NEET SS Surgical Gastroenterology (MCh) Syllabus

Surgical Gastroenterology (MCh) syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Surgical Gastroenterology (MCh) in NEET SS, not a summary of it.

1. 1

   Hepatobiliary Surgery

   3 topics

   • Liver Resections and Transplantation
     • Anatomical liver resection
     • Living donor liver transplantation
   • Biliary Surgery
     • Bile duct injury and reconstruction
     • Choledochal cysts
   • Portal Hypertension Surgery
     • Shunt and devascularization procedures
2. 2

   Pancreatic Surgery

   3 topics

   • Surgery for Pancreatic Cancer
     • Whipple's pancreaticoduodenectomy
   • Surgery for Chronic Pancreatitis
     • Drainage and resection procedures
   • Pancreatic Neuroendocrine and Cystic Tumors
     • Enucleation and resection
3. 3

   Foregut and Esophagogastric Surgery

   3 topics

   • Esophageal Surgery
     • Achalasia and antireflux surgery
     • Esophageal carcinoma resection
   • Gastric Surgery
     • Gastric cancer and lymphadenectomy
     • Bariatric surgery
   • Gastroduodenal Benign Disease
     • Complicated peptic ulcer disease
     • Gastric outlet obstruction
4. 4

   Colorectal, Small Bowel and Minimal Access Surgery

   3 topics

   • Colorectal Surgery
     • Colorectal cancer resections
     • Inflammatory bowel disease surgery
   • Small Bowel and Intestinal Failure
     • Short bowel syndrome
   • Minimal Access and Endoscopic Surgery
     • Laparoscopic and robotic techniques
     • Therapeutic GI endoscopy

Surgical Gastroenterology (MCh) flashcards for NEET SS

19 of 50 cards from the Surgical Gastroenterology (MCh) deck — real questions with worked answers.

1. In liver surgery, what does the Couinaud classification divide the liver into, and on what basis?

   It divides the liver into 8 functionally independent segments based on portal vein and hepatic artery inflow plus biliary drainage, with hepatic veins forming the boundaries. Each segment has its own vascular pedicle, allowing segmental resection.

2. What is the '50-50 criteria' used to predict mortality after major hepatectomy?

   On postoperative day 5: prothrombin time <50% (INR >1.7) AND serum bilirubin >50 micromol/L (>2.9 mg/dL). Meeting both predicts >50% mortality risk from post-hepatectomy liver failure.

3. What minimum future liver remnant (FLR) volume is generally required to avoid post-hepatectomy liver failure in a normal vs. cirrhotic/chemotherapy-treated liver?

   Normal liver: at least 20-25% FLR. Liver injured by chemotherapy: ~30%. Cirrhotic liver: at least 40%.

4. What is portal vein embolization (PVE) used for before major liver resection?

   PVE occludes the portal branch to the lobe to be resected, redirecting flow to the future liver remnant (FLR) to induce compensatory hypertrophy (typically over 4-6 weeks), increasing FLR volume to a safe level before resection.

5. What is the ALPPS procedure?

   Associating Liver Partition and Portal vein ligation for Staged hepatectomy. Stage 1: in-situ liver splitting + portal vein ligation; this induces rapid FLR hypertrophy within 1-2 weeks. Stage 2: completion of the resection. Used when conventional PVE gives insufficient hypertrophy.

6. What are the standard Milan criteria for liver transplantation in hepatocellular carcinoma (HCC)?

   Single tumor <=5 cm, OR up to 3 tumors each <=3 cm, with no macrovascular invasion and no extrahepatic spread.

7. What is the Pringle maneuver and what does it control?

   Temporary clamping of the hepatoduodenal ligament (porta hepatis), occluding the portal vein and hepatic artery to reduce inflow bleeding during liver resection. It does NOT control hepatic venous (backflow) bleeding.

8. What scoring system allocates deceased-donor livers, and what variables does it use?

   MELD (Model for End-stage Liver Disease) score, calculated from serum bilirubin, creatinine, and INR (MELD-Na adds sodium). Higher score = higher 3-month mortality = higher transplant priority.

9. What is the most common anatomic variant of the cystic/biliary anatomy relevant to cholecystectomy injury, and what is Calot's triangle bounded by?

   Calot's triangle (cystohepatic triangle) is bounded by the cystic duct (inferiorly), the common hepatic duct (medially), and the inferior edge of the liver (superiorly). It contains the cystic artery. The 'critical view of safety' must be achieved before clipping.

10. Describe the Strasberg classification of bile duct injuries (types A-E).

    A: cystic duct/duct of Luschka leak; B: occlusion of aberrant right hepatic duct; C: transection of aberrant right duct without ligation; D: lateral injury to main bile duct; E: circumferential injury of main duct (E1-E5 = Bismuth levels by distance from hilum).

11. What is the Bismuth-Corlette classification used for, and what defines a Type IV tumor?

    It classifies hilar cholangiocarcinoma (Klatskin tumor) by extent of ductal involvement. Type IV = tumor involving both the right and left secondary biliary radicles (multicentric/bilateral), generally considered unresectable or requiring extended resection/transplant protocols.

12. What is the gold-standard operation for a benign biliary stricture or major bile duct injury?

    Roux-en-Y hepaticojejunostomy — anastomosis of healthy proximal bile duct to a defunctionalized Roux limb of jejunum, performed above the level of the stricture on healthy duct.

13. What is the Todani classification, and which type is most common?

    It classifies choledochal (bile duct) cysts. Type I (fusiform/cystic dilatation of the common bile duct) is the most common (~50-80%). Treatment is complete cyst excision with Roux-en-Y hepaticojejunostomy due to malignancy risk.

14. What is Charcot's triad and Reynold's pentad?

    Charcot's triad (acute cholangitis): fever/rigors, right upper quadrant pain, jaundice. Reynold's pentad adds hypotension (shock) and altered mental status (confusion), indicating suppurative cholangitis/sepsis.

15. What defines portal hypertension hemodynamically (HVPG values)?

    Hepatic Venous Pressure Gradient (HVPG) >5 mmHg defines portal hypertension. Clinically significant portal hypertension = HVPG >=10 mmHg (varices form); variceal bleeding risk rises at HVPG >=12 mmHg.

16. What is a TIPS, and what is its main indication and main complication?

    Transjugular Intrahepatic Portosystemic Shunt — a stent connecting a hepatic vein to a portal vein branch to decompress portal pressure. Main indications: refractory variceal bleeding and refractory ascites. Main complication: hepatic encephalopathy (and shunt stenosis).

17. Differentiate selective from non-selective surgical portosystemic shunts, giving an example of each.

    Non-selective (e.g., portocaval, side-to-side): decompress the entire portal system, controlling bleeding well but causing high encephalopathy and reduced hepatic perfusion. Selective (e.g., distal splenorenal/Warren shunt): decompress only gastroesophageal varices via the spleen while maintaining portal flow to the liver, with less encephalopathy.

18. What is the first-line pharmacologic therapy and definitive endoscopic therapy for acute esophageal variceal bleeding?

    Pharmacologic: vasoactive drugs (octreotide/somatostatin or terlipressin) plus prophylactic antibiotics. Definitive endoscopic therapy: endoscopic variceal band ligation (EVL), preferred over sclerotherapy.

19. What is the Sugiura procedure used for in portal hypertension?

    An extensive esophagogastric devascularization (with esophageal transection, splenectomy, and devascularization of the lower esophagus/upper stomach) used to control variceal bleeding while preserving portal flow, typically when shunting is not feasible (e.g., portal/splenic vein thrombosis).

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