10/28/2018

Question 1

Treatment of gastric adenocarcinoma with T3 or N+ disease?

Answer 1

Neoadjuvant + resection.

NCCN now recommends neoadjuvant therapy for locally advanced (T3 or node positive based on EUS) gastric cancer.

Question 2

erythromycin MoA?

Answer 2

binds and activates motillin receptors to stimulate smooth muscle contraction in the stomach.

Question 3

What type of gastric polyps have NO malignant potential?

Answer 3

Fundic polyps!

Risk factors include H.Pylori and gastritis.

Question 4

What are the three patterns of inflammation with H. pylori infection?
Which is most common?

Answer 4

Diffuse, antral and stomach-body related.

Diffuse is most common, but it is not associated with the development of a peptic ulcer.

Question 5

What cells release somatostatin?

Answer 5

D cells. Released in response to acid environment.

Located in duodenum, stomach, and pancreas.

Question 6

Treatment of H.Pylori

Answer 6

PPI + 2 antibiotics.

Amoxicillin, metronidazole, tetracyclin, clarithromycin.

Question 7

Rank EGD findings in terms of highest to lowest risk of bleed.

Answer 7

Highest risk of a bleed comes from a previously seen as an active bleeding vessel. - needs endo-therapy
Next is from a non-bleeding visible vessel. - Need endo-therapy

An adherent clot is just intermediate risk.
A black spot or a clean base are classified as low risk for bleeding.