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Jaspie - Surgery > 11 - Esophagus and Stomach > Flashcards

11 - Esophagus and Stomach Flashcards

1
Q

Blood supply of the esophagus:

A

-upper third: inferior thyroid artery

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2
Q

Venous drainage of the esophagus:

A

-upper third: inferior thyroid vein -middle third: azygos vein -lower third: left gastric vein

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3
Q

First diagnostic test in patients with suspected esophageal disease

A

barium swallow

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4
Q

Essential tool in preoperative evaluation of patients before antireflux surgery

A

manometry

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5
Q

Gold standard for diagnosis of GERD

A

24 hour ambulatory pH monitoring 96% specificity

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6
Q

Most specific symptom of foregut disease

A

dysphagia

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7
Q

Characteristics of defective sphincter

A
  1. LES with mean resting pressure of < 6 mmHg 2. overall sphincter length of < 2 cm 3. intraabdominal sphincter length of <1 cm
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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

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9
Q

Hallmark of barett esophagus

A

presence of intestinal goblet cells in the esophageal epitheliem (intestinal metaplasia)

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10
Q

Medical Management of GERD

A

12 weeks of emperic antacid

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11
Q

Surgical Management of GERD

A
  1. 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
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12
Q

Procedure for esophageal lengthening

A

collis gastroplasty

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13
Q

Procedure for placement of silastic device around the distal esophagus, keeping this segment in the abdomen

A

angelchik prosthesis

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14
Q

Type of hernia where there is upward dislocation of the CARDIA

A

Type 1 Sliding Hernia

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15
Q

Type of hernia where there is upward dislocation of the FUNDUS

A

Type 2 Rolling Hernia

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16
Q

A hernia that stretches the phrenoesophageal ligament

A

Type 1 Sliding Hernia

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17
Q

A hernia with a defect in the phrenoesophageal membrane

A

Type 2 Rolling Hernia

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18
Q

A hernia wherein the esophagogastric junction is in the mediastinum

A

Type 3 Mixed

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19
Q

A complication of hernia that is an emergency

A

Gastric volvulus

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20
Q

Triad of gastric volvulus

A

Borchardt’s triad 1. pain 2. nausea with inability to vomit 3. inability to pass NGT

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21
Q

What is the diagnostic test for paraesophageal hernia

A

Barium esophagogram

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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

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23
Q

Predominant feature of scleroderma of esophagus

A

atrophy of the smooth muscle

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24
Q

This is the most common esophageal diverticulum

A

zenkers diverticulum

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25
Q

This disease is due to weakness of the cricopharyngeal muscle at the KILLIAN’S AREA

A

zenkers diverticulum

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26
Q

Treatment of zenkers diverticulum

A
  1. pharyngomyotomy: < 2 cm 2. diverticulectomy/diverticulopexy: >2 cm
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27
Q

A disease characterized by complete absence of peristalsis in the esophageal body and failure of relaxation of LES

A

Achalaasia

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28
Q

Triad of achalaasia

A
  1. weight loss 2. regurgitation 3. dysphagia
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29
Q

treatment of achalasia

A

Heller’s Myotomy

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30
Q

Characteristic feature of achalasia in barium esophagogram?

A

Dilated esophagus with a tapering Bird’s Beak appearance

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31
Q

This disease is seen in the esophagogram as corkscrew esophagus or pseudodiverticulosis

A

DES - diffuse and segmental esophageal spasm

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32
Q

This is also known as supersqueezer esophagus

A

nutcracker esophagus

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33
Q

This is a puslion diverticula

A

Epiphrenic diverticula False Diverticula Cause: Motor Disorder

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34
Q

This is a traction diverticula

A

Midesophageal Diverticula True Diverticula Cause: Inflammatory disorder

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35
Q

A disease with spontaneous perforation of the esophagus

A

Boerhaave;s syndrome (post emetic esophageal rupture)

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36
Q

Treamtent of esophageal perforation

A

primary closure of the perforation within 24 hours results in 80 - 90% survival

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37
Q

Most common location of esophageal perforation

A

left lateral wall of esophagus, just above the GEJ

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38
Q

This disease is characterized as longitudinal tear in the mucosa of the GE junction

A

Mallory weiss syndrome

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39
Q

Phases of caustic injury

A
  1. acute necrotic phase 2. ulceration and granulation phase 3. cicatrization and scarring
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40
Q

The phase of caustic injury where in the esophagus is weakest

A

ulceration and granulation phase

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41
Q

This phase of caustic injury is characterize by dysphagia

A

Cicatrizaation and scarring

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42
Q

Diagnostic test for caustic injury

A

Esophagogram within 12 hours

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43
Q

Most common presenting symptom of esophageal carcinoma

A

dysphagia

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44
Q

Characteristic of cervical esophagus carcinoma

A
  1. squamous 2. unresectable 3. invades larynx, trachea, great vessels
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45
Q

treatment of cervical esophagus carcinoma

A

Stereotactic radiation with concomitant chemotherapy

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46
Q

Characteristic of thoracic esophagus carcinoma

A
  1. squamous 2. lymph node metastasis
47
Q

treatment of thoracic esophagus carcinoma

A

VATS + thoracotomy

48
Q

Characteristic of distal esophagus carcinoma

A
  1. adenocarcinoma
49
Q

treatment of distal esophagus carcinoma

A

curative resection requires cervical division of esophagus + >50% gastrectomy

50
Q

It is a procedure for middle/thoracic esophageal lesion wherein all the LN are removed en bloc with the lesser curvature of the stomach

A

Ivor Lewis Procedure

51
Q

This surgical procedure is excellent in exposure of the distal esophagus

A

Left thoracoabdominal approach

52
Q

where are the parietal cells located

A

Body of the stomach

53
Q

largest artery to the stomach

A

left gastric artery

54
Q

What is the nerve in the posterior fundus that is easily missed during truncal or highly selective vagotomy

A

criminal nerve of grassi

55
Q

What nerve innervates gastric contraction

A

vagus nerve from parasympathetic fibers

56
Q

Location of gastric ulcers associated with increase gastric acid production

A

pylorus type II and III

57
Q

Most serious complication of EGD

A

esophageal perforation

58
Q

Advantage of double contrast upper GI series compared to EGD

A
  1. diverticula 2. fistula 3. tortuosity or stricture location 4. size of hiatal hernia
59
Q

Gold standard for H. pylori diagnostic

A

Histologic examination of antral biopsy with special stains

60
Q

Test for eradication of H. pylori

A

urease breath test

61
Q

Blood type more common duodenal ulcer

A

type O

62
Q

Blood type more common gastric ulcer

A

Type A

63
Q

Peptic ulcer formed after severe burn injury

A

curling ulcer

64
Q

Peptic ulcer formed after severe brain injury

A

cushing ulcer

65
Q

Types of ulcer associated with increased gastric acid secretion

A

Type II and III

66
Q

Types of ulcer associated with normal or decreased gastric acid secretion

A

Type I and IV

67
Q

Ulcer located in the Angularis Incisura

A

Type I - most common

68
Q

Ulcer located in the angularis incisura but with accompanying duodenal ulcer

A

Type II

69
Q

Ulcer located in the Prepyloric area

A

Type III

70
Q

Ulcer located in the GE junction

A

Type IV

71
Q

Ulcer caused by NSAID and can occur anywhere

A

Type V

72
Q

Indications of endoscopy in PUD

A
  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
Q

Location of High risk ulcer for massive bleeding

A
  1. lesser curvature of stomach with erosion to left gastric artery 2. posterior duodenal ulcer with erosion to gastroduodenal artery
74
Q

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

A

highly selective vagotomy parietal cell vagotomy proximal gastric vagotomy

75
Q

This is a posterior truncal vagotomy and anterior seromyotomy

A

Taylor procedure

76
Q

This procedure is useful for patients who require pyloroduodenotomy to deal with the ulcer complication

A

truncal vagotomy + pyloroplasty

77
Q

This is a good choice in patients with gastric outlet obstruction

A

truncal vagotomy + gastrojejunostomy

78
Q

Where is gastrin produced

A

antral G cells

79
Q

What is the most potent inhibitor of gastrin

A

luminal acid

80
Q

what is the most potent stimulatn of gastrin

A

luminal peptide and amino acid

81
Q

Where does 90% of Zollinger Ellison Syndrome occur

A

Pasaro’s Triangle Gastrinoma triangle

82
Q

What are the boundaries of Pasaro’s Triangle

A
  1. junction of cystic and common bile duct 2. 2nd and 3rd segment of duodenum 3. junction of body and neck of pancreas
83
Q

Confirmatory Test for ZES

A

Posivie secretin stimulation test

84
Q

What other laboratory test are needed to check for ZES

A

serum calcium and PTH to rule out MEN1 -parathyroid -pituitary -pancreatic or duodenal tumors

85
Q

What is the preoperative imaging of choice for gastrinoma

A

Somatostatin receptor scintigraphy

86
Q

Where is somatostatin produced

A

D cells located through out the gastric mucosa

87
Q

Major stimulus for somatostatin release

A

antral acidification

88
Q

What inhibits somatostatin release

A

acetylcholine

89
Q

A type of ulcer that is due to inadequate gastric mucosal blood flow

A

Stress ulcer

90
Q

Which risk factor has no role in gastric adenocarcinoma

A

ALCOHOL!

91
Q

Type of polyps associated with gastric carcinoma

A
  1. hyperplastic 2. adenomas
92
Q

Protective factors of gastric carcinoma

A
  1. vitamin c 2. aspirin 3. high in fruits and vegetables
93
Q

What is the most common precancerous lesion in gastric carcinoma

A

atrophic gastritis

94
Q

What is the most important prognosticating factor or gastric cancer

A

lymph node involvemet depth of tumor invasion

95
Q

Another name for linitis plastica

A

Scirrhous Tumor

96
Q

A name for palpable umbilical nodule in gastric CA

A

sister mary and joseph nodule

97
Q

A name for palpable nodule in the pouch of douglas

A

blumer nodes sign of drop metastases

98
Q

Only curative treatment of gastic cancer

A

radical subtotal gastrectomy

99
Q

goal of resecting gastric cancer

A

R0 resection grossly negative margin of at least 5 cm

100
Q

What is the most common site for primary GI lymphoma

A

stomach

101
Q

Treatment of gastric lymphoma

A

chemotherapy It is equivalent to surgery

102
Q

It is a submucosal solitary slow growing tumor arising from the interstitial cells of cajal

A

GIST

103
Q

Most common cell type of GIST

A

epithelial cell stromal GIST

104
Q

Marker for GIST

A

(+) c - kit

105
Q

Treatment of GIST

A

wedge resection with clear margins

106
Q

Treatmet of unresectable or metastatic GIST

A

Imatinib - tyrosine kinase inhibitor

107
Q

Mode of metastasis of GIST

A

hematogenous: liver and lungs

108
Q

Most common type of polyp

A

hyperplastic (regenerative) polyp - 75%

109
Q

What is the cause of afferent limb obstruction (blind loop syndrome)

A

billroth II - distal gastric resection followed by gastrojejunal anastomosis

110
Q

What is the treatment of afferent limb obstruction?

A

conversion of billroth II to rouy en y gastric bypass

111
Q

What is roux syndrome

A

delayed gastric emptying Endoscopy: Bezoar formation

112
Q

This presents with hypochloremic, hypokalemic, metabolic alkalosis

A

Gastric outlet obstruction

113
Q

This disease occurs when there is delivery of a hyperosmolar load into the small bowel

A

Dumping Syndrome

Jaspie - Surgery (18 decks)

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