GI GI Surgery and Interventional Procedures 1 — Questions and Answers
Question 1: The Whipple procedure (pancreaticoduodenectomy) removes which structures?
- Pancreatic tail, spleen, and left colon
- Head of pancreas, duodenum, gallbladder, and distal common bile duct (Correct answer)
- Entire pancreas, stomach, and duodenum
- Distal pancreas and stomach only
Correct answer: Head of pancreas, duodenum, gallbladder, and distal common bile duct
The classic Whipple resects the pancreatic head, entire duodenum, gallbladder, distal common bile duct, and often the distal stomach.
Question 2: Roux-en-Y gastric bypass (RYGB) achieves weight loss primarily through which mechanism?
- Pure malabsorption by bypassing 80% of the small intestine
- Restriction and hormonal changes (reduced ghrelin, altered GLP-1/PYY) with mild malabsorption (Correct answer)
- Increased gastric acid production accelerating emptying
- Vagal nerve transection causing anorexia
Correct answer: Restriction and hormonal changes (reduced ghrelin, altered GLP-1/PYY) with mild malabsorption
RYGB restricts stomach volume, reduces ghrelin (hunger hormone), and alters gut hormones (GLP-1, PYY) to improve satiety and insulin sensitivity, with modest malabsorption.
Question 3: The most dreaded early complication of esophagectomy is anastomotic leak; what is the preferred initial management of a cervical anastomotic leak?
- Immediate return to the operating room for surgical repair
- Broad-spectrum antibiotics and opening of the neck wound for drainage (Correct answer)
- Endoscopic stent placement only
- Observation with NPO status alone
Correct answer: Broad-spectrum antibiotics and opening of the neck wound for drainage
Cervical anastomotic leaks are managed by opening the neck incision to allow drainage, along with antibiotics and enteral feeding via jejunostomy.
Question 4: A Hartmann's procedure involves which surgical steps?
- Total colectomy with ileorectal anastomosis
- Sigmoid resection with end colostomy and closure of the rectal stump (Correct answer)
- Anterior resection with primary anastomosis
- Abdominoperineal resection with permanent colostomy
Correct answer: Sigmoid resection with end colostomy and closure of the rectal stump
Hartmann's procedure resects the diseased sigmoid/rectosigmoid, creates a proximal end colostomy, and closes the distal rectal stump as a blind pouch for later reversal.
Question 5: Endoscopic band ligation is the preferred endoscopic treatment for acute bleeding from which source?
- Peptic ulcer bleeding
- Dieulafoy's lesion
- Esophageal variceal bleeding (Correct answer)
- Mallory-Weiss tear
Correct answer: Esophageal variceal bleeding
Endoscopic variceal band ligation (EVL) is the first-line endoscopic treatment for acute esophageal variceal hemorrhage, and is also used for secondary prophylaxis.
Question 6: Which procedure is performed for refractory ascites in cirrhosis when patients fail repeated large-volume paracentesis?
- Transjugular intrahepatic portosystemic shunt (TIPS) (Correct answer)
- Peritoneal dialysis catheter placement
- Splenectomy
- Hepatic artery embolization
Correct answer: Transjugular intrahepatic portosystemic shunt (TIPS)
TIPS creates a low-resistance channel between the portal and hepatic veins, reducing portal pressure and decreasing ascites formation in refractory cases.
GI GI Surgery and Interventional Procedures 1
The Whipple procedure (pancreaticoduodenectomy) removes which structures?