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ABSITE Flash Cards > Foregut Surgery > Flashcards

Foregut Surgery Flashcards

1
Q

initial management for bacterial overgrowth after gastric bypass, without obstructed afferent limb

A
  • Rifaximin and metronidazole
  • if fails can consider surgical revision
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2
Q

normal percent time of elevated acid exposure in esophagus on 24 hour pH monitoring

A

< 4%

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3
Q

according to percent time exposure on 24 hour pH monitoring, which patients would likely benefit from surgical intervention for GERD

A

percent time exposure >6%

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4
Q

minimum amount of time needed on PPI before surgery should be considered for GERD

A

3-6 months

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5
Q

margins needed for a distal gastric adenocarcinoma

A

5-6 cm proximal margin, 2 cm margin onto 1st portion of the duodenum

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6
Q

what test is the most sensitive for achalasia?

A

high-resolution manometry

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7
Q

severe epigastric pain, inability to vomit, and inability to pass NGT…what should you be worried about

A

gastric volvulus

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8
Q

Borchardt triade

A
  • severe epigastric pain
  • inability to vomit
  • inability to pass NGT

gastric volvulus

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9
Q

surveillance for stage II gastric cancer

A

CT CAP every 6-12 months for 2 years, then annually for 5 years

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10
Q

surveillance for stage I gastric cancer

A

CT CAP as needed

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11
Q

what is a D-xylose test, what is it used for

A

carbohydrate breath test

used to measure metabolism of carbohydrate substrates from bacteria, aids in diagnosing blind loop syndrome

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12
Q

esophageal biopsy reveals Barrett esophagus with high grade dysplasia, what should be done

A
  • endoscopic mucosal resection

esophagectomy is no longer standard of care

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13
Q

High-resolution manometry finding that would suggest Type 1 Achalasia

A
  • lack of peristalsis
  • partial or absent relaxation of lower esophageal sphincter
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14
Q

High-resolution manometry finding that would suggest Type 2 Achalasia

A
  • pan-esophageal contraction
  • partial or absent lower esophageal relaxation
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15
Q

For a Zenker Diverticulum, when would you excise the sac?

A

if the sac is > 5 cm in size

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16
Q

For open repair of a Zenker diverticulum, what muscles do you perform your myotomy on?

A
  • Thyropharyngeus
  • cricopharyngeus
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17
Q

What clinical study would you use to determine the recurrence of a hiatal hernia?

A

Upper GI series

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18
Q

location and malignant potential of gastric hyper plastic polyps

A
  • Anywhere in the stomach
  • Low malignant potential
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19
Q

When should you completely resect a gastric polyp

A

when it is larger than 0.5 cm

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20
Q

in what patient population would you expect a phytobezoar?

A

diabetic patients with delayed gastric emptying

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21
Q

first line treatment for gastric reflux secondary to scleroderma

A

agressive proton pump inhibitor

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22
Q

first line treatment for esophageal dysmotility disorders

A

calcium channel blockers

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23
Q

what is believed to be the predominant driver of the hyper-insulin response from dumping syndrome?

A

large bolus of carbohydrates

24
Q

Demeester score considered abnormal?

A

> /= 14.72

25
Q

what is the imaging study of choice for an esophageal perforation

A

eosphagram with water soluble contrast

26
Q

what marks the proximal edge of the antrum

A

incisura angularis

27
Q

Magnetic Sphincter augmentation, long term data when compared to Nissen Fundoplication for GERD

A

similar with 80% of patients not needing PPIs at 5 years

28
Q

immediate post-op care for Magnetic Sphincter Augmentation for GERD

A

solid diet to void stenosis/scar of the esophagus

29
Q

treatment of choice for a person with refractory peptic ulcers and no H. Pylori infection

A

Truncal Vagotomy and Antrectomy

30
Q

what kind of cells make intrinsic factor

A

parietal cells

31
Q

where is B12 absorbed in the GI tract

A

terminal ileum

32
Q

What is another term for a false diverticulum

A

Pulsión diverticulum

33
Q

What is a false diverticulum

A

A diverticulum that does not involve all the layers of GI tract

  • ie Zenker’s diverticulum
34
Q

What is a pulsión diverticulum

A

Synonymous with a false diverticulum

35
Q

a barium esophagram demonstrates atonic esophagus with free reflux of gastric contents, what is this describing

A

scleroderma esophagus

36
Q

first line treatment for scleroderma esophagus causing acid reflux disease

A

PPI

37
Q

is a CT scan with oral and IV contrast or an upper GI series with water soluble contrast more sensitive in detecting an anastomotic leak after gastric surgery?

A

upper GI with water soluble contrast is more sensitive

38
Q

which gastric surgery has the highest association with bile gatritis

A

Billroth II (up to 85% of patients)

39
Q

what do S cells from GI tract secrete

A

secretin

40
Q

what do I cells from GI tract secrete

A

cholecystokinin

41
Q

what do D cells from GI tract secrete

A

somatostatin

42
Q

What drug has been shown to improve symptomatology and decrease frequency of dilations in patients with esophageal strictures secondary to caustic injury

A

Mitomycin C

43
Q

benign esophageal tumor that arises from smooth muscle

A

leiomyoma

44
Q

gastric reconstruction associated with the most risk for dumping syndrome

A

Billroth II

45
Q

Risk of dumping syndrome after Billroth II

A

70%

46
Q

partial or absent LES relaxation and lack of peristalsis of the esophageal body

A

Type I Achalasia

47
Q

Type 1 Achalasia on manometry

A

partial or absent LES relaxation and lack of peristalsis of the esophageal body

48
Q

Panesophageal contraction with partial or absent LES relaxation

A

Type II Achalasia

49
Q

Type II achalasia on manometry

A

Panesophageal contraction with partial or absent LES relaxation

50
Q

When do you perform follow up endoscopy in patients who initially presented with a Mallory-Weiss tear?

A

trick question, you don’t

  • cases of hemorrhage are usually self limited
51
Q

When there is a concern for an esophageal leak what kind of contrast do you use in an esophagram

A

water soluble first

  • less inflammatory response than Barium
52
Q

When testing for an esophageal leak after repair when do you do your esophagram and what kind of contrast do you use?

A

4-5 days after repair

water-soluble contrast (less inflammation than barium)

53
Q

Mesenterioaxial volvulus

A

Duodenum above the stomach

54
Q

Organoaxial volvulus

A

Organ twisting gastric volvulus

55
Q

What is a cameron ulcer

A

ulcer at GEJ in patients with a hiatal hernia

56
Q

Patient with a hiatal hernia presents with GI bleed, what is one potential cause for the bleed that is directly caused by the hiatal hernia

A

Cameron Ulcer

ABSITE Flash Cards (23 decks)

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