11 - Esophagus and Stomach Flashcards
1
Q
Blood supply of the esophagus:
A
-upper third: inferior thyroid artery
2
Q
Venous drainage of the esophagus:
A
-upper third: inferior thyroid vein -middle third: azygos vein -lower third: left gastric vein
3
Q
First diagnostic test in patients with suspected esophageal disease
A
barium swallow
4
Q
Essential tool in preoperative evaluation of patients before antireflux surgery
A
manometry
5
Q
Gold standard for diagnosis of GERD
A
24 hour ambulatory pH monitoring 96% specificity
6
Q
Most specific symptom of foregut disease
A
dysphagia
7
Q
Characteristics of defective sphincter
A
- LES with mean resting pressure of < 6 mmHg 2. overall sphincter length of < 2 cm 3. intraabdominal sphincter length of <1 cm
8
Q
Grading of esophagitis
A
I - small circular nonconfluent erosion II - linear erosion with granulation tissue, bleeds easily when touched III - coalesce to form circumferential loss, cobble stone mucosa IV - presence of stricture
9
Q
Hallmark of barett esophagus
A
presence of intestinal goblet cells in the esophageal epitheliem (intestinal metaplasia)
10
Q
Medical Management of GERD
A
12 weeks of emperic antacid
11
Q
Surgical Management of GERD
A
- nissen fundoplication - 360 degree wrap 2. belsey operation - 280 degree wrap 3. hill operation - 180 degree wrap 4. collis gastroplasty - esophageal lengthening 5. angelchik prosthesis - placement of silastic device around the distal esophagus
12
Q
Procedure for esophageal lengthening
A
collis gastroplasty
13
Q
Procedure for placement of silastic device around the distal esophagus, keeping this segment in the abdomen
A
angelchik prosthesis
14
Q
Type of hernia where there is upward dislocation of the CARDIA
A
Type 1 Sliding Hernia
15
Q
Type of hernia where there is upward dislocation of the FUNDUS
A
Type 2 Rolling Hernia
16
Q
A hernia that stretches the phrenoesophageal ligament
A
Type 1 Sliding Hernia
17
Q
A hernia with a defect in the phrenoesophageal membrane
A
Type 2 Rolling Hernia
18
Q
A hernia wherein the esophagogastric junction is in the mediastinum
A
Type 3 Mixed
19
Q
A complication of hernia that is an emergency
A
Gastric volvulus
20
Q
Triad of gastric volvulus
A
Borchardt’s triad 1. pain 2. nausea with inability to vomit 3. inability to pass NGT
21
Q
What is the diagnostic test for paraesophageal hernia
A
Barium esophagogram
22
Q
It is a thin submucosal circumferential ring in the Lower esophagus at the squamocolumnar junction, often associated with hiatal hernia
A
Schatzki’s Ring
23
Q
Predominant feature of scleroderma of esophagus
A
atrophy of the smooth muscle
24
Q
This is the most common esophageal diverticulum
A
zenkers diverticulum
25
This disease is due to weakness of the cricopharyngeal muscle at the KILLIAN'S AREA
zenkers diverticulum
26
Treatment of zenkers diverticulum
1. pharyngomyotomy: \< 2 cm 2. diverticulectomy/diverticulopexy: \>2 cm
27
A disease characterized by complete absence of peristalsis in the esophageal body and failure of relaxation of LES
Achalaasia
28
Triad of achalaasia
1. weight loss 2. regurgitation 3. dysphagia
29
treatment of achalasia
Heller's Myotomy
30
Characteristic feature of achalasia in barium esophagogram?
Dilated esophagus with a tapering Bird's Beak appearance
31
This disease is seen in the esophagogram as corkscrew esophagus or pseudodiverticulosis
DES - diffuse and segmental esophageal spasm
32
This is also known as supersqueezer esophagus
nutcracker esophagus
33
This is a puslion diverticula
Epiphrenic diverticula False Diverticula Cause: Motor Disorder
34
This is a traction diverticula
Midesophageal Diverticula True Diverticula Cause: Inflammatory disorder
35
A disease with spontaneous perforation of the esophagus
Boerhaave;s syndrome (post emetic esophageal rupture)
36
Treamtent of esophageal perforation
primary closure of the perforation within 24 hours results in 80 - 90% survival
37
Most common location of esophageal perforation
left lateral wall of esophagus, just above the GEJ
38
This disease is characterized as longitudinal tear in the mucosa of the GE junction
Mallory weiss syndrome
39
Phases of caustic injury
1. acute necrotic phase 2. ulceration and granulation phase 3. cicatrization and scarring
40
The phase of caustic injury where in the esophagus is weakest
ulceration and granulation phase
41
This phase of caustic injury is characterize by dysphagia
Cicatrizaation and scarring
42
Diagnostic test for caustic injury
Esophagogram within 12 hours
43
Most common presenting symptom of esophageal carcinoma
dysphagia
44
Characteristic of cervical esophagus carcinoma
1. squamous 2. unresectable 3. invades larynx, trachea, great vessels
45
treatment of cervical esophagus carcinoma
Stereotactic radiation with concomitant chemotherapy
46
Characteristic of thoracic esophagus carcinoma
1. squamous 2. lymph node metastasis
47
treatment of thoracic esophagus carcinoma
VATS + thoracotomy
48
Characteristic of distal esophagus carcinoma
1. adenocarcinoma
49
treatment of distal esophagus carcinoma
curative resection requires cervical division of esophagus + \>50% gastrectomy
50
It is a procedure for middle/thoracic esophageal lesion wherein all the LN are removed en bloc with the lesser curvature of the stomach
Ivor Lewis Procedure
51
This surgical procedure is excellent in exposure of the distal esophagus
Left thoracoabdominal approach
52
where are the parietal cells located
Body of the stomach
53
largest artery to the stomach
left gastric artery
54
What is the nerve in the posterior fundus that is easily missed during truncal or highly selective vagotomy
criminal nerve of grassi
55
What nerve innervates gastric contraction
vagus nerve from parasympathetic fibers
56
Location of gastric ulcers associated with increase gastric acid production
pylorus type II and III
57
Most serious complication of EGD
esophageal perforation
58
Advantage of double contrast upper GI series compared to EGD
1. diverticula 2. fistula 3. tortuosity or stricture location 4. size of hiatal hernia
59
Gold standard for H. pylori diagnostic
Histologic examination of antral biopsy with special stains
60
Test for eradication of H. pylori
urease breath test
61
Blood type more common duodenal ulcer
type O
62
Blood type more common gastric ulcer
Type A
63
Peptic ulcer formed after severe burn injury
curling ulcer
64
Peptic ulcer formed after severe brain injury
cushing ulcer
65
Types of ulcer associated with increased gastric acid secretion
Type II and III
66
Types of ulcer associated with normal or decreased gastric acid secretion
Type I and IV
67
Ulcer located in the Angularis Incisura
Type I - most common
68
Ulcer located in the angularis incisura but with accompanying duodenal ulcer
Type II
69
Ulcer located in the Prepyloric area
Type III
70
Ulcer located in the GE junction
Type IV
71
Ulcer caused by NSAID and can occur anywhere
Type V
72
Indications of endoscopy in PUD
1. patient \> 45 y.o 2.patient regardless of age with alarm symptoms a. weight loss b. dysphagia c. anemia d. bleeding e.recurrent vomiting
73
Location of High risk ulcer for massive bleeding
1. lesser curvature of stomach with erosion to left gastric artery 2. posterior duodenal ulcer with erosion to gastroduodenal artery
74
This surgery is done by severing the proxial 2/3 of vagal supply to the stomach, preserves the antrum and pylorus and remaining abdominal viscera
highly selective vagotomy parietal cell vagotomy proximal gastric vagotomy
75
This is a posterior truncal vagotomy and anterior seromyotomy
Taylor procedure
76
This procedure is useful for patients who require pyloroduodenotomy to deal with the ulcer complication
truncal vagotomy + pyloroplasty
77
This is a good choice in patients with gastric outlet obstruction
truncal vagotomy + gastrojejunostomy
78
Where is gastrin produced
antral G cells
79
What is the most potent inhibitor of gastrin
luminal acid
80
what is the most potent stimulatn of gastrin
luminal peptide and amino acid
81
Where does 90% of Zollinger Ellison Syndrome occur
Pasaro's Triangle Gastrinoma triangle
82
What are the boundaries of Pasaro's Triangle
1. junction of cystic and common bile duct 2. 2nd and 3rd segment of duodenum 3. junction of body and neck of pancreas
83
Confirmatory Test for ZES
Posivie secretin stimulation test
84
What other laboratory test are needed to check for ZES
serum calcium and PTH to rule out MEN1 -parathyroid -pituitary -pancreatic or duodenal tumors
85
What is the preoperative imaging of choice for gastrinoma
Somatostatin receptor scintigraphy
86
Where is somatostatin produced
D cells located through out the gastric mucosa
87
Major stimulus for somatostatin release
antral acidification
88
What inhibits somatostatin release
acetylcholine
89
A type of ulcer that is due to inadequate gastric mucosal blood flow
Stress ulcer
90
Which risk factor has no role in gastric adenocarcinoma
ALCOHOL!
91
Type of polyps associated with gastric carcinoma
1. hyperplastic 2. adenomas
92
Protective factors of gastric carcinoma
1. vitamin c 2. aspirin 3. high in fruits and vegetables
93
What is the most common precancerous lesion in gastric carcinoma
atrophic gastritis
94
What is the most important prognosticating factor or gastric cancer
lymph node involvemet depth of tumor invasion
95
Another name for linitis plastica
Scirrhous Tumor
96
A name for palpable umbilical nodule in gastric CA
sister mary and joseph nodule
97
A name for palpable nodule in the pouch of douglas
blumer nodes sign of drop metastases
98
Only curative treatment of gastic cancer
radical subtotal gastrectomy
99
goal of resecting gastric cancer
R0 resection grossly negative margin of at least 5 cm
100
What is the most common site for primary GI lymphoma
stomach
101
Treatment of gastric lymphoma
chemotherapy It is equivalent to surgery
102
It is a submucosal solitary slow growing tumor arising from the interstitial cells of cajal
GIST
103
Most common cell type of GIST
epithelial cell stromal GIST
104
Marker for GIST
(+) c - kit
105
Treatment of GIST
wedge resection with clear margins
106
Treatmet of unresectable or metastatic GIST
Imatinib - tyrosine kinase inhibitor
107
Mode of metastasis of GIST
hematogenous: liver and lungs
108
Most common type of polyp
hyperplastic (regenerative) polyp - 75%
109
What is the cause of afferent limb obstruction (blind loop syndrome)
billroth II - distal gastric resection followed by gastrojejunal anastomosis
110
What is the treatment of afferent limb obstruction?
conversion of billroth II to rouy en y gastric bypass
111
What is roux syndrome
delayed gastric emptying Endoscopy: Bezoar formation
112
This presents with hypochloremic, hypokalemic, metabolic alkalosis
Gastric outlet obstruction
113
This disease occurs when there is delivery of a hyperosmolar load into the small bowel
Dumping Syndrome
