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FUN MED SPRING 2018 > 5. Gastric Cancer, Zollinger-Ellison Syndrome, & Pyloric Stenosis > Flashcards

5. Gastric Cancer, Zollinger-Ellison Syndrome, & Pyloric Stenosis Flashcards

1
Q

What is the 5 year survival rate for localized stomach cancer?

A

67%

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2
Q

How does gastric cancer spread?

A

Direct extension through the GASTRIC WALL and LYMPHATICS

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3
Q

What are the most common type of gastric cancer?

A

Adenocarcinoma

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4
Q

Type of cells in the cardia

A

Mucus secreting cells

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5
Q

Type of cells in the fundus and body of stomach

A

Mucoid, Chief, and Parietal Cells

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6
Q

Cells in the pylori

A

Mucus secreting cells and endocrine cells

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7
Q

30% of gastric cancers originate in the_______stomach, 20% in ________, and 40% in ___________.

A

Distal
Mid
Proximal third

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8
Q

What kind of fungus is a risk factor for gastric cancer?

A

Aflatoxin

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9
Q

What kind of blood type is a risk factor for gastric cancer?

A

Group A

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10
Q

Common symptom of gastric cancer

A

Postprandial fullness

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11
Q

A patient presents with palpable enlarged stomach with succession splash…….

A

Gastric Cancer

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12
Q

Which lymph nodes are generally enlarged in gastric cancer?

A

Virchow Nodes

Irish Nodes

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13
Q

Test used to evaluate the gastric wall, obtain a biopsy and establish lymph node involvement.

A

EGD

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14
Q

If you wanted to assess the tumor stage for preoperation what test would you use?

A

EUS

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15
Q

Metastatic ovarian nodules (tumor).

A

Krukenberg’s tumor

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16
Q

Periumbilical nodes (tumor).

A

“Sister Mary Jospeh node”

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17
Q

Metastasis to the peritoneal cul-de-sac (tumor)

A

Blumer’s shelf

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18
Q

What test would you use when obstructive sx are present?

A

Double-contrast upper GI series and barium swallows.

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19
Q

Tests used to evaluate for metastatic lesions.

A

Chest Radiography

CT or MRI

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20
Q

Lab tests for Gastric Cancer

A

CBC-id anemia (found in 30% of pt’s b/c of bleeding)

CMP:used to characterize the patient’s clinical state

Carcinoembryonic antigen (CEA): inc. in 45-50%

Cancer Antigen 19-9: elevated in 20%

Stool occult blood test

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21
Q

Tx of gastric adenocarcinoma

A

Complete surgical removal of the tumor with RESECTION of adjacent lymph nodes (only chance of survival)

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22
Q

Cure rate for early lesions limited to the mucosa or submucosa in gastric adenocarcinoma

A

> 80%

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23
Q

What additional tx would you give to medically fit patients with potentially resectable tumors?

A

Preoperative chemo or chemoradiotherpy followed by surgery

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24
Q

Tx of choice for pt’s with DISTAL carcinomas.

A

Subtotal gastrectomy

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25
Q

What kind of gastrecomy is required for PROXIMAL tumors?

A

TOTAL or NEAR-TOTAL gastrectomy

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26
Q

What is the best form of palliation?

A

Reduction of tumor bulk

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27
Q

A relatively radioresistant tumor?

A

Adenocarcinoma

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28
Q

What can prolong survival in pt’s with adenocarcinoma?

A

Combo radiotherapy and 5-fluorouracil (5-FU)

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29
Q

Probability of survival after 5 yrs for the 25-30% of pt’s unable to complete resection is 20% for _________and <10% for _______

A

Distal

Proximal

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30
Q

What reduces the recurrence rate and prolongs survival in pt’s with gastric adenocarcinoma?

A

Combo chemo before and after surgery along with postoperative chemo with radiation therapy

31
Q

What is the most frequent extranodal site for lymphoma?

A

Stomach

32
Q

The majority of gastric lymphoma’s are __________.

A

B Cell lymphomas

33
Q

S/S of Gastric Lymphoma

A
  • 6th decade
  • Epigastric pain
  • Early satiety
  • Generalized fatigue
  • Ulcers with a ragged, thickened mucosal pattern
34
Q

What do you need to get to diagnose gastric lymphoma?

A

DEEP GASTRIC BIOPSY

35
Q

Is gastric lymphoma more treatable than adenocarcinoma?

A

Yes

36
Q

First step in Tx for gastric lymphoma

A

Antibiotic tx. For H. Pylori

37
Q

If a pt has. a lack of response to antimicrobial treatment during antibiotic tx for gastric lymphoma what would you consider?

A

Chromosomal abnormality

38
Q

What is a highly effective therapy for gastric lymphoma?

A

CHOP + rituximab

39
Q

What has led to a 5 yr survival rate of 40-60% in pt’s with localized high-grade lymphomas?

A

Subtotal gastrectomy with chemo

40
Q

Also known as gastrinoma….

A

ZES

41
Q

A pancreatic neuroendocrine tumor that secretes gastrin:

A

ZES

42
Q

ZES causes: (2 things)

A

Gastric acid hypersecretion

Growth of the gastric mucosa (more parietal and ECL cells)

43
Q

Where is ZES usually located?

A

Doudenal ulcers

44
Q

A pt. presents with duodenal ulcers, a NEGATIVE H. Pylori test and chronic diarrhea……

A

ZES

45
Q

The high acidity of chyme in intestines from ZES causes______and _______.

A

Diarrhea

Malabsorption

46
Q

20-25% of pt’s with ZES have_______

A

MEN 1

47
Q

Mutations of the MEN1 tumor suppressor gene at the ________

A

11q13 locals

48
Q

What should you measure in pt’s with ZES?

A

MEN1!

-plasma ionized calcium, prolactin levels, plasma hormone levels

49
Q

A patient presents with abdominal pain and GERD, diarrhea and weight loss. On exam you find epigastric tenderness and note dental caries. Stool samples show steotorrhia with some bleeding.

A

ZES

50
Q

3 tests for diagnosis ZES

A

Fasting Gastrin Level
Basal Gastric Acid Output
Secretin Provocative Test

51
Q

Results of Fasting Gastrin Level in ZES

A

Inappropriate fasting hypergastrinemia

Gastrin >1000 pg/mL

52
Q

Results of Basal gastric acid output in ZES

A

Fasting pH< or = to 2 when OFF antisecretory drugs

53
Q

Results of secretin provocative test

A

Positive-gastrin levels rise 120 pg w/in 15 min of injection

54
Q

This test uses radioactive tracers to help locate tumors.

A

Somatostatin receptor scintigraphy

55
Q

The most sensitive imaging modality for detection of primary or metastatic lesions.

A

Somatostatin receptor scintigraphy

56
Q

This test is used to locate a tumor and evaluate for metastatic disease (less sensitive).

A

CT

57
Q

What test would you use if you wanted to look for duodenal ulceration and hypertrophy of gastric folds in pt’s with ZES?

A

EGD

58
Q

What test would use if you wanted to localize the gastrinoma?

A

EU

59
Q

Tx for ZES

A

PPI
H2
B 12 may be needed

60
Q

Successful resection of gastrinoma results in :

A

Dec/ chance of liver metastasis.

Inc. disease-related survival rate.

61
Q

What must you do in tx. for pt’s with MEN1 and ZES?

A

Must treat hyperparathyroidism for antisecretory drugs BEFORE MEDS

62
Q

5-yr survival rate for pt’s WITH metastatic gastrinoma to the LIVER is _______with 10 yr_______

A

20%

10%

63
Q

Newborn has projectile postprandial vomiting.

A

Pylori Stenosis

64
Q

Age that vomiting begins in pyloric stenosis

A

Between 2-4 weeks

65
Q

Risk factors for Pyloric Stenosis

A 
Male
Caucasian
Premature
Family Hx
Smoking during pregnancy
Erythromycin
66
Q

What type of alkalosis do you see in pyloric stenosis?

A

Hypochloremic, hypokalemic, metabolic alkalosis

67
Q

You see peristaltic waves from left to right and an oval mass on RIGHT UPPER abdomen?

A

Pyloric stenosis

68
Q

The diagnostic tool of choice for pyloric stenosis?

A

Ultrasonography

69
Q

What would you expect to find an ultrasound of a pt with pyloric stenosis?

A

Hypoechoic muscle ring > 4 mm with hyper dense center and a pyloric channel length >15mm

70
Q

Immediate tx for pyloric stenosis.

A

Need to correct fluid looks, electrolytes and acid-base imbalance.

71
Q

What kind of surgery is common in the tx pyloric stenosis?

A

RAMSTEDT pyloromyotomy

72
Q

When can infants feed after recovery from anesthesia during surgery for pyloric stenosis?

A

4-8 hrs

73
Q

Is it normal for pt’s to regurgitate after surgery for pyloric stenosis?

A

YES, worrisome if 5 days after

74
Q

Pt’s with pyloric stenosis have 4x greater risk for developing_______

A

Chronic abdominal pain

FUN MED SPRING 2018 (14 decks)

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