Exam 2 GASTRIC CA

Question 1

Zollinger-Ellison Synd (ZES) is?

a/w? (3)

Answer 1

Gastrinoma of pancreas
Non-β islet cell tumor

↑↑ acid secretion
PUD
Multiple Endocrine Neoplasm Synd

Question 2

ZES ulcers U seen where?

Answer 2

duodenal bulb

60% malig, 1/2 die w/i 5 yrs

Question 3

ZES presentation? (4)

Answer 3

Abd pain
Severe reflux
D from large vol of acid
Steatorrhea from acid inactivation of pancreatic lipase

Question 4

ZES Labs?

ZES tx? (2)

Answer 4

Fasting Serum Gastrin = >300

DOC: PPI
P tumor resection

Question 5

Gastric CA: U what kind?

See in?

Answer 5

Adeno

M > F
< 40yo

Question 6

Gastric CA caused by? (5)

Answer 6

H. pylori (untreated)
Chronic gastritis
Gastric polyps
Prior gastric surgery
Genes

Question 7

Gastric CA clinical presentation? (5)

Answer 7

Asympt early or PUD sxs
"Mass effect" pain
Wgt loss
Occult GI bleed 
P Fe Def anemia

Question 8

Virchow’s Node is?

Answer 8

metastatic spread to supraclavicular LN

Question 9

Sister Mary Joseph’s Node is?

Answer 9

metastatic spread to periumbilical LN

Question 10

Gastric CA imaging?

Answer 10

UGI for pathology
Bx for dx
Abd CT for resectability and LN involv

Question 11

Gastric CA metastasizes how?

Answer 11

Directly or via blood

to regional LN, omentum, liver

Question 12

Gastric CA tx? (2)

Prognosis?

Answer 12

Stage w/ CXR, CT (chest/abd/pelvis), MRI
Gastrectomy

Stage II 1/2 5 yrs
Stage III 1/4 5 yrs