Chapter 5: Stomach Flashcards
Most proximal portion of the stomach immediately distal to the GEJ
Cardia
Most superior portion of the stomach
Fundus
Largest portion of the stomach
Corpus/Body
Extends from the fundus to the pylorus
Corpus/Body
Begins at the angularis incisura as a wider area that leads into a narrower pyloric canal and sphincter
Antrum
Part of the stomach that includes the pyloric sphincter
Pylorus
Cells that produce pepsinogen in response to food and acethylcholine
Chief cells
pH level wherein pepsinogen is activated to pepsin
<5 pH
Cells that secretes HCl and Intrinsic Factor
Parietal/Oxyntic cells
Secretes mucous and HCO3-
Mucous neck cells
Secrete gastrin
G cells
Secrete somatostatin
D cells
Secrete serotonin
Enterochromaffin cells/Kulchitsky cells
Secrete histamine
Enterochromaffin-like cells
Supplies the proximal portion of the lesser curvature
Originates from the celiac trunk
Left gastric artery
Supplies the distal portion of the lesser curvature
Originates from the common or proper hepatic artery
Right gastric artery
Supplies the proximal portion of the greater curvature
Originates from the splenic artery
Left gastroepiploic artery
Supplies the distal portion of the greater curvature and the pylorus
Originates from gastroduodenal artery
Right gastroepiploic artery
Contribute to the supply of proximal stomach
Short gastric arteries
Supplies the acetylcholine-mediated, parasympathetic innervation of the stomach
Vagus nerve
Supplies sympathetic innervation of the stomach
Celiac plexus
Enteric nervous system is composed of the following plexuses
Auerbach’s and Meissner’s plexuses
Left vagus nerve runs ______ to the stomach
anterior
Right vagus nerve runs ______ to the stomach
posterior
Etiologies of stress-induced gastritis
Sepsis
Shock
Severe burn
Most common type of peptic ulcer disease
Duodenal ulcers
Food tends to exacerbate the epigastric pain in this type of ulcer
Gastric ulcer
Food relieves the pain in this type of ulcer
Duodenal ulcer
Most common type of gastric ulcer
Type 1
Gastric ulcer found in the distal portion of the lesser curvature
Type 1
Gastric ulcer found in the prepyloric or pyloric region
Type 3
Gastric ulcer found in the proximal portion of the lesser curvature
Type 4
Gastric ulcer found in the distal portion of lesser curvature and is associated with duodenal ulcer
Type 2
Indications for surgical management of PUD
Refractory or recurrent disease
Complications (perforation, obstruction, uncontrolled bleeding)
Rare disorder caused by gastrin-secreting tumor
Zollinger-Ellison Syndrome
Gastrinoma triangle
Pancreatic neck
Porta hepatis
3rd portion of the duodenum
Gastrin levels confirming the diagnosis of ZES
> 1000 pg/mL
Increase in gastrin level >200 pg/mL after a secretin challenge
Clinical triad of ZES
Hypersecretion of HCl
Severe PUD
Gastrinoma
Most commonly performed operation for GERD that involves a 360 degrees wrap
Nissen fundoplication
Operation for GERD that includes 180 degrees wrap
Toupet
Operation for GERD that includes 270 degrees wrap performed through the chest
Belsey Mark IV
Most common complication from anti-reflux procedures
Pneumothorax
Most common form of gastric cancer
Gastric adenocarcinoma
Diffuse neoplasm involving the entire stomach to give a ‘leather bottle’ appearance
Linitis plastica
Treatment for gastric adenocarcinoma
Surgical resection with a 6-cm resection margin
Treatment for gastric adenocarcinoma in the proximal stomach
Total gastrectomy
Treatment for gastric adenocarcinoma in the distal stomach
Subtotal gastrectomy with negative margins
Submucosal, mesenchymal tumors arising from the interstitial cells of Cajal
Gastrointestinal Stromal Tumors (GIST)
Mutation found in GIST
Gain of function tyrosine kinase mutation (KIT proto-oncogene)
Non-Hodgkin’s lymphoma associated with H. pylori infection
Gastric MALToma
Indications for bariatric surgery
BMI > 40 kg/m2 or
BMI >35 kg/m2 with a comorbid condition
What GI hormones are involved in the regulation of insulin release?
Gastric inhibitory peptide
CCK
A 69-year old man is diagnosed with gastric adenocarcinoma. What are the most common symptoms?
Weight loss, early satiety, abdominal pain
A 55-year old woman is found to have PUD without increase HCL secretion. What types of gastric ulcers may be present?
Types I or IV
What type of gastric ulcer is often not responsive to highly selective vagotomy?
Type III
What is the strongest layer of the GI tract wall?
Submucosa
What technique is used for laparascopic band placement during which the gastrohepatic ligament is divided, a plane between the right diaphragmatic crus, and the overlying fat pad is dissected?
Pars flaccida technique
