INI-CET 2018 — Surgery

Q: All of the following are usually associated findings in the given condition except? (AIIMS May 2018)

Absent kidney. ***Absent kidney*** - **Absent kidney (renal agenesis)** is not a typical associated finding in biliary atresia. - Biliary atresia primarily involves malformations of the **bile ducts** and is not directly linked to renal agenesis. - This is the correct answer to this "EXCEPT" question. *Hepatic artery anomalies* - **Hepatic artery anomalies**, such as aberrant or hypoplastic hepatic arteries, are frequently associated with biliary atresia. - These vascular malformations can contribute to the pathogenesis or progression of the disease. *Malrotation of gut* - **Intestinal malrotation** is a common abdominal anomaly found in conjunction with biliary atresia. - The altered embryological development affecting the biliary system can simultaneously impact gut rotation. *Polysplenia* - **Polysplenia**, a condition with multiple small spleens, is part of the heterotaxy syndrome often linked with biliary atresia. - This association reflects a broader developmental defect affecting left-right body axis determination. *Cardiac anomalies* - **Cardiac anomalies** are recognized associations with biliary atresia, particularly in the syndromic form. - These can include various congenital heart defects as part of the broader malformation syndrome. [Practice more Surgery PYQs on OnCourse]

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All of the following are usually associated findings in the given condition except? (AIIMS May 2018)

A 3-month-old child presents with umbilical discharge. The appearance is shown below. Which of the following is the next step in management of this patient? (AIIMS May 2018)

INI-CET 2018 - Surgery INI-CET Practice Questions and MCQs

Question 1: All of the following are usually associated findings in the given condition except? (AIIMS May 2018)

A. Hepatic artery anomalies
B. Absent kidney (Correct Answer)
C. Malrotation of gut
D. Polysplenia
E. Cardiac anomalies

Explanation: ***Absent kidney*** - **Absent kidney (renal agenesis)** is not a typical associated finding in biliary atresia. - Biliary atresia primarily involves malformations of the **bile ducts** and is not directly linked to renal agenesis. - This is the correct answer to this "EXCEPT" question. *Hepatic artery anomalies* - **Hepatic artery anomalies**, such as aberrant or hypoplastic hepatic arteries, are frequently associated with biliary atresia. - These vascular malformations can contribute to the pathogenesis or progression of the disease. *Malrotation of gut* - **Intestinal malrotation** is a common abdominal anomaly found in conjunction with biliary atresia. - The altered embryological development affecting the biliary system can simultaneously impact gut rotation. *Polysplenia* - **Polysplenia**, a condition with multiple small spleens, is part of the heterotaxy syndrome often linked with biliary atresia. - This association reflects a broader developmental defect affecting left-right body axis determination. *Cardiac anomalies* - **Cardiac anomalies** are recognized associations with biliary atresia, particularly in the syndromic form. - These can include various congenital heart defects as part of the broader malformation syndrome.

Question 2: A 3-month-old child presents with umbilical discharge. The appearance is shown below. Which of the following is the next step in management of this patient? (AIIMS May 2018)

A. MRI abdomen
B. USG abdomen (Correct Answer)
C. CECT
D. Exploratory laparotomy
E. MCUG

Explanation: ***USG abdomen*** - An **urgent ultrasound** of the abdomen is the initial step for umbilical discharge in an infant, especially with a suspected **patent omphalomesenteric duct** or **urachus**, which USG can visualize and identify. - It's a **non-invasive** and readily available method to confirm the diagnosis and assess the extent of the connection or any associated complications without exposing the infant to radiation. *MRI abdomen* - **MRI** is typically reserved for cases where **ultrasound is inconclusive** or if there is a strong suspicion of more complex anatomical abnormalities that require higher resolution imaging. - It involves **longer scan times** and may require **sedation** in infants, making it less ideal as a first-line diagnostic tool for this presentation. *CECT* - **CECT (Contrast-Enhanced Computed Tomography)** involves significant **radiation exposure**, which is generally avoided in infants unless absolutely necessary and other modalities have failed. - While it provides detailed anatomical information, the **risks of radiation** and potential need for **contrast material** make it an unsuitable initial diagnostic choice for umbilical discharge. *MCUG* - **MCUG (Micturating Cystourethrogram)** is specifically used to evaluate the **bladder and urethra** during voiding, primarily for vesicoureteral reflux or urethral abnormalities. - While it may be considered if a **patent urachus** with bladder connection is suspected, it is **not the first-line investigation** for umbilical discharge and involves **radiation exposure** and catheterization. *Exploratory laparotomy* - **Exploratory laparotomy** is a **surgical procedure** and is considered a definitive treatment or a last resort for diagnosis when other imaging modalities have been exhausted and the clinical picture remains unclear, or in cases of acute complications like **peritonitis** or **bowel obstruction**. - Performing an invasive surgery as the first step for diagnosis without prior imaging is **not standard medical practice** and carries significant risks for an infant.