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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
Q

What is the cause of a Mallory Weiss tear? What is the treatment?

A

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.

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26
Q

What occurs in term of gastric emptying with vagal denervation?

A

All forms increase liquid emptying

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27
Q

What is a truncal vagotomy vs a selective vagotomy?

A

Truncal vagotomy - divides the vagal trunks at the level of the esophagus
Selective vagotomy - divides nerves of Latarjet

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28
Q

What is a highly selective (proximal) vagotomy?

A

Divides individual fibers, preserves “crow’s foot”

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29
Q

What is the difference on gastric emptying between a complete and highly selective vagotomy?

A 
Complete vagotomy (truncal or selective) - decrease emptying of solids 
Highly selective vagotomy - normal emptying of solids
30
Q

What is the MC problem following a vagotomy?

A

Diarrhea - caused by sustained MMCs forcing bile acids into the colon

31
Q

What are some risk factors of UGI bleeding?

A

Previous UGI bleed, PUD, NSAID use, smoking, liver disease, esophageal varices, splenic vein thrombosis, sepsis, burn injuries, trauma, severe vomiting

32
Q

What is the most important predictor of continued or recurrent UGI bleed?

A

Bleeding at the time of EGD

33
Q

What is the next step in a patient with UGI bleeding and hypotension despite resuscitation?

A

go to OR

34
Q

If you are having trouble localizing the bleeding source, what is the next step?

A

Tagged RBC scan

35
Q

What are the three biggest risk factors for rebleeding at the time of EGD?

A 
#1 Spurting blood vessel (60% chance of rebleed)
#2 Visible blood vessel (40% chance of rebleed)
#3 Diffuse oozing (30% chance of rebleed)
36
Q

What is the most frequent ulcer and where it is located?

A

Duodenal ulcer; more common in men

Usually 1st part of duodenum; usually anterior

37
Q

What is the MC complication of anterior and posterior duodenal ulcers?

A

Anterior - perforate

Posterior - Bleed from GDA

38
Q

What is the triple therapy for H. pylori?

A

Bismuth salts, amoxicillin, metronidazole/tetracycline (BAM or BAT)

39
Q

What are the surgical indications for PUD?

A

Perforation, Protacted bleeding despite EGD therapy, Obstruction, Intractability, Inability to rule out cancer

40
Q

What are the surgical options for duodenal ulcers?

A

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
Q

What is the MOST frequent complication of duodenal ulcers?

A

Bleeding

42
Q

What is consider major bleeding?

A

> 6 units of blood in 24 hours or patient remains hypotensive despite transfusion

43
Q

How many sutures are needed to ligate the GDA?

A

Three - Proximal and distal brnches of GDA + transverse pancreatic branch

44
Q

What is the conservative and surgical options for obstruction secondary to duodenal ulcer?

A

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
Q

What is consider intractability?

A

> 3 months without relief while on H-pump inhibitor therapy or recurrence >1 year after medical therapy based on EGD not symptoms

46
Q

What is the test of choice for ZES?

A

Secretin stimulation test causes high gastrin level

47
Q

What pancreatic tumor size can be enucleated?

A

< 2cm

48
Q

What are the riks factors for gastric ulcers?

A

Male, tobacco, ETOH, NSAIDs, H. pylori, uremia, stress (burns, sepsis and trauma), steroids, chemotherapy

49
Q

What is the CLO test?

A

Detects urease released from H. pylori

50
Q

What type of ulcers are associated with type A and O blood?

A

Type A blood - type I ulcers

Type O blood - type II-IV ulcers

51
Q

What are the 5 types of gastric ulcers and what is the treatment for each of them?

A

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
Q

What is chronic gastritis type A and B?

A 
Type A (fundus) - associated with pernicious anemia, autoimmune disease
Type B (antral) - associated with H. pylori
53
Q

Where are most of gastric cancers located?

A

Antrum - 40%

54
Q

What are risk factors for gastric cancer?

A

adenomatous polyps, tobacco, previous, gastric operations, intestinal metaplasia, atrophic gastritis, pernicious anemia, type A blood, nitrosamines

55
Q

What is the Krukenberg tumor?

A

Metastases to ovaries

56
Q

What is the Virchow’s node?

A

Metastases to supraclavicular node

57
Q

What is the treatment for stage I gastric cancer?

A

Subtotal gastrectomy (need 5cm margins)

58
Q

What is linitis plastica? What is the treatment?

A

Diffuse gastric cancer due to lymphatic invasion

Tx: Total gastrectomy if no metastatic disease

59
Q

What is the MC benign gastric tumor?

A

GIST tumors or leiomyoma

60
Q

How are GIST diagnosed and treated?

A

Dx - Hypoechoic on US, smooth edges, biopsy

Tx: resection with 1cm margins, consider chemotherapy if >5cm or >5-10 mitoses/HPF

61
Q

What chemo agent can be give to GIST patients and why?

A

Gleevec (TK inhibitor) because most are C-KIT positive.

62
Q

How are the leiomyosarcomas diagnosed and how can they spread?

A

Cancer diagnosis based on mitosis/HPF (>5-10 associated with increase risk of metastases)
Hematogenous spread

63
Q

What is the ogan most commonly involved in extranodal lymphoma?

A

Stomach

64
Q

What agent is MALT lymphoma related to? What is the treatment?

A

H. pylori
Tx - usually regresses after treatment for H. pylori, triple therapy antibiotics and surveillance
If MALT does not regress, need chemotherapy (CHOP)

65
Q

What are the criteria for bariatric surgery?

A 
BMI > 40
BMI > 35 with coexisting comorbidities
Failure of nonsurgical methods of weight reduction
Psychological stability
Absence of drug and alcohol abuse
66
Q

What are the risk of a roux-en-Y gastric bypass?

A

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
Q

What is the MCC of leak in a RNY gastric bypass?

A

Ischemia

68
Q

What is dumping syndrome?

A

Occurs from rapid entering of CHO into the small bowel

69
Q

What are the 2 phases of dumping syndrome?

A

Hyperosmotic load causes fluid shift into bowel (diarrhea, dizziness, hypotension)
Reactive increase in insulin and decrease in glucose (2nd phase rarely occurs)

70
Q

What is the treatment for dumping syndrome?

A

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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