Gastrointestinal surgery: marginal ulcer: 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: marginal ulcer

Sample item

Eight months after a gastrojejunostomy for duodenal ulcer, a man has epigastric pain and bleeding. Endoscopy shows an ulcer on the jejunal side of the anastomosis. What is the likely cause?

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

The answer and the reasoning

A. Acid acting on jejunal mucosa that is not acid-resistant

A marginal ulcer forms where acid meets jejunal mucosa, which lacks the protection of gastric or duodenal mucosa, especially with incomplete vagotomy or retained antrum. Treatment is acid suppression and H. pylori eradication.

Option by option

  • A. Acid acting on jejunal mucosa that is not acid-resistant (correct)

    Correct. Unprotected jejunal mucosa is injured by acid.

  • B. Afferent loop stasis

    Afferent loop stasis causes bilious vomiting.

  • C. Rapid gastric emptying

    Rapid emptying causes dumping symptoms.

  • D. Bile reflux into the stomach

    Bile reflux causes gastritis, not an anastomotic ulcer.

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.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Acid acting on jejunal mucosa that is not acid-resistant. A marginal ulcer forms where acid meets jejunal mucosa, which lacks the protection of gastric or duodenal mucosa, especially with incomplete vagotomy or retained antrum.

Why is "Afferent loop stasis" not the answer?

Afferent loop stasis causes bilious vomiting.

Why is "Rapid gastric emptying" not the answer?

Rapid emptying causes dumping symptoms.

Why is "Bile reflux into the stomach" not the answer?

Bile reflux causes gastritis, not an anastomotic ulcer.

What concept does this question test?

It tests Gastrointestinal surgery: marginal ulcer in General Surgery. Treatment is acid suppression and H. pylori eradication.

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: marginal ulcer?

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.