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What is the most common complication of sleeve gastrectomy?
Nutritional deficiencies may arise from sleeve gastrectomy due to a decrease in food consumption.
True
What type of surgical technique is used in sleeve gastrectomy?
Notes procedure
The procedure known as __________ is a type of primary obesity surgery performed endoscopically.
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Match the following complications with their descriptions:
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What is the initial investigation for caecal volvulus?
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Caecopexy is performed only in cases with peritonitis.
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List one cause of intestinal strictures.
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In Heineke-mikulicz stricturoplasty, the strictures are handled using ___ approach.
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Match the type of stricturoplasty with its description:
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Which of the following is a potential complication of laparoscopic gastric banding?
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The Allurion balloon used in intra-gastric balloon placement is non-dissolving.
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What should patients supplement after gastric banding surgery?
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The distance from the GE junction to where the adjustable band is placed during gastric banding is __________ cm.
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Match the following surgical procedures to their order of maximum weight loss:
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What sign may indicate a large bowel obstruction when viewed on an X-ray?
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In caecal volvulus, the apex of the distended bowel typically points to the right shoulder.
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Which feature is NOT associated with Adynamic Bowel Obstruction?
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What is the emergency procedure for sigmoid volvulus if there are no signs of peritonitis?
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In cases of perforated caecal volvulus, the procedure involves performing a __________ followed by a colostomy.
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Obstruction in the upper GI tract typically presents with distension first.
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Match the type of volvulus with their respective characteristics:
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What is the initial investigation used to diagnose bowel obstruction?
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In bowel obstruction, > 3 air-fluid levels on an erect X-ray suggest ______.
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Match the type of bowel obstruction with the corresponding characteristic:
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Which type of anastomosis is performed in a Roux-en-Y mini gastric bypass?
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The Roux Limb length is fixed at 100 cm for all patients undergoing the procedure.
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What is the most common cause of mortality in the first month after Roux-en-Y mini gastric bypass?
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Anastomotic leaks can lead to symptoms such as __________ in the abdomen.
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Match the following complications with their descriptions:
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Which patient group has the longest Roux Limb length?
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Nutritional deficiencies are a potential complication of Roux-en-Y mini gastric bypass.
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What diagnostic tools are mentioned for managing complications like leaks?
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The __________ is the removed portion of the stomach in the Roux-en-Y mini gastric bypass.
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Which of the following is NOT a potential complication of Roux-en-Y mini gastric bypass?
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What is the initial management step for bowel obstruction?
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The jejunum appears featureless when affected by bowel obstruction.
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What is the primary definitive management for bowel obstruction?
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The critical diameter for the small intestine is _____ cm.
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Match the bowel section with its description:
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What is a common clinical feature of jejunal atresia?
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Intussusception can occur as a result of hypertrophy of Peyer’s patches in children.
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What is the primary management for jejunal atresia?
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Type ___ of intestinal atresia refers to an atretic cord with an intact mesentery.
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Match the type of intussusception to its description:
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What is the most common type of duodenal atresia?
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The double-bubble sign is primarily indicative of congenital hypertrophic pyloric stenosis (CHPS).
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List one clinical feature of duodenal atresia.
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In checking for bowel viability, a viable bowel shows a ________ color and may have visible mesenteric artery pulsations.
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Match the following conditions with their associated imaging findings:
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Which of the following is NOT a symptom of intussusception in children?
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Volvulus can occur due to twisting of a bowel loop around its vessels.
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What imaging technique is considered the investigation of choice (IOC) for adults presenting with intussusception?
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A diagnostic sign observed in intussusception can be described as the _____ sign, which appears as one bowel loop inside another.
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Match the following clinical features or signs to their corresponding conditions:
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Study Notes
Sleeve Gastrectomy
- Surgical procedure for weight loss
- Functions by reducing the size of the stomach, leading to early satiety
- Promotes weight loss by decreasing food consumption
-
Common Complications:
- Nutritional deficiencies: Iron, Vitamin B, and Calcium
- Bleeding from staple line
- Leakage from angle of His: Requires revision surgery
- Deep vein thrombosis (DVT) and pulmonary embolism (PE)
- Gastro-esophageal reflux
- Barrett's esophagus
- Weight gain due to redisention of the sleeve
-
Procedure Types:
- ROSE (Restorative Obesity Surgery Endoscopically)
- Endocinch: Primary obesity surgery endoscopically
- TOGA (Transoral Gastroplasty)
Roux en Y Mini Gastric Bypass
-
Types:
- Gastrojejunostomy
- Jejunojejunostomy
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Procedure Description:
- Creates a gastric pouch
- Removes a portion of the stomach
- Connects the small intestine to the pouch
- Bypasses a portion of the small intestine
- The length of the Roux limb varies depending on the patient's condition:
- Peptic ulcer: 50 cm
- Bariatric surgery patients: 100 cm
- Superobese patients: 150 cm
-
Complications:
- DVT/PE: Most common cause of mortality
- Anastomotic leak: Can cause peritonitis
- Nutritional deficiencies: Iron, Vitamin B, and Calcium
- Internal hernias: Stemmer's and Petersen's hernias
- Anastomotic ulcer/stricture: Narrowing of the connection site
B. CAECAL VOLVULUS
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Predisposing Factors:
- Mobile caecum
- Caecal bascule (Type of mobile caecum)
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Investigations:
- X-ray abdomen (Erect and supine)
- CECT abdomen: IOC
-
Management:
- If no peritonitis: Laparotomy - (R) Hemicolectomy
- If peritonitis: (R) Hemicolectomy
- Caecopexy: Derotate anti-clockwise
Intestinal Strictures
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Causes:
- Cancer
- Post radiotherapy
- TB
- Crohn's
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Investigations:
- X-ray abdomen (Erect & supine): Initial investigation
-
Management:
- If multiple strictures close together: Resection + Anastomosis
- If strictures are far apart: Stricturoplasty
- Side-to-side anastomosis
- Heineke-mikulicz stricturoplasty
- Finney's stricturoplasty
Reversible Surgery: Laparoscopic Gastric Banding
-
Procedure
- Adjustable band placed 6 cm from the GE junction
- Port of balloon placed near umbilicus
- Post-surgery: Balloon inflated with NS
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Complications
- Access port infection
- DVT/PE
- Band infection
- Tubing leak
- Band slippage leading to weight gain
- Stomach erosion
- Band intolerance
- Weight regain
-
Intra-gastric Balloon Placement: Endoscopically placed balloon
- Allurion: Self-dissolving balloon
-
Nutritional Guidelines:
- After gastric banding: Multivitamins, minerals, and thiamine
- After sleeve gastrectomy and gastric bypass: Same as gastric banding, plus selenium, copper, zinc, folic acid, and Vitamins B, A, E, and K
Bowel Obstruction: Part 1
-
Investigations:
- X-ray abdomen (Erect and supine)
- Coffee bean sign/Bent inner tube sign
- Distended large intestine
- Apex to (Right) shoulder
- CECT abdomen: 10C
- Contrast enema: Bird's beak/Ace of spades appearance
- X-ray abdomen (Erect and supine)
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Management
-
Sigmoid volvulus:
- No c/o peritonitis: Emergency sigmoidoscopic decompression + Definitive Sx
- Sigmoidopexy
- Sigmoidectomy
- No c/o peritonitis: Emergency sigmoidoscopic decompression + Definitive Sx
-
Caecal volvulus:
- Apex → (Left) Shoulder tip
- Small intestine distended
- Peritonitis
- Sepsis
- Emergency Laparotomy + Resection of perforated segment
- Colostomy
- Creation of stoma
- Re-anastomosis (once healed)
- 6-8 weeks
-
Sigmoid volvulus:
BOWEL OBSTRUCTION: PART 1
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Types
- Dynamic Bowel Obstruction: Mechanical obstruction, bowel contraction (+), hyperdynamic sounds (+)
- Adynamic Bowel Obstruction: No mechanical obstruction, bowel contraction (-), no hyperdynamic sounds, silent abdomen (+)
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CLINICAL FEATURES
- Abdominal pain
- Distension
- Vomiting
- Obstruction
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INVESTIGATIONS
- Initial investigation: X-ray abdomen
- Adults: CT abdomen
- Children: USG abdomen
- Erect X-ray: > 3 air-fluid levels suggest obstruction
- Supine X-ray: Used to note site of obstruction
- Initial investigation: X-ray abdomen
Jejunal Atresia
- Non-canalization of the jejunum
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Clinical Features:
- Cardinal features of bowel obstruction
- Bilious vomiting
- X-ray: Triple bubble sign
- Management: Emergency laparotomy -> Resection and anastomosis
Note: Types of Intestinal atresia
Type | Description |
---|---|
Type I | Mucosal web or diaphragm |
Type II | Atretic cord; intact mesentery |
Type IIIa | Blind ends of bowel |
Type IIIb | |
Type IV | Multiple atresia or string of sausage appearance |
Intussusception
- Telescoping of one bowel loop into the other
- Intussuscepiens: Receiving portion
- Intussusceptum: Telescoping portion
-
Types:
- Primary: Children (6 months - 2 years), Hypertrophy of Peyer's patches, Ileocolic (Ileum → Colon)
- Secondary: 2° to a pathological lead point: Polyp, Cancer, Meckel's diverticulum, Colo-colic (Colon → Colon)
- Clinical FEATURES (both types): Cardinal features of bowel obstruction
Bowel Obstruction: Part 1
- Jejunum: Feathery appearance, complete volvulus, concertina/step ladder pattern
- Ileum: Featureless loops
- Large bowel: Peripherally arranged, incomplete haustrations
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Critical diameters:
- Small intestine: 3 cm
- Large intestine: 6 cm
- Caecum: 9 cm
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MANAGEMENT
- Initial conservative mx:
- Nil per oral
- i/v fluids (Ringer's Lactate)
- Ryle tube/NG tube → Decompression
- i/v antibiotics: Aerobic, anaerobic, and gram negative cover
- i/v painkillers
- Definitive mx: Emergency exploratory laparotomy
- Caecum visualized first
- Collapsed → Small intestinal obstruction
- Distended → Large intestinal obstruction
- Viable → Check for viability
- Retain (if viable)
- Non-viable → Resection and anastomosis/Stoma
- Initial conservative mx:
Viable vs. Non-viable bowel
Feature | Viable Bowel | Non-Viable Bowel |
---|---|---|
Circulation | Dark color, becomes lighter.Visible mesenteric artery pulsations | Dark color remains.Mesenteric artery pulsations (−) |
General Appearance | Shiny | Dull and lustreless |
Intestinal Musculature | Firm.Peristalsis (may be observed) | Flabby, thin, and friable.No peristalsis |
Duodenal Atresia
- One of the most common causes of bowel obstruction in neonates
- Due to non-canalization of the duodenum
- Associated with Down's syndrome (mothers often have polyhydramnios)
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Clinical Features:
- Vomiting since birth
- Bilious vomiting
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D/d
- Congenital hypertrophic pyloric stenosis (CHPS)
Condition | Clinical Picture | Associations | Imaging | Treatment |
---|---|---|---|---|
CHPS | Normal at birth; non-bilious, projectile vomiting after a few weeks | First born male child | USG Abdomen | Ramstedt pyloromyotomy |
Duodenal Atresia | Vomiting since birth; bilious vomiting | Down's syndrome | X-ray (Double-bubble sign) | Diamond Duodeno-duodenostomy |
Gastrointestinal and Abdominal Surgery
Intussusception
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In Children:
- Symptoms: Drawing up of legs due to pain, red currant jelly stools, and signs of dance
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Investigations:
- USG Abdomen: Target/Donut sign and Pseudokidney sign
- Contrast Enema: Claw/Pincer sign (diagnostic and therapeutic)
- Contraindications: Recurrent intussusception, pathological lead point, and strangulation
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In Adults:
- Investigations: CECT Abdomen (IOC).
- Surgery: Reduction of intussusception, Resection and anastomosis if perforation, strangulation, or pathological lead point
Volvulus
- Definition: Twisting of a bowel loop around its vessels
-
Sigmoid Volvulus (Predisposing Factors):
- Long and narrow mesentery
- Redundant sigmoid
- Loaded sigmoid
- Patient on anti-psychotic medications
- Institutionalized patients
- Clinical Features: Cardinal features of bowel obstruction, prominent distension, obstipation (constipation), closed loop obstruction with high chances of strangulation
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Description
This quiz covers two popular surgical procedures for weight loss: Sleeve Gastrectomy and Roux en Y Mini Gastric Bypass. It will explore their functions, common complications, and various procedure types. Test your knowledge on the intricacies of these weight loss surgeries.