Gastrointestinal surgery: alkaline reflux gastritis: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Gastrointestinal surgery: alkaline reflux gastritis

Sample item

Two years after a Billroth II gastrectomy for ulcer disease, a man has constant epigastric burning pain, bilious vomiting that does not relieve the pain, weight loss and anaemia. Endoscopy shows a red, friable gastric remnant with bile pooling and no stomal ulcer or obstruction. Which operation is indicated for refractory symptoms?

AConversion to Roux-en-Y gastrojejunostomyBRedo antrectomy with Billroth IICShortening of the afferent limbDTruncal vagotomy with pyloroplasty

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Conversion to Roux-en-Y gastrojejunostomy

Alkaline (bile) reflux gastritis arises when duodenal contents wash over the gastric remnant. Pain is unrelieved by vomiting, unlike afferent loop syndrome. The definitive operation is Roux-en-Y diversion with a Roux limb long enough to prevent reflux.

Option by option

A. Conversion to Roux-en-Y gastrojejunostomy (correct)
Correct. A Roux limb diverts bile and pancreatic juice away from the gastric remnant.
B. Redo antrectomy with Billroth II
Another Billroth II keeps the same configuration that causes the reflux.
C. Shortening of the afferent limb
Shortening the afferent limb does not prevent bile from reaching the stomach and does not divert it.
D. Truncal vagotomy with pyloroplasty
Vagotomy lowers acid but does nothing to stop bile reflux.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Conversion to Roux-en-Y gastrojejunostomy. Alkaline (bile) reflux gastritis arises when duodenal contents wash over the gastric remnant.

Why is "Redo antrectomy with Billroth II" not the answer?

Another Billroth II keeps the same configuration that causes the reflux.

Why is "Shortening of the afferent limb" not the answer?

Shortening the afferent limb does not prevent bile from reaching the stomach and does not divert it.

Why is "Truncal vagotomy with pyloroplasty" not the answer?

Vagotomy lowers acid but does nothing to stop bile reflux.

What concept does this question test?

It tests Gastrointestinal surgery: alkaline reflux gastritis in General Surgery. Pain is unrelieved by vomiting, unlike afferent loop syndrome. The definitive operation is Roux-en-Y diversion with a Roux limb long enough to prevent reflux.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastrointestinal surgery: alkaline reflux gastritis?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.