Esophagus & Stomach

Question 1

What type of metaplasia in esophagus is associated with increased malignancy risk?

Answer 1

Columnar epithelium (intestinal type metaplasia)

Question 2

What is the cause of Zenker’s diverticulum

Answer 2

Dysfunction of cricopharyngeal muscle - posterior mucosal herniation through Killian’s triangle

Question 3

Type I gastric ulcer

Answer 3

Lesser curvature (decreased mucosal protection)

Question 4

Type II gastric ulcer

Answer 4

Lesser curvature AND duodenum (increased acid secretion/H. pylori)

Question 5

Type III gastric ulcer

Answer 5

Prepyloric (increased acid secretion/H. pylori)

Question 6

Type IV gastric ulcer

Answer 6

Cardia/lesser curvature near GE junction (decreased mucosal protection)

Question 7

Type V gastric ulcer

Answer 7

Anywhere - associated with NSAID use

Question 8

Management of gastric bezoar

Answer 8

First try chemical dissolution (coca cola)

Question 9

Stamm gastrostomy placement - where to place?

Answer 9

3cm below costal margin and 3cm left of midline

Question 10

Thoracic duct course

Answer 10

Originates in cysterna chyli (T10-L3), enters chest to the right of the aorta, turns towards the left at T5 posterior to aortic arch, until neck where it drains into left jugular-subclavian junction

Question 11

Most common vitamin deficiency in bariatric patients

Answer 11

Vitamin D

Question 12

Pathologic findings of achalasia

Answer 12

T cell and eosinophil infiltration of myenteric plexus

Question 13

Manometry findings of achalasia

Answer 13

Aperistalsis in distal esophagus, impaired LES relaxation (>15mmHg), and elevated LES resting pressures

Question 14

Surgical management of achalasia

Answer 14

Heller myotomy and partial (Dor or Toupet) fundoplication

Question 15

Dor fundoplication

Answer 15

180 degree anterior wrap

Question 16

Toupet fundoplication

Answer 16

270 posterior wrap

Question 17

What effect does adenosine have on gastrin secretion

Answer 17

Inhibits

Question 18

Surgical options for refractory gastroparesis

Answer 18

Gastric pacemaker or pyloroplasty

Question 19

Truncal vagotomy

Answer 19

Anterior and posterior vagus nerves are transected at distal esophagus, 4cm proximal to GE junction

Question 20

Selective vagotomy

Answer 20

Anterior and posterior vagus nerves divided just below posterior celiac branches

Question 21

Highly selective vagotomy

Answer 21

Nerves are dissected near terminal ends, with preservation of nerve of Latarjet (innvervates the pylorus)

Question 22

Surveillance for Barrett’s

Answer 22

Lifelong PPI
If no dysplasia, endoscopy q3-5yrs with 4-quadrant biopsies every 2cm

Question 23

Treatment of T1a esophageal cancer

Answer 23

Can consider endoscopic mucosal resection

Question 24

Treatment of T1-T2 esophageal cancer (N0)

Answer 24

Upfront esophagectomy

Question 25

Treatment of T3/T4 or nodal disease esophageal cancer

Answer 25

Neoadjuvant chemoradiation -> surgery

Question 26

When to give adjuvant chemoradiation for esophageal cancer

Answer 26

After resection if node positive, pT3 or pT4

Question 27

Size of staples for gastric sleeve

Answer 27

3.5mm large

Question 28

Complications of jejunoileal bypass

Answer 28

Used to be used for obesity; high rate of nutritional deficiency and end-stage liver failure

Question 29

Normal phi angle for gastric band

Answer 29

4-58 phi

Question 30

Gastric poylps

Answer 30

Common in patients with history of H. pylori infection. Low malignant potential

Question 31

Nutcracker esophagus

Answer 31

Swallowing contractions are too powerful; often caused by GERD

Question 32

Gastric MALT lymphoma management

Answer 32

If low-grade: antibiotics If high-grade: chemo

Question 33

Where are most of the gastrin-secreting G cells located

Answer 33

Antrum

Question 34

Management of esophageal SCC

Answer 34

If <5cm from cricopharyngeus -> definitive chemorads If >5cm distance -> neoadjuvant chemorads then surgery for T2 and above