Upper GI Resection And Anastomosis

Question 1

Bilious vomiting with DJ flexure on right in neonates

Answer 1

Ladd’s procedure for malrotation with volvulus

Question 2

Fecal peritonitis with liver metastasis from sigmoid cancer

Answer 2

Heartmans procedure

Question 3

Treatment of fulminant ulcerative colitis

Answer 3

RIF end ileostomy

Question 4

Cecal tomorrow on barium enema with PR bleeding causing iron deficiency anemia

Answer 4

Right hemicolectomy

Question 5

Blood gas of high output ureterosigmoidostomy

Answer 5

Metabolic acidosis with respiratory hyperventilation

Question 6

Treatment if gallstone ileus

Answer 6

Remove some from proximal enterostomy and leaving the gall bladder alone

Question 7

Obstructing sigmoid cancer on CT

Answer 7

Sigmoidectomy with end colostomy

Question 8

Toxic megacolon from ulcerative colitis

Answer 8

End ileostomy

Question 9

Stoma for colorectal anastomosis after Anterior resection

Answer 9

Loop ileostomy

Question 10

Significant terminal ileal stricture from ulcerative colitis

Answer 10

Right hemicolectomy

Question 11

Fixed rectal carcinoma found on laparotomy

Answer 11

Transverse loop colostomy for defunctioning

Question 12

Generalized abdominal pain starting from left iliac fossa

Answer 12

Hartmann’s

Question 13

Large invasive rectal carcinoma

Answer 13

Loop transverse colostomy

Most common site of this loop is transverse colon or sigmoid colon.

Question 14

Investigation of meconium ileus

Answer 14

Sweat chloride test will be high

Question 15

Following diagnostic work up rectal cancer of T2 N0 and 2 cm from anal verge

Answer 15

ELAPE

Question 16

Treatment for sigmoid diverticular stricture

Answer 16

Hartmann’s

Question 17

Sigmoid diverticular peritonitis

Answer 17

Heartmans

Question 18

Stab injury of left colon

Answer 18

End colostomy after resection

Question 19

Furosemide on plasma K

Answer 19

Hypo kalamia

Question 20

Failure of medical therapy for ulcerative colitis
Definitive treatment
Emergency treatment

Answer 20

Subtotal in emergency
Pan procto colectomy is definitive

Question 21

Bleeding from upper rectal tumor
Vs
Bleeding from lower rectal tumor

Answer 21

Anterior resection for upper

Total mesorectal excision for middle and lower & abdomino perineal when can’t get adequate margin through abdominal approach.

Question 22

Adverse effect of TPN on liver function

Answer 22

Jaundice

Question 23

Ulcer associated with Crohn’s disease

Answer 23

Pyoderma gangrenosum

Question 24

Earliest complication of stoma

Answer 24

Necrosis

Question 25

Most common complication of stoma

Answer 25

Dermatitis

Question 26

Surgical treatment of biliary atresia

Answer 26

Roux-en-Y Porto jejunostomy

Question 27

Best decompression for jaundice from carcinoma of head of pancreas

Answer 27

ERCP
If failed then
PCT and drain with stenting

Question 28

In low rectal large invasive carcinoma

Answer 28

Anterior resection with LIF end colostomy
Patient most likely needs adjuvant chemotherapy for T2N1M0

Question 29

Stoma after restorative proctocolectomy for ulcerative colitis

Answer 29

Loop ileostomy at RIF
for the anastomosis to heal
Loop is closed at 10 weeks

Question 30

Which ganglion is affected in hirsprungs disease

Answer 30

Auerbach plexus and Meissner plexus

The myenteric plexus and Auerbach’s plexus are the same thing.
located between the inner circular and outer longitudinal layers of the muscularis externa

Question 31

which ganglion is affected in achalasia cardia

Answer 31

Achalasia cardia is caused by a loss of inhibitory ganglion cells in the myenteric plexus of the esophagus

Question 32

Immunohistochemical evidence of hirsprungs disease

Answer 32

Increased activity of acetylcholinesterase

Question 33

Definitive treatment for hirsprungs disease

Answer 33

Pull through operation
But rectal irrigation or an emergency colostomy before that

Question 34

Perforated caecal cancer

Answer 34

Right hemicolectomy
Spout end ileostomy
Mucous fistula

Question 35

Confirmation of parastomal hernia

Answer 35

CT

Question 36

Treatment of fulminant ulcerative colitis

Answer 36

Total colectomy with RIF end ileostomy

Question 37

End point of subtotal colectomy for ulcerative colitis

Answer 37

Depending on recovery perform an ileo rectal anastomosis

Question 38

Some causes of malabsorption

Answer 38

Primary biliary cirrhosis
Ileo colic bypass
Chronic pancreatitis
Whipple’s disease

Question 39

Some indications for heartmann’s

Answer 39

Proctitis
Diverticulitis
Perforated diverticulum
Diverticular stricture
Procto sigmoid itis
Colon cancer

Question 40

Stoma for low rectal invasive cancer

Answer 40

Permanent LIF colostomy after abdomino PERINEAL excision

Question 41

Investigation for hirsprungs disease

Answer 41

Full thickness rectal biopsy

Question 42

Definitive surgery for hirsprungs

Answer 42

Resection and anastomosis after 9-12 months of age
Until then stoma by laparotomy

Question 43

ELAPE vs APE

Answer 43

Extralevator abdominoperineal excision (ELAPE) is a relatively new surgical technique for low rectal cancers. It is a more radical approach than conventional abdominoperineal excision (APE) with potentially better oncological outcome.

They can also be done for anal cancer

Question 44

Parts to resect during ELAPE vs APE

Answer 44

ELAPE involves removing the anal canal, levators, and low mesorectum,
while APE is the operation of choice for tumors that infiltrate the sphincter or levatorani muscles.

Question 45

Investigation for rectal cancer extension

Answer 45

MRI

Question 46

The route of total mesorectal excision (TME)

Answer 46

The route of total mesorectal excision (TME) depends on several factors, including the size and height of the tumor, the width of the mesorectum and pelvis, and the extent of colonic mobilization. The two main routes are through an abdominal incision or transanally

Question 47

Surgery for rectal cancer with sphincter invasion

Answer 47

Abdomino perineal excision