GI GI Surgery and Interventional Procedures 2 — Questions and Answers
Question 1: Laparoscopic cholecystectomy is the gold standard for symptomatic cholelithiasis; which intraoperative injury is the most feared complication?
- Bowel perforation
- Common bile duct injury (Correct answer)
- Hepatic artery laceration
- Cystic artery hemorrhage
Correct answer: Common bile duct injury
Common bile duct injury occurs in approximately 0.3–0.5% of laparoscopic cholecystectomies and can cause biliary stricture, cholangitis, and significant morbidity.
Question 2: Endoscopic mucosal resection (EMR) is appropriate for polyp removal when the lesion is confined to which layer of the GI wall?
- Muscularis propria and serosa
- Mucosa and superficial submucosa (sm1) (Correct answer)
- Deep submucosa (sm2/sm3) and beyond
- Adventitia
Correct answer: Mucosa and superficial submucosa (sm1)
EMR safely resects lesions confined to the mucosa and superficial submucosa (sm1) where lymphovascular invasion risk is low; deeper invasion requires surgery.
Question 3: Ileostomy output exceeding 1,500–2,000 mL/day places patients at risk for which metabolic complication?
- Hypernatremia and hyperkalemia
- Hyponatremia, hypokalemia, and dehydration (Correct answer)
- Metabolic alkalosis and hyperchloremia
- Hypercalcemia and hyperphosphatemia
Correct answer: Hyponatremia, hypokalemia, and dehydration
High-output ileostomy causes loss of sodium-rich intestinal fluid, leading to hyponatremia, hypokalemia, and volume depletion with pre-renal azotemia.
Question 4: Which endoscopic technique involves injecting a submucosal fluid cushion before resecting a large flat lesion en bloc?
- Endoscopic mucosal resection (EMR)
- Endoscopic submucosal dissection (ESD) (Correct answer)
- Argon plasma coagulation
- Radiofrequency ablation
Correct answer: Endoscopic submucosal dissection (ESD)
ESD uses submucosal injection to lift the lesion and specialized knives to dissect along the submucosal plane, enabling en bloc resection of large lesions.
Question 5: A patient undergoes total proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis; what is the most common late complication of the pouch?
- Pouch adenocarcinoma
- Pouchitis (Correct answer)
- Pouch-vaginal fistula
- Anastomotic stenosis
Correct answer: Pouchitis
Pouchitis, a non-specific inflammation of the ileal reservoir, occurs in up to 50% of patients with IPAA and is the most common long-term complication.
Question 6: Transjugular intrahepatic portosystemic shunt (TIPS) procedure is contraindicated in patients with which condition?
- Refractory ascites
- Recurrent variceal bleeding on beta-blockers
- Severe or overt hepatic encephalopathy (Correct answer)
- Hepatorenal syndrome type 1
Correct answer: Severe or overt hepatic encephalopathy
Pre-existing severe hepatic encephalopathy is a contraindication to TIPS because shunting additional portal blood past the liver worsens ammonia clearance.
GI GI Surgery and Interventional Procedures 2
Laparoscopic cholecystectomy is the gold standard for symptomatic cholelithiasis; which intraoperative injury is the most feared complication?