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ABSITE Review > ABSITE Review - Stomach > Flashcards

ABSITE Review - Stomach Flashcards

1
Q

What is the approximate transit stomach time?

A

3-4 hours

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2
Q

Does peristalsis occurs in the stomach?

A

Only in distal stomach

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3
Q

What is the blood supply of the stomach?

A

Lesser curvature - right (common hepatic artery) and left gastric (celiac trunk)
Greater curvature - right (GDA) and left gastroepiploic artery (splenic artery), short gastric (splenic artery)

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4
Q

What the epithelium of the stomach mucosa?

A

Simple columnar

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5
Q

What are the glands in the cardia?

A

Mucus secreting

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6
Q

What are the glands in the fundus and body of the stomach?

A

Chief and parietal cells

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7
Q

What are the three stimulators for HCL secretion?

A

ACh, gastrin, histamine

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8
Q

What is the first enzyme in proteolysis?

A

pepsinogen

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9
Q

What is released by the parietal cells?

A

H+ and intrinsic factor

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10
Q

How differs the mechanism for HCl release of histamine vs ACh/gastrin?

A

Histamine acts on adenylate cyclase –> cAMP –> protein kinase A to increase HCl
Ach/Gastrin act on phospholipase –> PIP –> DAG + IP3 to increase Ca; activates phosphorylase kinase –> increase HCl production

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11
Q

What is the main inhibitor of the H/K ATPase in parietal cell?

A

Omeprazole

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12
Q

What are the inhibitors of the parietal cells?

A

Somatostatin, PGE1, secretin, CCK

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13
Q

What is the function of intrinsic factor?

A

Binds B12 and the complex is reabsorbed in the terminal ileum

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14
Q

What are the glands in the antrum and pylorus of the stomach?

A

Mucus and HCO3 screting glands, G cells, D cells

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15
Q

Where are the Brunner’s glands? What they secrete?

A

They are in the duodenum; they secrete pepsinogen and alkaline mucus

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16
Q

What are the causes of increase acid and gastrin?

A

ZES, antral cell hyperplasia, retained antrum, renal failure, gastric outlet obstruction, short bowel syndrome

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17
Q

What are the causes of increase gastrin but normal/low acid?

A

Pernicious anemia, chronic gastritis, gastric CA, postvagotomy, medical acid suppression

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18
Q

What are some causes of rapid gastric emptying?

A

Previous surgery (#1), ZES, ulcers

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19
Q

What are some causes of delayed gastric emptying?

A

Opiates, anticholinergics, myxedema, hyperglycemia, diabetes

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20
Q

What is a Billroth I?

A

Antrectomy with gastroduodenal anastomosis

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21
Q

What is a Billroth II?

A

Antrectomy with gastrojejunal anastomosis

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22
Q

What is the disavantage of a Billroth I and II vs RNY gastrojejunostomy?

A

Increase marginal ulceration and diarrhea

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23
Q

What is the Dieulafoy’s ulcer?

A

Vascular malformation

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24
Q

What is Menetrier disease?

A

Mucous cell hyperplasia, increase rugal folds

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25
What is the cause of a Mallory Weiss tear? What is the treatment?
Forceful vomiting - presents as hematemesis following severe retching Tx - EGD, tear is usually in lesser curvature (near GEJ), PPI, transfusion If continued bleeding, may need gastrostomy and oversewing of the vessel.
26
What occurs in term of gastric emptying with vagal denervation?
All forms increase liquid emptying
27
What is a truncal vagotomy vs a selective vagotomy?
Truncal vagotomy - divides the vagal trunks at the level of the esophagus Selective vagotomy - divides nerves of Latarjet
28
What is a highly selective (proximal) vagotomy?
Divides individual fibers, preserves "crow's foot"
29
What is the difference on gastric emptying between a complete and highly selective vagotomy?
``` Complete vagotomy (truncal or selective) - decrease emptying of solids Highly selective vagotomy - normal emptying of solids ```
30
What is the MC problem following a vagotomy?
Diarrhea - caused by sustained MMCs forcing bile acids into the colon
31
What are some risk factors of UGI bleeding?
Previous UGI bleed, PUD, NSAID use, smoking, liver disease, esophageal varices, splenic vein thrombosis, sepsis, burn injuries, trauma, severe vomiting
32
What is the most important predictor of continued or recurrent UGI bleed?
Bleeding at the time of EGD
33
What is the next step in a patient with UGI bleeding and hypotension despite resuscitation?
go to OR
34
If you are having trouble localizing the bleeding source, what is the next step?
Tagged RBC scan
35
What are the three biggest risk factors for rebleeding at the time of EGD?
``` #1 Spurting blood vessel (60% chance of rebleed) #2 Visible blood vessel (40% chance of rebleed) #3 Diffuse oozing (30% chance of rebleed) ```
36
What is the most frequent ulcer and where it is located?
Duodenal ulcer; more common in men | Usually 1st part of duodenum; usually anterior
37
What is the MC complication of anterior and posterior duodenal ulcers?
Anterior - perforate | Posterior - Bleed from GDA
38
What is the triple therapy for H. pylori?
Bismuth salts, amoxicillin, metronidazole/tetracycline (BAM or BAT)
39
What are the surgical indications for PUD?
Perforation, Protacted bleeding despite EGD therapy, Obstruction, Intractability, Inability to rule out cancer
40
What are the surgical options for duodenal ulcers?
Truncal vagotomy and pyloroplasty Truncal vagotomy and antrectomy with Billroth I or II - BEST surgery for preventon of recurrence Proximal or highly selective vagotomy - lowest rate of complications
41
What is the MOST frequent complication of duodenal ulcers?
Bleeding
42
What is consider major bleeding?
>6 units of blood in 24 hours or patient remains hypotensive despite transfusion
43
How many sutures are needed to ligate the GDA?
Three - Proximal and distal brnches of GDA + transverse pancreatic branch
44
What is the conservative and surgical options for obstruction secondary to duodenal ulcer?
Serial dilation If near ampulla of Vater or removing ulcer is difficult --> Billroth II, antrectomy, and truncal vagotomy If proximal to ampulla of Vater --> antrectomy (with ulcer excision) with Billroth II and truncal vagotomy
45
What is consider intractability?
>3 months without relief while on H-pump inhibitor therapy or recurrence >1 year after medical therapy based on EGD not symptoms
46
What is the test of choice for ZES?
Secretin stimulation test causes high gastrin level
47
What pancreatic tumor size can be enucleated?
< 2cm
48
What are the riks factors for gastric ulcers?
Male, tobacco, ETOH, NSAIDs, H. pylori, uremia, stress (burns, sepsis and trauma), steroids, chemotherapy
49
What is the CLO test?
Detects urease released from H. pylori
50
What type of ulcers are associated with type A and O blood?
Type A blood - type I ulcers | Type O blood - type II-IV ulcers
51
What are the 5 types of gastric ulcers and what is the treatment for each of them?
Type I - lesser curve along the body of stomach; due to increase mucosal protection Tx: distal gastrectomy including ulcer with billroth I or II +/- vagotomy Type II - 2 ulcers (lesser curve and duodenal); high acid secretion Tx: distal gastrectomy including ulcer with billroth I or II and truncal vagotomy Type III - prepyloric ulcer; high acid secretion, increase bleeding Tx: distal gastrectomy including ulcer with billroth I or II and truncal vagotomy Type IV - lesser curve high along cardia of stomach; increase risk of bleeding due to decrease mucosal protection Tx: ulcer excision +/- highly selective vagotomy or truncal vagotomy and pyloroplasty Type V - ulcer associated with NSAIDs
52
What is chronic gastritis type A and B?
``` Type A (fundus) - associated with pernicious anemia, autoimmune disease Type B (antral) - associated with H. pylori ```
53
Where are most of gastric cancers located?
Antrum - 40%
54
What are risk factors for gastric cancer?
adenomatous polyps, tobacco, previous, gastric operations, intestinal metaplasia, atrophic gastritis, pernicious anemia, type A blood, nitrosamines
55
What is the Krukenberg tumor?
Metastases to ovaries
56
What is the Virchow's node?
Metastases to supraclavicular node
57
What is the treatment for stage I gastric cancer?
Subtotal gastrectomy (need 5cm margins)
58
What is linitis plastica? What is the treatment?
Diffuse gastric cancer due to lymphatic invasion | Tx: Total gastrectomy if no metastatic disease
59
What is the MC benign gastric tumor?
GIST tumors or leiomyoma
60
How are GIST diagnosed and treated?
Dx - Hypoechoic on US, smooth edges, biopsy | Tx: resection with 1cm margins, consider chemotherapy if >5cm or >5-10 mitoses/HPF
61
What chemo agent can be give to GIST patients and why?
Gleevec (TK inhibitor) because most are C-KIT positive.
62
How are the leiomyosarcomas diagnosed and how can they spread?
Cancer diagnosis based on mitosis/HPF (>5-10 associated with increase risk of metastases) Hematogenous spread
63
What is the ogan most commonly involved in extranodal lymphoma?
Stomach
64
What agent is MALT lymphoma related to? What is the treatment?
H. pylori Tx - usually regresses after treatment for H. pylori, triple therapy antibiotics and surveillance If MALT does not regress, need chemotherapy (CHOP)
65
What are the criteria for bariatric surgery?
``` BMI > 40 BMI > 35 with coexisting comorbidities Failure of nonsurgical methods of weight reduction Psychological stability Absence of drug and alcohol abuse ```
66
What are the risk of a roux-en-Y gastric bypass?
Marginal ulcers, leak, necrosis, B12 deficiency (IF needs acidic environment to bind B12), iron deficiency anemia (bypass duodenum, when Fe absorbed), gallstones (from rapid weight loss)
67
What is the MCC of leak in a RNY gastric bypass?
Ischemia
68
What is dumping syndrome?
Occurs from rapid entering of CHO into the small bowel
69
What are the 2 phases of dumping syndrome?
Hyperosmotic load causes fluid shift into bowel (diarrhea, dizziness, hypotension) Reactive increase in insulin and decrease in glucose (2nd phase rarely occurs)
70
What is the treatment for dumping syndrome?
Small, low-fat, low-CHO, increased-protein meals; no liquids with meals, no lying down after meals

ABSITE Review (32 decks)

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