Gastrointestinal Surgery — MCQs

Gastrointestinal Surgery Indian Medical PG Practice Questions and MCQs

Question 1121: Spigelian hernia is

A. Through linea alba
B. Through lateral border of rectus abdominis (Correct Answer)
C. Through lateral wall of inguinal canal
D. Through medial wall of inguinal canal

Explanation: ***Through lateral border of rectus abdominis*** - A **Spigelian hernia** protrudes through the **Spigelian aponeurosis**, which is the aponeurosis of the transversus abdominis muscle, primarily located along the **lateral border of the rectus abdominis muscle**. - Its typical location is often at the **semilunar line**, making it a challenging diagnosis due to its intermittent presentation and potential for strangulation. *Through linea alba* - A hernia through the **linea alba** (midline fibrous structure) is known as an **epigastric hernia** if above the umbilicus, or an **umbilical hernia** if at the umbilicus. - These are distinct from Spigelian hernias which are lateral to the rectus sheath. *Through lateral wall of inguinal canal* - This description typically refers to an **indirect inguinal hernia**, where the contents pass through the **deep inguinal ring**. - This type of hernia travels through the entire inguinal canal and emerges through the superficial ring. *Through medial wall of inguinal canal* - This would describe a **direct inguinal hernia**, which protrudes directly through the posterior wall of the inguinal canal, specifically through **Hesselbach's triangle**. - This is medial to the inferior epigastric vessels, while Spigelian hernias are more superior and lateral.

Question 1122: What is the type of Intussusception that is most frequently observed?

A. Ileocolic type (Correct Answer)
B. Ileoileal type
C. Colo-colic type
D. Caeco-colic type

Explanation: ***Ileocolic type*** - This is the **most common form of intussusception**, accounting for approximately 75% to 90% of cases, especially in children. - It occurs when the **ileum telescopes into the colon** at the ileocecal valve. *Ileoileal type* - This type involves the **invagination of one part of the ileum into another part of the ileum**. - While it can occur, it is **less common than ileocolic intussusception** and is more often associated with a pathological lead point in older children and adults. *Colo-colic type* - This involves the **telescoping of one segment of the colon into another segment of the colon**. - It is **rare in children** and, when present, is almost always associated with a pathological lead point, such as a polyp or tumor, primarily in adults. *Caeco-colic type* - This type occurs when the **cecum telescopes into the ascending colon**. - It is also a **relatively uncommon form of intussusception** compared to the ileocolic type.

Question 1123: Which of the following is a common consequence of gastrectomy?

A. Calcium deficiency
B. Iron deficiency (Correct Answer)
C. Steatorrhoea
D. Fluid loss

Explanation: ***Iron deficiency*** - Gastrectomy often leads to **achlorhydria** or hypochlorhydria, reducing the conversion of **ferric iron** (Fe3+) to its more absorbable ferrous form (Fe2+). - Additionally, bypassing the duodenum, a primary site of iron absorption, further contributes to **iron malabsorption**. *Calcium deficiency* - While gastrectomy can contribute to calcium malabsorption due to reduced gastric acidity and faster transit, **iron deficiency** is typically a more direct and common initial consequence. - **Vitamin D deficiency**, often co-occurring with gastrectomy, is a more direct cause of **calcium malabsorption**. *Steatorrhoea* - **Steatorrhoea** (fat malabsorption) is more commonly associated with conditions affecting the **pancreas** or **small intestine** (e.g., celiac disease, chronic pancreatitis) rather than primarily gastrectomy unless there is significant bile salt malabsorption or rapid gastric emptying affecting nutrient mixing. - Although rapid transit post-gastrectomy can sometimes impair fat digestion, it's not the most common direct consequence compared to iron deficiency. *Fluid loss* - **Fluid loss** is usually an acute post-surgical complication or related to conditions causing vomiting or diarrhea, and not a common long-term consequence of gastrectomy itself. - While **dumping syndrome** can occur after gastrectomy, causing osmotic fluid shifts into the intestine, generalized chronic fluid loss is not a primary recognized long-term sequela.

Question 1124: What does the term 'gastrotomy' refer to?

A. Closing the stomach after tube insertion
B. Making an incision into the stomach (Correct Answer)
C. Removing a part of the stomach
D. Resecting the upper part of the stomach

Explanation: ***Making an incision into the stomach*** - The suffix **-otomy** specifically refers to the **surgical creation of an incision** or a cutting open of an organ or structure. - In this context, **gastr-** refers to the **stomach**, thus "gastrotomy" means cutting into the stomach. *Closing the stomach after tube insertion* - While a gastrotomy might precede tube insertion, "closing" the stomach is distinct and typically part of the **wound closure** rather than the incision itself. - The term for surgical closure is generally **-rrhaphy**, not -otomy. *Removing a part of the stomach* - The surgical removal of a part of an organ is indicated by the suffix **-ectomy**, such as in **gastrectomy**. - Gastrotomy only implies making an incision, not the resection of tissue. *Resecting the upper part of the stomach* - This describes a **partial gastrectomy** or **fundectomy**, which involves the removal of tissue. - Gastrotomy is a simpler procedure involving only an incision, without tissue removal.

Question 1125: Which of the following is not an indication for percutaneous aspiration, injection, and reaspiration treatment in hydatid cyst?

A. Unilocular cyst
B. Cyst in lung
C. Cyst in liver
D. Size < 5 cm (Correct Answer)

Explanation: ***Size < 5 cm*** - Percutaneous aspiration, injection, and reaspiration (PAIR) is generally indicated for **larger hydatid cysts** (typically > 5 cm) that are symptomatic or at risk of complications. - Smaller cysts (< 5 cm) may be managed with **medical therapy alone** (albendazole) or monitored, as the risks of PAIR might outweigh the benefits in small cysts. - This is **NOT an indication** for PAIR. *Unilocular cyst* - **Unilocular cysts** (WHO CE1 and CE3a types) are ideal candidates for PAIR because their simple structure allows for effective aspiration and scolicidal agent instillation. - **Multiseptated or multiloculated cysts** are contraindications for PAIR due to multiple compartments limiting scolicidal agent distribution. - This **IS an indication** for PAIR. *Cyst in lung* - **Pulmonary hydatid cysts are a contraindication to PAIR** due to high risk of complications including anaphylaxis, bronchial spillage, pneumothorax, and empyema. - Lung cysts are primarily treated with **surgery** (cystotomy, capitonnage, or lobectomy). - However, in the context of this question, some sources may consider PAIR for lung cysts in highly selected cases, making "size < 5 cm" the more definitive non-indication. *Cyst in liver* - The **liver** is the most common site for hydatid cysts (50-70% of cases), and PAIR is a well-established and effective treatment option for hepatic hydatidosis. - PAIR is considered a safe, minimally invasive alternative to surgery for appropriately selected liver cysts. - This **IS an indication** for PAIR.

Question 1126: All are components of Saint's triad except:

A. Hiatus hernia
B. Diverticulosis coli
C. Gallstones
D. Renal Stones (Correct Answer)

Explanation: ***Renal Stones*** (Correct Answer - NOT part of Saint's triad) - **Saint's triad** specifically refers to the coexistence of **gallstones**, **diverticulosis**, and **hiatal hernia**. - Renal stones are not considered a component of this particular triad, making this the correct answer to the "except" question. *Hiatus hernia* - A **hiatal hernia** is characterized by the protrusion of a part of the stomach through the diaphragm into the chest cavity. - It is one of the three conditions comprising **Saint's triad**. *Diverticulosis coli* - **Diverticulosis coli** involves the formation of small pouches or sacs (diverticula) in the wall of the colon. - This condition is consistently listed as a member of **Saint's triad**. *Gallstones* - **Gallstones** are solid particles that form in the gallbladder, often causing pain and other symptoms. - They are a recognized component of **Saint's triad**.

Question 1127: In the context of surgical removal of a mass located in the descending colon, which artery must be ligated to facilitate the procedure?

A. Superior mesenteric artery
B. Inferior mesenteric artery (Correct Answer)
C. External iliac artery
D. Internal iliac artery

Explanation: ***Inferior mesenteric artery*** - The **descending colon** receives its primary arterial supply from branches of the **inferior mesenteric artery (IMA)**, specifically the **left colic artery** and **sigmoid arteries**. - Ligation of the IMA or its main branches is necessary during the surgical removal of a mass in the descending colon to control blood supply and facilitate resection. *Superior mesenteric artery* - The **superior mesenteric artery (SMA)** supplies the **midgut** derivatives, including the **duodenum** (distal to the major papilla), **jejunum**, **ileum**, **cecum**, **ascending colon**, and the proximal two-thirds of the **transverse colon**. - It does not supply the descending colon, so its ligation would not be relevant for a mass in this location. *External iliac artery* - The **external iliac artery** primarily supplies the **lower limbs** and terminates as the femoral artery. - It has no direct vascular branches that supply the descending colon. *Internal iliac artery* - The **internal iliac artery** supplies the **pelvic organs**, gluteal region, and medial thigh. - While it has branches to parts of the rectum and anal canal, it does not supply the descending colon.

Question 1128: What is the type of incision commonly used in pancreaticoduodenectomy?

A. Chevron incision (Correct Answer)
B. Lanz incision
C. Maylard incision
D. Kocher's incision

Explanation: ***Chevron incision*** - A **chevron incision** (also known as a rooftop or bilateral subcostal incision) provides **excellent exposure** to the upper abdomen, making it ideal for complex procedures like **pancreaticoduodenectomy** (Whipple procedure). - This incision allows for wide access to the **pancreas**, **duodenum**, **biliary tree**, and **major vessels**, facilitating the extensive dissection and reconstruction required. *Kocher's incision* - **Kocher's incision** is a right subcostal incision typically used for procedures on the **gallbladder** and **biliary tree**. - It does not offer sufficient exposure for the extensive and multi-quadrant dissection required during a **pancreaticoduodenectomy**. *Lanz incision* - A **Lanz incision** is a short, oblique incision in the right lower quadrant, primarily used for **appendectomy**. - This incision is far too small and incorrectly located to be used for any upper abdominal surgery, let alone a **pancreaticoduodenectomy**. *Maylard incision* - The **Maylard incision** is a transverse incision made in the lower abdomen, commonly used for **gynecological** and **urological** procedures. - It is unsuitable for upper abdominal operations such as a **pancreaticoduodenectomy** due to its low anatomical position.

Question 1129: A patient with complaints of dysphagia for solids who can only take liquids and has a history of smoking and weight loss. What is the most likely diagnosis?

A. Achalasia cardia
B. Carcinoma esophagus (Correct Answer)
C. Esophageal stricture
D. Barrett's esophagus

Explanation: ***Carcinoma esophagus*** - Progressive dysphagia starting with **solids** and progressing to **liquids** is a classic symptom of esophageal carcinoma, indicating mechanical obstruction that worsens over time. - History of **smoking** is a major risk factor for esophageal squamous cell carcinoma. - Unexplained **weight loss** is a red flag sign of malignancy, commonly seen in advanced esophageal cancer. - This triad (progressive dysphagia, smoking, weight loss) strongly suggests malignancy. *Achalasia cardia* - In achalasia, dysphagia typically occurs for both **solids and liquids simultaneously** from the onset due to impaired relaxation of the lower esophageal sphincter. - The pattern is non-progressive or paradoxical (sometimes liquids are more difficult than solids). - While weight loss can occur, smoking is not a risk factor for achalasia. *Esophageal stricture* - Benign esophageal strictures usually occur secondary to **chronic GERD** or caustic injury. - While they cause progressive dysphagia for solids, the absence of reflux history and presence of significant **weight loss** and **smoking history** make malignancy more likely. - Strictures typically have a more chronic, stable course without the constitutional symptoms seen here. *Barrett's esophagus* - Barrett's esophagus is a **pre-malignant condition** characterized by intestinal metaplasia of the esophageal mucosa. - It is typically **asymptomatic** or presents with GERD symptoms, not progressive dysphagia. - While it can progress to adenocarcinoma, Barrett's itself does not cause mechanical obstruction or dysphagia. - The clinical presentation here suggests established malignancy, not a pre-malignant condition.

Question 1130: A 60-year-old patient with air in the biliary tree, colicky abdominal pain, and hyper-peristaltic abdominal sounds. What is the diagnosis?

A. Hemobilia
B. Cholangitis
C. Pneumobilia
D. Gallstone ileus (Correct Answer)

Explanation: ***Gallstone ileus*** - This condition presents with the classic triad of **pneumobilia** (air in the biliary tree), symptoms of **small bowel obstruction** (colicky abdominal pain, hyper-peristaltic sounds), and evidence of a **gallstone in the ileum**. - The gallstone typically erodes through the gallbladder wall into the small intestine, causing obstruction, often at the **ileocecal valve**. *Hemobilia* - Characterized by **bleeding into the biliary tree**, which presents with upper gastrointestinal bleeding, biliary colic, and jaundice. - It does not cause bowel obstruction or pneumobilia and is often associated with trauma, iatrogenic injury, or vascular malformations. *Cholangitis* - An **infection of the bile ducts**, typically presenting with **Charcot's triad**: fever, right upper quadrant pain, and jaundice. - While it involves the biliary tree, it does not typically cause air in the biliary tree or small bowel obstruction. *Pneumobilia* - Refers specifically to the presence of **air in the biliary tree** and is a sign, not a diagnosis for the entire clinical picture. - While present in this case, pneumobilia alone does not explain the colicky abdominal pain, hyper-peristaltic sounds, and bowel obstruction.

Practice by Chapter

Esophageal Disorders

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Gastric Disorders

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Small Intestine Pathology

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Appendicitis

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Inflammatory Bowel Disease

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Intestinal Obstruction

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Gastrointestinal Bleeding

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Diverticular Disease

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Anorectal Disorders

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Colorectal Neoplasms

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Gastrointestinal Stomas

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Bariatric Surgery Principles

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