Foregut Flashcards
Bleeding duodenal ulcer refractory to endoscopy and unstable; next step
Duodenotomy and oversewing GDA and transverse pancreatic
Initial management of phytobezoar
Chemical dissolution (Coca-Cola)
Released from parietal cells and aids in B12 absorption in the TI
Intrinsic factor
Gastroparesis refractory to medical therapy; tx
Pyloroplasty and gastric pacemaker
Tx marginal ulcers in RYGB
PPI
Unique about gastric fundic polyps
No malignant potential
Options for ERCP with RYGB
Lap assisted, balloon enteroscopy
T1 gastric cancer distal 2/3rds of stomach; tx
Partial gastrectomy with 5cm prox and 2cm distal margin + D2 LND
Indication for neoadjuvant chemo in gastric cancer
Potentially resectable T2N0 (muscularis propria) or higher non-cardia gastric cancer
Dx test for gastro-gastric fistula s/p gastric division procedures
Oral contrasted CT or upper GI
Most common sarcoma in the GI tract and where
GIST, stomach then SB
Staging laparoscopy for gastric cancer
Peritoneal washings from left/right parabolic gutters and pelvis as well as suspicious nodules
Sign of highest risk of rebleed, peptic ulcer
Pulsatile bleed
Classification for Endoscopic findings and rebleeding risk in PUD
Forrest classification
Ia - active pulsatile bleeding
Ib - active oozing
IIa - nonbleeding vessel
IIb - adherent clot
Iic - black spot
III - clean base
Absolute contraindication for peritoneal dialysis catheter placement
Impaired mental ability to care for it
Severe protein malnutrition
Active intraabdominal infection
Frequent diverticulitis
Secreted by D cells and inhibits insulin, glucagon and PP
Somatostatin
Initial tx of bile reflux and alkaline reflux gastritis after partial gastrectomy
Weight loss, smoking cessation, small frequent meals, cholestyramine
Absolute contraindications to PEG placement
Active infection
Complete oropharyngeal/esophageal obstruction
Hemodynamic instability
Peritoneal carcinomatosis
Severe malnutrition
Uncontrolled ascites
Uncorrected coagulopathy
Spiral shaped, gram-neg, motile bacteria, increase risk for PUD and gastric cancer
H. Pylori
Lifestyle modification that can treat marginal ulcers s/p RYGB
Snoking cessation
Hx lap band with free intraperitoneal air; dx and tx
Band erosion, band removal and defect repair
Proximal gastric adenocarcinoma; tx
Total gastrectomy
Gastric emptying; study, dx result, tx
Gastric emptying study, >60% tracers at 2hrs or >10% at 4hrs, Dopamine receptor antagonists (Metoclopramide and domperidone)
Initial Gastric Outlet Obstruction management
H Pylori eradication and endoscopic balloon dilation
Types of vagotomy, describe, which need drainage procedure
Truncal - main trunk, need drainage
Selective - Ant/Post nerves of Latarjet, need drainage
Proximal - highly selective fibers innervating parietal cells
First line therapy for suspected GI bleed
EGD
Acute pancreatitis with duodenal diverticula identified on ERCP; management
Treat pancreatitis, subsequent diverticulectomy
S/p Billroth II with severe pain and non bilious emesis, dilated limb proximal to anastomosis; dx and tx
Afferent loop syndrome, immediate operation to prevent bowel necrosis or duodenal blowout
Prevention of afferent loop syndrome during Billroth reconstruction
Keep afferent limb <12-15cm from LT
Early dumping timing and etiology
15-60min, hyperosmolality leading to rapid fluid shift
Late dumping syndrome timing and etiology
2-3hrs, Hyperinsulinemia after carb ingestion
GIST antigen and gene
CD117 and KIT
Released by K cells, decreases acid secretion and stimulates insulin
GIP
Released by G cells, stimulated by alkaline environment
Gastrin
Released by S cells, inhibits gastrin and stimulates bicarb
Secretin
Acidification of duodenum stimulates what
Somatostatin, Secretin, GIP, Motilin
