Gastric: outlet obstr/cyclic vomit/adenoca/dumping/bile gstristis

Question 1

GASTRIC OUTLET OBSTRUCTION. causes?

Answer 1

Malignancy. PUD. Crohn disease. Strictures secondary to caustic agent ingestion. Gastric bezoars.

Question 2

GASTRIC OUTLET OBSTRUCTION. physical exam?

Answer 2

Succession splash:
▪ Placing the stethoscope over the upper abdomen and ricking the patient back and forth at the hips.

▪ Retained gastric material >3 hours after a meal will generate a splash sound.

Question 3

GASTRIC OUTLET OBSTRUCTION. management?

Answer 3

o NG tube suction to decompress the stomach.
o IV fluids.
o Endoscopy for definitive diagnosis.

Question 4

CYCLIC VOMITING SYNDROME. positive what?

Answer 4

THC positive.

Question 5

CYCLIC VOMITING SYNDROME. cp?

Answer 5

Marijuana habitual use. Cycle of nausea and vomiting.

Question 6

CYCLIC VOMITING SYNDROME. diagnosis?

Answer 6

Clinical diagnosis.
Recurrent: EGD.

Question 7

CYCLIC VOMITING SYNDROME. treatment?

Answer 7

Stop THC. Metoclopramide. Erythromycin.

Question 8

gastric adenoc. etiology?

Answer 8

Etiology: Increased incidence in east Asia. Associated with nitrites exposure.

Question 9

gastric adenoc. cp?

Answer 9

• Early satiety.
• Unintentional weight loss.
• Leser-Trelat sign: sudden development of seborrheic keratoses.
• Acanthosis nigricans.

Question 10

gastric adenoc. diagnosis? 2

Answer 10

Endoscopy and biopsy: signet ring cells.
PET scan and CT scan for staging.

Question 11

gastric adenoc. treatment - only mucosa?

Answer 11

Only mucosa –> endoscopic resection.

Question 12

gastric adenoc. treatment - otherwise than mucosa?

Answer 12

Otherwise –> tumor resection +/ lymphadenectomy.

Question 13

gastric adenoc. treatment - metastatic?

Answer 13

Metastatic –> palliative chemotherapy and radiation. Surgery for obstruction.

Question 14

staging for gastric adeno scheme. initial?

Answer 14

initial endoscopy/biopsy positive for adeno

Question 15

staging for gastric adeno scheme. positive biopsy –>?

Answer 15

CT abdomen and pelvis

Question 16

staging for gastric adeno scheme. CT abdomen and pelvis –>?

Answer 16

PET/CT, endoscopic UG
Laparoscopy, CT chest
+/- paracentesis/peritoneal lavage

Question 17

staging for gastric adeno scheme. broad invetigation: PET/CT, endoscopic UG
Laparoscopy, CT chest
+/- paracentesis/peritoneal lavage –> IF LIMITED STAGE?

Answer 17

Surgical resection

Question 18

staging for gastric adeno scheme. broad invetigation: PET/CT, endoscopic UG
Laparoscopy, CT chest
+/- paracentesis/peritoneal lavage –> IF ADVANCED STAGE?

Answer 18

Chemo +/- palliative surgery

Question 19

Dumping. what syndrome? mechanism?

Answer 19

Common postgastrectomy syndrome. Caused by loss of normal action of pyloric sphincter due to injury or surgical bypass.

Question 20

Dumping. symptoms?

Answer 20

Abdominal pain, diarrhea, nausea
Hypotension/tachycardia
Dizziness/confusion, fatigue, diaphoresis

Question 21

Dumping. timing?

Answer 21

15-30 min after meals

Question 22

Dumping. pathogenesis?

Answer 22

rapid emptying of HYPERTONIC gastric contents

Question 23

Dumping. differentiate from what?

Answer 23

Differentiate from SIBO:
* SNS activation leading to tachycardia, flushing, etc.
* No steatorrhea and no vitamin B12 deficiency.

Question 24

Dumping. diagnosis?

Answer 24

Clinical diagnosis.
UGI x-ray series or gastric emptying studies can be used.

Question 25

Dumping. management?

Answer 25

Drink fluids between meals rather than during meals.
Unresponsive –> octreotide or reconstructive surgery.

Question 26

BILE REFLUX GASTRITIS. mechanism?

Answer 26

Incompetent pyloric sphincter (gastric surgery).
Retrograde flow of bile-rich duodenal fluid into the stomach and esophagus.

Question 27

BILE REFLUX GASTRITIS. CP?

Answer 27

Vomiting. Heartburn. Abdominal pain.