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Esophaus

Stomach and Duodenum


Small Bowel
Large Bowel
Liver
Extrahepatic biliary system
Pancreas

Suggestions and This website is dedicated to surgery multiple choice questions(MCQ). These
Queries questions have been taken from various entrance examinations and websites.
Questions 84-88 We have tried to provide accurate explanation with references. Suggestions,
queries and more questions are welcome.
Questions 78-83
Questions 70-77 Q1. Esophageal lower esophageal sphincter contraction is caused by?

Questions 66-70 a) protein b) fat


Questions 61-65 c) peppermint d) alcohol
Questions 55-60
Questions 51-55 Q2. Growth factor for adaptive response is
Question 46-50 a) Gastrin b) Secretin
Questions 41-45 c) Neurotensin d) VIP
Question 36-40
Questions 31-35
Q3. Schilling test is not used in
a) Steatorrhoea b) Blind loop syndrome

Questions 26-30 c) Pernicious Anemia


Questions 21-25
Questions 16-20 Q4. Most important investigation for Dysphagia in 60 year old is
a) Upper GI Endoscopy b) CT Thorax
c) Barium Swallow d) MRI

Q5. Maximum potassium concentration is seen in


a) Saliva b) Gastric Secretion
c) Jejunum d) Colon

Answers
1. A
the lower esophageal sphincter is not a anatomical sphincter, rather it is a
physiological sphincter which is in a state of tonic contraction. The sphincter
relaxes to allow bolus of food to pass and comes in a state of contraction again
Lower esophageal sphincter tone is decreased by: - Pregnancy
- Obesity
- Smoking, Alcohol
- Fatty foods, large meals, chocolate
- Diseases such as diabetes.
Tone of lower esophageal sphincter is increased by proteins,hormones such as
motilin, gastrin etc.

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2. C
SHORT BOWEL SYNDROME is a clinical condition characterized by rapid
intestinal transit and malabsorption in individuals who have a congenital or
acquired lesion leading to intestinal resection .
Surgical outcome in a given individual depends on the extent and location of
resection and how well the residual intestine adapts to the reintroduction of oral
nutrition.
All layers of the bowel wall have been shown to participate in a hyperplastic
adaptive response to intestinal resection
In addition to a marked increment in the diameter and some increase in the
length of the residual intestine there are structural, functional, and cytokinetic
adaptations of the mucosa, with augmentation of the intestinal mucosal
surface area. In both animal and human studies, the adaptive increase in
intestinal mucosal mass is associated with gradual functional compensation that is
characterized by diminishing fecal losses and increased transit time associated
with increased segmental absorption of water, electrolytes, and nutrients

The mediators of intestinal adaptive response are multifactorial, and the literature
supports three categories of factors:
Intestinal luminal nutrients such assoluble fiber, fatty acids, triglycerides, glutamine,
polyamines, and lectins,
pancreaticobiliary secretions of small intetine
Intestinal hormonal and/or systemic factors [growth hormone, epidermal growth
factor, transforming growth factor-, enteroglucagon, insulin-like growth factors I and
II, keratinocyte growth factor, GLP-2, peptide YY, neurotensin, bombesin, and
cytokines including interleukin (IL)-3, IL-5, and IL-11]
Gastrin can also have an effect
Ref. http://ajpgi.physiology.org/cgi/content/full/275/5/G911
3. A
The Schilling test is used to determine whether the body absorbs Vitamin B12
normally
Abnormal Stage I and II Schilling tests may indicate:
Biliary disease
Intestinal celiac disease (sprue)
Hypothyroidism
Liver disease

Lower-than-normal amounts of Vitamin B12 absorption may indicate:


biliary disease, resulting in intestinal malabsorption (inadequate absorption of
nutrients from the intestinal tract)
intestinal malabsorption (for example, related to sprue or celiac disease)
liver disease (causing malabsorption)
pernicious anemia

Additional conditions under which the test may be performed:


anemia of B-12 deficiency
blind loop syndrome
megaloblastic anemia
Steatorrhea is intestinal fat malabsorbtion
4. A
To rule out esophageal carcinoma in a 60 year old manis the 1st concern in this
case. Endoscopy of the esophaguswould aid in direct visualisation as well as
biopsy.
although barium would provide a road map for endoscopy most important remains
a.
5. A
we are checking for references
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