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Surgery Rotation > EOR GI part 4- gastric CA, bariatric surgery, SBO > Flashcards

EOR GI part 4- gastric CA, bariatric surgery, SBO Flashcards

1
Q

What are the associated RFs of gastric CA- diet?

A 
Smoked meats
High nitrates
Low fruits and veggies
EtOH 
Tobacco
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2
Q

RFs of gastric CA- environmental

A 
Raised in high-risk area
Poor SES
Atrophic gastritis
Male gender
Blood type A
Previous partial gastrectomy
Pernicious anemia
Polyps
H. pylori
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3
Q

Which blood type is associated with gastric CA?

A

Blood type A

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4
Q

What are the sx of gastric CA?

A 
Weight loss
Emesis
Anorexia
Pain/epigastric discomfort
Obstruction
Nausea
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5
Q

What is a Blumer’s shelf?

A

Solid peritoneal deposit anterior to rectum, forming a “shelf”, palpated on rectal exam

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6
Q

What is a Virchow’s node?

A

Metastatic gastric CA to the nodes in the left supraclavicular fossa

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7
Q

What is a surveillance lab finding in gastric CA?

A

CEA elevated in 30% of cases (if pos, useful for post-op surveillance)

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8
Q

What is the initial workup for gastric CA?

A 
EGD with bx
Endoscopic u/s to evaluate the level of invasion
CT abdomen/pelvis for metastasis
CXR
Labs
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9
Q

What is the histology of gastric CA?

A

Adenocarcinoma

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10
Q

What is the DDx for gastric tumors?

A 
Adenocarcinoma
Leiomyoma
Leiomyosarcoma
Lymphoma
Carcinoid
Ectopic pancreatic tissue
Gastrinoma
Benign gastric ulcer
Polyp
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11
Q

Which morphologic type of gastric CA is named after a “leather bottle”?

A

Linitis plastica- the entire stomach is involved and looks thickened (10% of cancers)

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12
Q

Which pts with gastric CA are non-operative?

A

Distant metastasis

Peritoneal implants

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13
Q

What is the role of laparoscopy in gastric CA?

A

To r/o peritoneal implants and to evaluate for liver metastasis

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14
Q

What is the genetic alteration seen in >50% of pts with gastric CA?

A

P53

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15
Q

What is the tx for gastric CA?

A

Surgical resection with wide (>5 cm checked for frozen section) margins and lymph node dissection

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16
Q

What operation is performed for a tumor in the antrum?

A

Distal subtotal gastrectomy

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17
Q

What operation is performed for a tumor in the midbody?

A

Total gastrectomy

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18
Q

What operation is performed for a tumor in the proximal?

A

Total gastrectomy

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19
Q

What is a subtotal gastrectomy?

A

75% of the stomach removed

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20
Q

What is a total gastrectomy?

A

Stomach is removed and a Roux-en-Y limb is sewn to the esophagus

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21
Q

When should splenectomy be performed in gastric CA?

A

When the tumor directly invades the spleen/splenic hilum or with splenic hilar adenopathy

22
Q

What is the adjuvant tx for gastric CA?

A

Stages II and III: post-op chemo and radiation

23
Q

Define morbid obesity

A

BMI >40
OR
BMI >35 with a medical problem related to morbid obesity

24
Q

What medical conditions are associated with morbid obesity?

A 
Sleep apnea
Coronary artery dz
Pulm dz
DM
Venous stasis ulcers
Arthritis
Infections
Sex-hormone abnormalities
HTN
Breast CA
Colon CA
25
Q

What are the current best options for bariatric surgery?

A

Sleeve gastrectomy
Gastric bypass (malabsorptive)
Vertical-banded gastroplasty

26
Q

Gastric bypass

A

Stapling off of small gastric pouch (restrictive)

Roux-en-Y limb to gastric pouch (bypass)

27
Q

How does gastric bypass work?

A

Creates a small gastric reservoir
Causes dumping sx when a pt eats too much food or high-calorie foods; the food is “dumped” into the Roux-en-Y limb
Bypass of small bowel by Roux-en-Y limb

28
Q

What is the MC sign of an anastomotic leak after a gastric bypass?

A

Tachycardia

29
Q

What is a LAP-BAND?

A

Laparoscopically placed band around stomach with a subcutaneous port to adjust constriction; results in smaller gastric reservoir

30
Q

What is a Petersen’s hernia?

A

Seen after bariatric gastric bypass- internal herniation of small bowel through the mesenteric defect from the Roux-en-Y limb

31
Q

What is small bowel obstruction?

A

Mechanical obstruction to the passage of intraluminal contents

32
Q

What are the S/sx of SBO?

A 
Abdominal discomfort
Cramping
Nausea
Abdominal distention
Emesis
High-pitched bowel signs
33
Q

What lab tests are performed with SBO?

A

Electrolytes
CBC
Type and screen
UA

34
Q

What are classic electrolyte/acid-base findings with proximal SBO?

A

Hypovolemic, hypochloremic, hypokalemia, alkalosis

35
Q

What must be r/o on PE in pts with SBO?

A

Incarcerated hernia (also look for surgical scars)

36
Q

What major AXR findings are associated with SBO?

A

Distended loops of small bowel air-fluid levels on upright film

37
Q

Define complete SBO

A

Complete obstruction of the lumen

38
Q

What is the danger of complete SBO?

A

Closed loop strangulation of the bowel leading to bowel necrosis

39
Q

Define partial SBO

A

Incomplete SBO

40
Q

What is initial management of all pts with SBO?

A

NPO
NGT
IVF
Foley

41
Q

What tests can differentiate partial from complete SBO?

A

CT with PO contrast

42
Q

What are the ABCs of SBO?

A

Causes:
Adhesions
Bulge (hernias)
CA and tumors

43
Q

What is SMA syndrome?

A

Seen with wt loss- SMA compresses duodenum, causing obstruction

44
Q

What is the tx of complete SBO?

A

Laparotomy and lysis of adhesions (LOA)

45
Q

What is the tx of incomplete SBO?

A

Initially, conservative tx with close observation plus NGT decompression

46
Q

Intraoperatively, how can the level of obstruction be determined in pts with SBO?

A

Transition from dilated bowel proximal to the decompressed bowel distal to the obstruction

47
Q

Can a pt have complete SBO and bowel movements and flatus?

A

Yes; the bowel distal to the obstruction can clear out gas and stool

48
Q

After a small bowel resection, why should the mesenteric defect always be closed?

A

To prevent an internal hernia

49
Q

What may cause SBO if pt is on Coumadin?

A

Bowel wall hematoma

50
Q

What is the #1 cause of SBO in adults (industrialized nations)

A

Postop adhesions

Surgery Rotation (19 decks)

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