Esophagus, Stomach

Question 1

First diagnostic test in patients with suspected esophageal disease

Answer 1

Barium swallow.

Determines ANATOMIC problems. if you want to do functional, you can use marshmallow impregnated with barium swallow

Question 2

Most direct mehod of measuring increased esophageal exposure to gastric juice (not reflux)

Answer 2

24 hour ambulatory pH monitoring

Question 3

Gold standard for the diagnosis of Gerd

Answer 3

24 hour ambulatory pH monitoring

Question 4

Most common esophageal pathology

Answer 4

GERD

Question 5

Most common esophageal pathology

Answer 5

GERD

Question 6

MC defect of GERD

Answer 6

Intrabdominal esophageal length is less than 1 cm (normal: 2-4cm)

Question 7

MC antireflux surgical prodecure and is the surgical standard of care

Answer 7

Nissen fundoplication
- full 360 degrees

Partial: Toupet fundoplication and Dor Fundoplication

Increase length: Collis gastroplasty

Question 8

MC antireflux surgical prodecure and is the surgical standard of care

Answer 8

Nissen fundoplication
- full 360 degrees

Partial: Toupet fundoplication and Dor Fundoplication

Increase length: Collis gastroplasty

Question 9

MC type of esophageal hernia

Answer 9

Type 1 (slidding hernia)
- upward dislocation fo GE junction and cardia into the thorax throgh the esopageal hiatus of the diaphragm.
CM: GERD

vs
Type 2 rolling or paraesophageal hernia: fundus
CM obstructive. tx sx
Type 3: combin

Question 10

chest pain
Retching with inability to vomit
Inability to pass NGT

What do you call this triad

Answer 10

Borchardt triad

- Indicative of incarcerated intra thoracic stomach

Question 11

MC esophageal diverticula

Answer 11

Zenker diverticulum

- d/t high pressure generated in the hypopharynx

Question 12

potential weakness behind the cricopharyngeus muscle. A RF for zenker diverticulum

Answer 12

Killian triangle: potential weakness behind the cricopharyngeus muscle

Question 13

Hypertensive LES
Aperistalsis of esophageal body
Failure of LES to relax

Answer 13

Achalasia

Question 14

Treatment of choice for achalasia

Answer 14

Heller myotomy + partial fundoplication

Question 15

MC primary esophageal motility disorder

Answer 15

Nutcracker esophagus / Hypertensive peristalsis

Question 16

In caustic injury, this is the phase where px is most symptomatic.

Answer 16

Acute necrotic phase (first phase)

Question 17

In caustic injury, this is the phase where you should do surgery

Answer 17

First phase acute necrotic phase (1 to 4 days)

Question 18

In caustic injury, this is the phase where the esophagus is at its weakest

Answer 18

2nd phase Ulceration and granulation phase (3-5 days)

Question 19

MC site of perforation in caustic injuries

Answer 19

Mid esophagus

Question 20

MC type if esophageal CA

Answer 20

SCC

Question 21

Cervical sympathetic nerve involved in Horner syndrome (ptosis myosis and anhydrosis)

Answer 21

C4

Question 22

Cervical sympathetic nerve involved in Horner syndrome (ptosis myosis and anhydrosis)

Answer 22

C4

Question 23

CURATIVE surgery for esophageal carcinoma

Answer 23

Transthoracic (Ivor Lewis)

Vs transhiatal (Orringer and Sloan)

Question 24

MCC of drug induced esophageal web

Answer 24

FeSO4

Question 25

``` Dysphagia Atrophic oral mucosa Spoon shaped fingers Brittle nails chronic anemia ```

Answer 25

Plummer vinson syndrome

Question 26

Most impt management for tracheoesophageal atresia /fistula

Answer 26

Ventilatory support

Question 27

Criminal nerve of Grassi supplies what organ?

Answer 27

Posterior fundus of the stomach

Question 28

Secretes HCl and intrinsic factor (for B12)

Answer 28

Parietal or Oxyntic cells

Question 29

Most numerous cells in the stomach

Answer 29

Chief / Zymogenic cells Secretes pepsinogen Gastric lipase Leptin

Question 30

Cells left after vagotomy

Answer 30

Enterochromaffin LIKE cells : secretes Histamine

Question 31

``` Gastric cells which secretes serotonin A. Enterochromoffin cells B. Enterochromoffin like cells C. S cells D. Zymogenic cell ```

Answer 31

A

Question 32

Gold standard for h pylori diagnosis

Answer 32

Histologic examination of antral mucosal biopsy

Question 33

Standard for test to CONFIRM eradication of H pyrloru post treatment

Answer 33

Urease breath test1

Question 34

MC type of gastric ulcer

Answer 34

Type 1 antral lesser curvature Type V NSAID induced

Question 35

MC pancreatic tumor in patinets with MEN I

Answer 35

Gastrinoma (Zollinger Ellison syndrome)

Question 36

MC neoplasm of the stomach

Answer 36

Adenocarcinoma 95%

Question 37

Type of stomach CA with worse prognosis

Answer 37

Diffuse type | - leather bottle

Question 38

LN metastasis at the pelvix cul de sac secondary to gastric CA

Answer 38

Blumer shelf

Question 39

Gold standard for dx of gastric CA | most sensitive and most specific

Answer 39

Upper endoscopy with biopsy

Question 40

MC location of gastric CA

Answer 40

Antrum / distal 75% Vs ulcers: lesser curvature Tx of choice: radical subtotal gastrectomy

Question 41

Characteristic of Diffused type of gastric cancer

Answer 41

Signet ring cells Lanitis plastica Leather bottle appearance Non distendable stomach

Question 42

First line treatment for low grade gastric lymphoma

Answer 42

H. pylori eradication If highgrade: chemoradiation

Question 43

Rapidly increasing gastric tumor, (+) donut sign on barium study

Answer 43

GIST: thickening of the submucosa

Question 44

Case: 30 yo man with intermittent bleeding. On endoscopy, there is normal appearing mucosa but with pulsating blood. Dx?

Answer 44

Dieulafoy lesion | Bleeding from a submucosal vessel

Question 45

Surgical management for Pyloric stenosis

Answer 45

Fredet Ramsted pyloromyotomy - spreading he muscle mucosa until it bulges to level of serosa - serosa and muscle layer only