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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
what is the imaging study of choice for an esophageal perforation
eosphagram with water soluble contrast
26
what marks the proximal edge of the antrum
incisura angularis
27
Magnetic Sphincter augmentation, long term data when compared to Nissen Fundoplication for GERD
similar with 80% of patients not needing PPIs at 5 years
28
immediate post-op care for Magnetic Sphincter Augmentation for GERD
solid diet to void stenosis/scar of the esophagus
29
treatment of choice for a person with refractory peptic ulcers and no H. Pylori infection
Truncal Vagotomy and Antrectomy
30
what kind of cells make intrinsic factor
parietal cells
31
where is B12 absorbed in the GI tract
terminal ileum
32
What is another term for a false diverticulum
Pulsión diverticulum
33
What is a false diverticulum
A diverticulum that does not involve all the layers of GI tract - ie Zenker’s diverticulum
34
What is a pulsión diverticulum
Synonymous with a false diverticulum
35
a barium esophagram demonstrates atonic esophagus with free reflux of gastric contents, what is this describing
scleroderma esophagus
36
first line treatment for scleroderma esophagus causing acid reflux disease
PPI
37
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?
upper GI with water soluble contrast is more sensitive
38
which gastric surgery has the highest association with bile gatritis
Billroth II (up to 85% of patients)
39
what do S cells from GI tract secrete
secretin
40
what do I cells from GI tract secrete
cholecystokinin
41
what do D cells from GI tract secrete
somatostatin
42
What drug has been shown to improve symptomatology and decrease frequency of dilations in patients with esophageal strictures secondary to caustic injury
Mitomycin C
43
benign esophageal tumor that arises from smooth muscle
leiomyoma
44
gastric reconstruction associated with the most risk for dumping syndrome
Billroth II
45
Risk of dumping syndrome after Billroth II
70%
46
partial or absent LES relaxation and lack of peristalsis of the esophageal body
Type I Achalasia
47
Type 1 Achalasia on manometry
partial or absent LES relaxation and lack of peristalsis of the esophageal body
48
Panesophageal contraction with partial or absent LES relaxation
Type II Achalasia
49
Type II achalasia on manometry
Panesophageal contraction with partial or absent LES relaxation
50
When do you perform follow up endoscopy in patients who initially presented with a Mallory-Weiss tear?
trick question, you don't - cases of hemorrhage are usually self limited
51
When there is a concern for an esophageal leak what kind of contrast do you use in an esophagram
water soluble first - less inflammatory response than Barium
52
When testing for an esophageal leak after repair when do you do your esophagram and what kind of contrast do you use?
4-5 days after repair water-soluble contrast (less inflammation than barium)
53
Mesenterioaxial volvulus
Duodenum above the stomach
54
Organoaxial volvulus
Organ twisting gastric volvulus
55
What is a cameron ulcer
ulcer at GEJ in patients with a hiatal hernia
56
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
Cameron Ulcer

ABSITE Flash Cards (23 decks)

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