40

MC done surgery for hiatus hernia

Back 40

Nissn's

Front 41

Surgeries for hiatus hernia

Back 41

Nissn's, Belsay's, Toupet's, Hill's, Collis', Watson's

Front 42

Procedure of choice to correct hiatus hernia, in case of a short oesophagus

Back 42

Collis' gastroplasty

Front 43

Some characteristics of an oesophageal web?

Back 43

Asymmetric, mucosal, @ the level of cricopharynx

Front 44

Some characteristics of an oesophageal ring

Back 44

Symmetric, submucosal, @ the level of lower thoracic oeso ABOVE the diaphragmatic indentation

Almost always a/w a small sliding hernia, which is @ the squamo-columnar junc - this is below the diaphragmatic indentation

Front 45

ABC rings of oesophagus

Back 45

A - mucosal oedema

B - Schatzki ring - non progressive, lower oeso , lumen always patent - mild to moderate dysphagia for solids, NEVER for liquids

C - hiatus

Front 46

Boerhaave's tear v/s Mallory Weiss tear

Back 46

Boerhaave's - through and through tear ; lower oesophagus ; due to retching against a closed glottis --> contents go to mediastinum, and after a rupture in pleura - lie in pleural space

Mallory Weiss - partial thickness tear ; cardia ; barotrauma

Front 47

Meckler's triad

Back 47

Vomiting

Retrosternal pain

Surgical emphysema

Front 48

Sign of pneumomediastinum on auscultation

Back 48

Hamman's sign - crackling sound due to movement of air with hearbeat

Front 49

X ray signs of pneumomediastinum

Back 49

Continuous diaphragm sign

Neclerio V sign (air along descending aorta and upper border of diaphragm)

Front 50

IOC Boerhaave?

Back 50

CT?

Front 51

Rx Boerhaave?

Back 51

Immediate L thoracotomy through 6th ICS --> repair ; to be done < 24 hrs

Front 52

c/f of Mallory Weiss tear

Back 52

Normal 1st vomiting --> subsequent haematemesis

Front 53

IOC for Mallory Weiss

Back 53

Endoscopy (avoided in Boerhaave)

Front 54

MC cause of 2˚ achalasia?

Back 54

Chaga's disease - T.cruzi

Front 55

MC cause of pseudo-achalasia?

Back 55

Ca of cardia

Front 56

Gold std inv for achalasia

Back 56

Manometry

Front 57

X ray findings in achalasia?

Back 57

-Air fluid level in mediastinum

-Absence of fundal gas shadow

Front 58

Barium swallow appearance of achalasia

Back 58

Bird beak > Rat tail

Front 59

Medical treatments tried for achalasia

Back 59

Nifedepine

Amyl nitrites

Front 60

Sx for achalasia

Back 60

Heller's myotomy + Partial fundoplication (to prevent reflux)

Front 61

Recurrence rate max in what mode of treatment of achalasia?

Back 61

Botox injection

Front 62

Rupture a/w what mode of treatment of achalasia?

Back 62

Balloon dilatation

Front 63

MC GI ca

Back 63

Rectum --> Colon --> Stomach

Front 64

Risk factors for oeso ca

Back 64

1.Dietary - vit c def, smoked fish, alc and smoking, hot beverages

2.Achalasia

3.Plummer vinson

4.Zenker's

5.Tylosis

6. HPV

7.Caustic injuries

Till here, these are r/f for squamous

For adeno - only one - Barrett's

Front 65

In oeso ca, mets first go to?

Back 65

LN

Front 66

In stomach ca, mets first go to?

Back 66

LN

Front 67

In GIST, mets first go to

Back 67

Liver. NOT TO LN

Front 68

IOC oeso ca

Back 68

Endoscopy for tumour

CECT for mets and operability

Front 69

Oeso ca on barium studies

Back 69

Filling defect / apple core / hour glass/ rat tail

Front 70

Frequency used - trans eso usg, trans abd, trans vaginal

Back 70

pic

Front 71

Best inv for liver mets

Back 71

18 FDG PET scan

Front 72

MC Sx for oeso ca

Back 72

Ivor Lewis oesophagectomy

Front 73

Safe margin for oeso

Back 73

10cm (2 for rectum, 5-6 for stomach)

Front 74

Best flap/substitute in Ivor Lewis

Back 74

Stomach

Front 75

Best interposition in Ivor Lewis

Back 75

L colon / jejunum

Front 76

MC complication of Ivor Lewis

Back 76

Atelectasis/collapse

Front 77

MC long term morbidity after Ivor Lewis

Back 77

Benign stricture

Front 78

MC cause of mortality after Ivor Lewis

Back 78

anastomotic leak

Front 79

Difference between McKeown's and transhiatal procedures

Back 79

McKeown's has 3 incisions - laparotomy, thoracotomy and neck incision. Thoracotomy is not done in transhiatal - the advantage is that there are no pulmonary complications

Front 80

Characteristics of gastric erosion

Back 80

Limited to mucosa, BM intact, heals without scarring

Front 81

Characteristics of gastric ulcer

Back 81

Muscle deep, BM not intact, heals with scarring

Front 82

MC artery involved in GI ischaemia

Back 82

Superior mesenteric

Front 83

MC site for curling's ulcers

Back 83

Duodenum 1st part

Front 84

MC site for cushing's ulcers

Back 84

?

Front 85

MC site for ischemic ulcers

Back 85

Fundus of stomach

Front 86

T/F : Chance of perforation is greater in Cushing's ulcers than curling's ulcers

Back 86

True

Front 87

In menetriere's disease, there is overexpression of what cytokine?

Back 87

TGF alpha

Front 88

Infectious associations of Menetriere's in adults and children?

Back 88

H.pylori in adults, CMV in children

Front 89

Rx of menetriere's

Back 89

Total gastrectomy. Cetuximab has been tried, but not FDA approved

Front 90

Associations of H.pylori

Back 90

Gastric ulcer and ca

duodenal ulcer

MALTOMA

Front 91

Stains for H.pylori

Back 91

Warthin silver starry stain

Giemsa

H&E

Front 92

Johnson classification of ulcers

Back 92

1 - lesser curv

5 - greater curv

2 - lesser and greater curv

4 - fundus

3 - prepyoric

Front 93

Johnson classification of ulcers

Back 93

1 - lesser curv

2 - lesser and greater curv

3 - prepyoric

4 - fundus

5 - greater curv

Front 94

Which classes of Johnson's ulcers are a/w hyperacidity?

Back 94

2 and 3

Front 95

Continuation of vagi (for understanding of vagotomy)

Back 95

pic

Front 96

Truncal v/s selective

Back 96

pic

Front 97

HSV

Back 97

pic

Front 98

Recurrence after vagotomy - max & least

Back 98

max - HSV

least - truncal

Front 99

Best vagotomy for chronic duo ulcer

Back 99

HSV

Front 100

Best vagotomy for recurrent duo ulcer

Back 100

truncal

Front 101

Criminal nerve of grassi

Back 101

Vertical strands coming out of R posterior vagus. Cut in truncal vagotomy

It innervates the gastric fundus. Called criminal because it is implicated in ulcer causation

Front 102

Difference between billroth 1 and billroth 2

Back 102

Billroth 1 - partial gastrectomy + gastroduodenostomy

Billroth 2 - partial gastrectomy + gastrojejunostomy

Front 103

If gastrojejunostomy is done from behind the colon?

Back 103

Polya gastrectomy

Front 104

GOO is common with ulcer at what location?

Back 104

duo 1st part

Front 105

MC cause of GOO

Back 105

Ca

Front 106

Complications of ulcer

Back 106

Teapot stomach

Hourglass stomach

GOO

Perforation

Peritonitis

Front 107

Inv with highest accuracy for gas below diaphragm

Back 107

CXR

Front 108

best x ray view for gas below diaphragm

Back 108

L lateral decubitus

Front 109

Best inv for pneumoperitoneum

Back 109

CT

Front 110

Riggler's sign?

Back 110

Free air in abdomen - s/o perforation

Front 111

MC Rx for duo perforation

Back 111

Graham's repair + H.pylori eradication

Front 112

MC c/f in posterior duo perf

Back 112

bleeding

Front 113

Causes for massive GI bleed?

Back 113

Varices

Posterior duodenal perforation

Front 114

Medical Rx for massive GI bleed

Back 114

Endoscopic sclerotherapy / ethanolamine oleate

Front 115

indications for Sx

Back 115

pic

Front 116

Sx in massive GI bleed?

Back 116

duodenotomy --> close bleeder with underrunning suture --> repair ulcer --> close duodenotomy like a pyloroplasty

Front 117

Complications of gastrectomies?

Back 117

Afferent loop syndrome

Dumping syndrome

Front 118

Duodenal blow out occurs on which day?

Back 118

4th day

Front 119

Features of afferent loop

Back 119

bilious vomiting, pain after meals

Front 120

Afferent loop syndrome can be prevented by

Back 120

Side to side jejunostomy

Front 121

Features of dumping syndrome

Back 121

Dehydration (increased haematocrit), pain after meals, initially hyperglycemia and later hypoglycemia

Front 122

Feature of early dumping syndrome

Back 122

Increased haematocrit

Front 123

Feature of late dumping syndrome

Back 123

hypoglycemia

Front 124

Rx of dumping syndrome

Back 124

Dietary modifications

Octreotide

Roux en Y jejunoplasty

Front 125

T/F : 1st born male child mc affected with CHPS

Back 125

True

Front 126

c/f of CHPS

Back 126

3-8 wks

non bilious vomiting

olive shaped lump

L-R peristalsis

Fluid and electrolyte imbalance

Front 127

What are the electrolyte and acid base disturbances in CHPS?

Back 127

hyponatremic, hypokalemic, hypochloraemic metabolic alkalosis with paradoxical aciduria

Front 128

Best fluids for electrolyte imbalance correction in CHPS

Back 128

N/2 saline

or

0.45% saline + 2.5%dextrose + K

or

RL (next preference)

Front 129

Sx for CHPS

Back 129

Ramstedt's pyloromyotomy (muscle splitting incision at the pylorus)