Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery > Gastric & Esophageal disorders > Flashcards

Gastric & Esophageal disorders Flashcards

1
Q

MCC of PUD (2)

A

Helicobacter pylori infection
Chronic NSAID use

*uncommonly → Gastrinoma (Zollinger-Ellison syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Abdominal pain increases shortly after eating → weight loss

A

Gastric Ulcer

less common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pain is relieved with food intake → weight gain

Pain increases 2–5 hours after eating.

A

Duodenal Ulcer

more common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Dyspepsia→ early satiety, gnawing, or burning epigastric pain

Pain relieved with ANTIACIDS

(+/-) anemia, hematemesis, or melena

(+) Fecal occult blood

Diagnosis?

A

Peptic Ulcer Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q 
Stress ulcer causes: 
(3)
major surgery
SIRS
kidney failure
A

Burns
TBI
polytrauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Curling ulcers caused by

stress ulcer

A

severe burns

*decreased plasma volume → decreased gastric blood flow → hypoxic tissue injury of stomach surface epithelium → weakening of the normal mucosal barrier

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cushing ulcer caused by

stress ulcer

A

brain injury

*increased vagal stimulation → increased production of stomach acid via Ach release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q 
Alarm features warranting an EGD in younger patients include:
progressive \_\_\_, \_\_\_\_
rapid weight loss, 
persistent vomiting, 
suspected GI bleeding, 
FMH of upper GI malignancy
A

dysphagia

odynophagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

The most accurate test to confirm the diagnosis of PUD.

A

EGD

*with therapeutic measures: hemostasis via electrocautery for active bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Indications for biopsy via EGD

A

Gastric ulcers present
To r/o malignancy

(Take from the edge and base of the ulcer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Gastric ulcers increase the risk for what malignancy?

A

Carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

First therapeutic approaches for PUD (3)

A

avoid NSAIDs, restrict alcohol, PPI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

If patient presentation is suspicious for PUD what should be ruled out first?

A

H. Pylori

urea breath test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Posterior gastric ulcers are more likely to ___ and anterior ulcers are more likely to ___

A

bleed

perforate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Gastric outlet obstruction

MCC: ___ → scarring and fibrosis

A

Chronic PUD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q 
Clinical features:
Postprandial, nonbilious emesis,
Succussion splash
Early satiety→ Weight loss
Dysphagia

hypokalemic hypochloremic metabolic alkalosis

Diagnosis?

A

Gastric outlet obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Gastric cancer risk factors:

Diet rich in \_\_\_
\_\_\_ infection
Nicotine use
\_\_\_ virus
Gastric ulcers
Partial \_\_\_ (procedure)
Chronic atrophic gastritis/ pernicious anemia
A

nitrates (smoked, cured)
H. pylori
Epstein-Barr
gastrectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

a pathologically increased growth of bacteria in the small intestine

A

Small intestinal bacterial overgrowth (SIBO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Suspect late dumping syndrome in a patient with previous ___ surgery and ___-glycemia.

A

gastric surgery

hypoglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Dumping syndrome is rapid ___ as a result of:
defective gastric reservoir function
impaired pyloric emptying mechanisms
or anomalous post-op gastric motility

A

gastric emptying

late/early dumping syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Late Dumping Syndrome Management
____
2nd-line treatment: ____
3rd-line treatment: surgery

A

Dietary modifications

Octreotide

22
Q

__ is indicated for HER2-positive GASTRIC adenocarcinomas s/p late stage surgery

A

Trastuzumab

23
Q

Gastric ___ (malignancy) are associated with H. pylori infection

A

MALToma

24
Q

Gastric MALTomas therapy:

First-line:

A

H. pylori eradication tx

25
Q

GERD is 2/2 imbalance between intragastric and ___ pressures

A

lower esophageal sphincter (LES)

26
Q

Typical GERD symptoms w/o alarm features in patients < 60 years of age next step in management:

A

Start PPI w/ lifestyle modifications

Good response: often used to confirm GERD diagnosis

27
Q 
Alarm features warranting EGD as next best step:
Dysphagia or Odynophagia
[Lab finding]
Unintentional weight loss
\_\_\_\_\_
No symptomatic improvement after \_\_\_
A

Anemia
Aspiration pneumonia
PPI trial

28
Q

Indications for ____ (surgery) in pts with GERD:
severe esophagitis
strictures
recurrent aspiration

A

Fundoplication (Nissen fundoplication)

Consider Roux-en-Y for obese patients

29
Q

Complication of chronic GERD:

A

Barrett esophagus
Metaplasia of the esophageal mucosa
premalignant can become →
esophageal adenocarcinoma

*other cx:
anemia & esophageal strictures

30
Q

Management & Monitoring Barrett esophagus

A

EGD + Biopsy of the suspicious areas (salmon-colored mucosa)

If high-grade dysplasia: endoscopic treatment of mucosal irregularities

31
Q 
Dysphagia
Regurgitation of undigested food
Halitosis
Aspiration
Coughing after food intake
Retrosternal pressure sensation and pain

Diagnosis

A

Zenker’s diverticulum

esophageal diverticulum

32
Q

2 diagnostic test for Zenker’s diverticulum

A

1st: Barium swallow (best confirmatory test) with dynamic continuous fluoroscopy
2nd: EGD to r/o malignancy

33
Q

Inadequate relaxation of the lower esophageal sphincter (LES) &

nonperistaltic contractions in the distal 2/3 of the esophagus

s/t degeneration of inhibitory neurons

A

Achalasia

Esophageal motility disorder

34
Q

__ typically presents with progressive dysphagia to solids and liquids

A

Achalasia

while esophageal obstruction manifests with dysphagia to solids only

35
Q

Achalasia diagnostic test

3

A 
Manometry:
(confirmatory test of choice)
-Absent/ uncoordinated peristalsis in the lower 2/3
-Incomplete LES relaxation
-High LES resting pressure

Esophageal barium swallow:

  • Bird-beak sign: dilation of proximal esophagus w/ stenosis of the GE junction
  • Delayed barium emptying
Upper endoscopy
(r/o pseudoachalasia)

Chest x-ray
(Widened mediastinum)

36
Q

Treatment of Achalasia:

  1. ## If a low surgical risk-
  2. If a high surgical risk
    - Botox the LES
    - nitrates or CCBs
A
  1. Pneumatic dilation via Endoscope-guided dilation of the LES
    1a. LES myotomy (Heller myotomy)
37
Q

Upper gastrointestinal bleeding caused by tears to the longitudinal mucous membrane at the gastroesophageal junction

A

Mallory-Weiss Syndrome

Longitudinal Lacerations
Epigastric or back pain
Hematemesis w/ HDS

38
Q

Mallory-Weiss Syndrome
Precipitating factor:
Severe vomiting

Predisposing conditions
\_\_\_\_
Bulimia nervosa
\_\_\_\_ 
GERD
A

Alcohol use disorder

Hiatal hernia

39
Q

Pt recently vomiting now has severe, retrosternal chest pain
mediastinal and/or subcutaneous emphysema

Diagnosis?

A

Esophageal Rupture (Boerhaave syndrome)

A spontaneous distal esophageal rupture as a result of a sudden increase in intra-esophageal pressure.

Usually 2/2 severe vomiting.

40
Q

Treatment of patients with Mallory Weiss Tear

  1. Not actively bleeding
  2. Active bleeding
A
  1. PPI therapy alone
  2. Endoscopic injection of an Epi or fibrin sealant
    2a. Endoscopic Electrocoagulation
    2b. Endoscopic band ligation
    2c. Angioembolization
41
Q

Esophageal perforation causes (2)

A

Injury during upper endoscopy (sxs w/in 24hrs)

Boerhaave syndrome

42
Q

Mackler triad:

  1. Vomiting
  2. Retrosternal pain radiating to the back
  3. Subcutaneous/mediastinal emphysema/crepitus
    or
    Hamman sign: crunching/crackling sound on chest auscultation

Diagnosis

A

Esophageal Rupture

esp. in Boerhaave syndrome

43
Q

initial and confirmatory imaging for suspected esophageal perforation:

A

Initial: CXR
(Widened mediastinum, Pleural effusion,
Pneumomediastinum, pneumothorax, pneumoperitoneum, subcutaneous emphysema)

Confirmatory: Contrast Esophagography (Barium swallow)

44
Q

Treatment approach to perforated esophagus

3

A

NPO
Broad-spectrum IV antibiotics
Surgery

45
Q

Major complication of perforated esophagus

A

Mediastinitis:
Retrosternal and/or back pain
Subcutaneous emphysema

46
Q 
Esophageal Adenocarcinoma risk factors:
Obesity
\_\_\_\_\_\_
Age 50 ≤ 
\_\_\_\_\_\_
A

Smoking

GERD/Barrett esophagus

47
Q

Esophageal Adenocarcinoma is located mostly in the __ of the esophagus

A

lower third

48
Q 
Esophageal Squamous cell carcinoma (SCC) risk factors:
\_\_\_\_
\_\_\_\_
\_\_\_\_
Diet low in fruits and vegetables
Nitrates (cured/smoked meat, bacon)
Age 60 ≤ 
Plummer-Vinson syndrome
Achalasia
A

Alcohol consumption
Smoking
HPV

49
Q

Esophageal Squamous cell carcinoma located mostly in the ___ of the esophagus

A

upper two-thirds

50
Q 
Signs of advanced esophageal cancer: 
\_\_\_\_ 
Retrosternal chest or back pain
Cervical adenopathy
\_\_\_ and/or persistent cough
A

Dysphagia (from solids to liquids) +/- Odynophagia

Hoarseness

Surgery (36 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions