Pg Blazer - Online Test Series 27 - Surgery

The most probable diagnosis in this case is portal hypertension. The patient's history of hematemesis (vomiting blood) along with low blood pressure and rapid heart rate suggests significant bleeding. The presence of splenomegaly (enlarged spleen) is a common finding in portal hypertension. This condition occurs when there is increased pressure in the portal vein, which carries blood from the intestines to the liver. It can be caused by liver cirrhosis, liver disease, or obstruction of blood flow within the liver. Portal hypertension can lead to varices (enlarged veins) in the esophagus or stomach, which can rupture and cause severe bleeding.

Barrett's esophagus is a condition in which the normal lining of the esophagus is replaced by abnormal cells, usually as a result of chronic acid reflux. This condition is commonly associated with adenocarcinoma, a type of cancer that develops in the glandular cells of the esophagus. Adenocarcinoma is the most common type of esophageal cancer and is often preceded by Barrett's esophagus. Squamous cell carcinoma, sarcoma, and gastrointestinal stromal tumor are not typically associated with Barrett's esophagus.

Hypokalemic metabolic alkalosis is the most common biochemical abnormality in congenital pyloric stenosis. This condition is characterized by a decrease in potassium levels in the blood (hypokalemia) and an increase in pH (alkalosis). Pyloric stenosis is a narrowing of the passage between the stomach and small intestine, leading to vomiting and dehydration. The loss of gastric acid through vomiting causes the body to compensate by retaining bicarbonate, leading to metabolic alkalosis. Additionally, the loss of hydrogen ions in the vomit results in the loss of potassium, leading to hypokalemia.

The most likely diagnosis in this case is a meningioma. Meningiomas are tumors that arise from the meninges, which are the protective layers that cover the brain and spinal cord. They are more common in females and can cause symptoms such as lower limb weakness, spasticity, and urinary hesitancy when they compress the spinal cord. The MRI findings of an intradural enhancing mass lesion further support the diagnosis of a meningioma. Dermoid cysts, intradural lipomas, and neuroepithelial cysts are less likely to present with these symptoms and MRI findings.

In acute spinal injury, the loss of sympathetic tone is the main reason for hypotension. The sympathetic nervous system plays a crucial role in maintaining blood pressure by regulating the constriction of blood vessels and the release of adrenaline. When there is damage to the spinal cord, the sympathetic nerves may be affected, leading to a loss of their ability to regulate blood pressure effectively. This can result in a drop in blood pressure, causing hypotension.

Barrett's esophagus is a condition in which the normal cells lining the lower part of the esophagus are replaced by cells that resemble the cells lining the intestines. This transformation is known as intestinal metaplasia. Squamous metaplasia refers to the transformation of the normal cells into squamous cells, which is not characteristic of Barrett's esophagus. Squamous dysplasia and intestinal dysplasia refer to the abnormal growth and development of cells, which may be seen in Barrett's esophagus but are not specific for its diagnosis. Therefore, the correct answer is intestinal metaplasia.

Glutamate dehydrogenase is not elevated in a child presenting with jaundice, icterus, pruritus, and clay-colored stools. This enzyme is not typically used as a marker for liver dysfunction or cholestasis. Gamma glutamyl transpeptidase (GGT), alkaline phosphatase, and 5'-nucleotidase are commonly elevated in liver diseases and can help diagnose the cause of jaundice.

Meningioma is also highly valscular, but it is said that glioblastoma is so vascular that it may resemble an arteriovenous malformation!

The most likely diagnosis in this case is achalasia cardia. Achalasia is a disorder of the esophagus where the lower esophageal sphincter fails to relax properly, leading to difficulty in swallowing (dysphagia) and regurgitation. It is more common in middle-aged individuals and the symptoms typically persist over time without worsening (non-progressive). Carcinoma of the esophagus, lower esophageal mucosal ring, and reflux esophagitis with esophageal stricture can also cause dysphagia, but the non-progressive nature of the symptoms in this patient makes achalasia cardia the most likely diagnosis.

Post operative complications that occur with sufficient frequency in ileostomy are : Nipple valve slippage, pouchitis, intestinal obstruction and fistula.
Ref: The ASCRS Manual of Colon and Rectal Surgery
Complications of ileostomy are Obstruction, Vitamin B12 anaemia, Pouchitis, Stoma problems, Valve malfunction and Phantom rectum
Ref: National Health Service UK website