Gastrointestinal surgery: post-gastrectomy syndromes: 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: post-gastrectomy syndromes

Sample item

Some months after a Billroth II gastrectomy, a man has postprandial epigastric fullness and pain that is relieved by sudden projectile vomiting of bile-stained fluid containing no food. What is the likely diagnosis?

AEarly dumping syndromeBAfferent loop syndromeCAlkaline reflux gastritisDGastrojejunal anastomotic ulcer

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

The answer and the reasoning

B. Afferent loop syndrome

Partial obstruction of the afferent limb lets bile and pancreatic juice build up after a meal, causing pain that is relieved when the loop empties in a bilious, food-free vomit. Dumping gives vasomotor symptoms soon after eating, and reflux gastritis causes constant burning pain with food-containing vomit.

Option by option

A. Early dumping syndrome
Early dumping causes sweating, palpitation and diarrhoea within minutes of eating.
B. Afferent loop syndrome (correct)
Correct. Pain relieved by bilious vomit without food points to the obstructed afferent limb.
C. Alkaline reflux gastritis
Alkaline reflux gastritis gives continuous burning pain unrelieved by vomiting.
D. Gastrojejunal anastomotic ulcer
An anastomotic ulcer gives pain related to acid and bleeding, not a food-free bilious vomit.

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 B, Afferent loop syndrome. Partial obstruction of the afferent limb lets bile and pancreatic juice build up after a meal, causing pain that is relieved when the loop empties in a bilious, food-free vomit.

Why is "Early dumping syndrome" not the answer?

Early dumping causes sweating, palpitation and diarrhoea within minutes of eating.

Why is "Alkaline reflux gastritis" not the answer?

Alkaline reflux gastritis gives continuous burning pain unrelieved by vomiting.

Why is "Gastrojejunal anastomotic ulcer" not the answer?

An anastomotic ulcer gives pain related to acid and bleeding, not a food-free bilious vomit.

What concept does this question test?

It tests Gastrointestinal surgery: post-gastrectomy syndromes in General Surgery. Dumping gives vasomotor symptoms soon after eating, and reflux gastritis causes constant burning pain with food-containing vomit.

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: post-gastrectomy syndromes?

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.