SMALL BOWEL

Question 1

What is triple tube drainage

Answer 1

This is really quadruple tube drainage if you count the lateral duodenostomy tube

For the duodenal blowout

Six French cystic duct tube for bile drainage

Retrograde duodenal tube brought through the proximal jejunum (the literature describes this as a 4 French!)

Feeding J-tube

Lateral of duodenostomy tube malencot

nissen-cooper repair

Question 2

Management of bad perforated posterior duodenal ulcer

Answer 2

Antrectomy
B2 Gastro J
Over so duodenal stump
L duodenostomy

Question 3

Massive hematemesis
History of PPI use
History of alcohol use eight years ago

Do not know where the bleeding is coming from

What is the management intraoperatively

Answer 3

Open the duodenum first if you do not know where the blood is coming from

Three stitch ligation gaastra duodenal pancreatic branch

If stable:
Do the truncal vagotomy and pyloroplasty (since failed PPI)

Truncal vagotomy:
take Down the gastrohepatic ligament
Retract the left lobe of the liver to the right

Dissecting frontal esophageal space in fact pad

Question 4

Workout for 50-year-old male with pancreatic cyst in the detail the pancreas symptomatic with dull ache the middle abdomen Times two months no history of surgery smoker

Answer 4

Pancreatic protocol CT scan

Send CEA in CA 19 nine

EUS - biopsy
Musen positive
Amlie 40
CEA 32

Musin + -> distal pancreatectomy