Page 12 of 14
SU28.5-9 | Upper Gastrointestinal Surgery — Graded Quiz
Click any question card to reveal the correct answer.
A swallowed coin lodges in the oesophagus of a child. Knowing the three normal oesophageal constrictions, at which level would a foreign body most commonly lodge FIRST?
Correct. The narrowest of the three oesophageal constrictions is the cricopharyngeal (upper oesophageal) sphincter at about C6, where swallowed foreign bodies most commonly lodge.
Three oesophageal constrictions: cricopharyngeal (~C6, narrowest), aortic/bronchial, diaphragmatic. Foreign bodies and corrosives strike hardest at these points; the cricopharyngeal is the commonest impaction site.
The three constrictions are the cricopharyngeal (~C6), the aortic/bronchial, and the diaphragmatic; the cricopharyngeal sphincter is the narrowest and the commonest site for an impacted foreign body.
Click to reveal answer
During gastric surgery the surgeon ligates vessels along the lesser curvature. Which artery, arising directly from the coeliac trunk, principally supplies the lesser curvature?
Correct. The lesser curvature is supplied by the left gastric artery (directly from the coeliac trunk) and the right gastric artery (from the hepatic artery); the greater curvature is supplied by the gastroepiploic and short gastric vessels.
Lesser curvature = left gastric (coeliac trunk) + right gastric (hepatic artery). Greater curvature = right/left gastroepiploic + short gastric arteries.
The left gastric artery (a direct branch of the coeliac trunk) supplies the lesser curvature; the gastroepiploic and short gastric arteries supply the greater curvature.
Click to reveal answer
A 58-year-old man with weight loss and dyspepsia is examined for stomach disease. Which single positive finding would most strongly mandate URGENT upper GI endoscopy with biopsy?
Correct. A palpable hard, irregular epigastric mass with weight loss is an alarm finding strongly suggesting gastric malignancy and demands urgent upper GI endoscopy with biopsy.
ALARM features (mass, weight loss, anaemia, dysphagia, GI bleed, persistent vomiting) in dyspepsia mandate urgent upper GI endoscopy with biopsy.
An epigastric mass with weight loss is an ALARM feature mandating urgent endoscopy and biopsy; mild tenderness, normal bowel sounds or an umbilical hernia are not.
Click to reveal answer
A 30-year-old man with recurrent duodenal ulcers tests positive for Helicobacter pylori. Which management principle is the cornerstone of treating his uncomplicated peptic ulcer disease?
Correct. The cornerstone of uncomplicated peptic ulcer disease is H. pylori eradication (a proton pump inhibitor plus two antibiotics) together with acid suppression; surgery is reserved for complications.
Peptic ulcer disease: H. pylori eradication (PPI + two antibiotics) + acid suppression is first-line. Surgery (e.g., Graham patch for perforation) is for complications.
Uncomplicated peptic ulcer disease is treated medically with H. pylori eradication and acid suppression; vagotomy/gastrectomy are now reserved for complications, not first-line.
Click to reveal answer
An endoscopic biopsy of a diffusely thickened, rigid stomach in a 65-year-old shows sheets of signet-ring cells infiltrating the wall, producing a 'leather-bottle' contracted stomach. What is this pattern called?
Correct. Diffuse signet-ring cell infiltration of the gastric wall producing a rigid, contracted 'leather-bottle' stomach is linitis plastica — a form of diffuse gastric adenocarcinoma.
Linitis plastica = diffuse signet-ring gastric adenocarcinoma giving a rigid 'leather-bottle' stomach; a marker of poor prognosis.
A rigid, contracted 'leather-bottle' stomach from diffuse signet-ring infiltration is linitis plastica (diffuse gastric carcinoma). Barrett's affects the oesophagus; the others are different entities.
Click to reveal answer
A 40-year-old presents with intermittent dysphagia to both solids and liquids, chest pain and regurgitation. Manometry confirms achalasia. Which treatment directly addresses the non-relaxing lower oesophageal sphincter?
Correct. Achalasia is treated by reducing LOS tone — endoscopic pneumatic balloon dilatation or surgical Heller's cardiomyotomy (often with an anti-reflux wrap); PPIs and antibiotics do not address the non-relaxing sphincter.
Achalasia treatment targets the non-relaxing LOS: pneumatic balloon dilatation or Heller's cardiomyotomy (± fundoplication). POEM is a newer endoscopic option.
Achalasia is managed by mechanically disrupting the LOS — pneumatic dilatation or Heller's myotomy. PPIs treat reflux, and Ramstedt myotomy is for infantile pyloric stenosis, not the oesophagus.
Click to reveal answer
Before performing a Ramstedt pyloromyotomy on an infant with hypertrophic pyloric stenosis, the team corrects dehydration and electrolytes. Why is correcting the alkalosis essential BEFORE anaesthesia?
Correct. The hypochloraemic, hypokalaemic metabolic alkalosis impairs ventilatory drive and predisposes to post-operative apnoea and arrhythmias, so it must be corrected first — pyloric stenosis is a medical emergency, not a surgical one.
Correct the hypochloraemic hypokalaemic alkalosis before pyloromyotomy: uncorrected alkalosis/hypokalaemia risk post-operative apnoea and arrhythmia. Resuscitation is the priority, surgery is elective.
Uncorrected metabolic alkalosis and hypokalaemia raise the risk of post-operative apnoea and arrhythmia, so they are corrected before anaesthesia; the operation itself is elective once the baby is resuscitated.
Click to reveal answer