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True Learn Studying 2021 > Gastric Surgery Review > Flashcards

Gastric Surgery Review Flashcards

1
Q

Patient is post-op from total gastrectomy, presents with malaise and megaloblastic anemia on smear…whats the issue?

A
  • loss of parietal cells -> loss of intrinsic factor -> cannot absorb vitamin B12
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2
Q

what is the most common site of leak for a biliopancreatic diversion with duodenal switch?

A
  • the gastric sleeve
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3
Q

first sign of a potential leak from a gastric surgery?

A
  • tachycardia
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4
Q

history of bill roth II reconstruction, complains of eipgastric pain relieved by bilious emesis…whats going on?

A
  • efferent loop obstruction
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5
Q

how does chronic efferent loop obstruction cause megaloblastic anemia

A

bacterial overgrowth in duodenal stump binds to B12 causing malabsorption of the vitamin downstream

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6
Q

how do you treat efferent loop obstruction from a Billroth II reconstruction?

A

covert to a Roux-en-y configuration

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7
Q

What is the Roux limb in a roux-en-y gastric bypass?

A

Roux limb = alimentary limb/efferent limb…the one attached to gastric pouch

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8
Q

how do you treat patient with chocledocholithiasis and roux-en-y gastric bypass?

A
  • ideally you do a laparoscopic assisted ERCP
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9
Q

How does a PPI work?

A

inhibits H+/K+ pump on parietal cells

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10
Q

give examples of H2 blockers

A

Cimetidine
Ranitidine
famotidine

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11
Q

how do you manage post-vagotomy dysphagia

A

exclude solid foods temporarily

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12
Q

bariatric surgery most likely to cure metabolic disorders

A

Biliopancreatic diversion with a duodenal switch

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13
Q

patient with 2 week history of epigastric pain 2-3 hours after eating, with high stress job

A
  • likely peptic ulcer in the duodenum (pain 3 hours after eating gives away the location)
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14
Q

patient with 2 week history of epigastric pain immediately after eating, with high stress job

A
  • peptic ulcer disease, ulcer in the stomach (pain right after eating gives away the location)
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15
Q

treatment for H. Pylori?

A

7-10 day course of:

  • PPI
  • amoxicillin
  • clarithromycin
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16
Q

why have we abandoned vertical gastric banding for weight loss?

A
  • not as effective as roux-en-y and gastric sleeve for sustained weight loss
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17
Q

how low can you take a low anterior resection for rectal cancer?

A

as long as tumor is 2 cm above the puborectal sling you can do an LAR…and its preferred over anal excision because of the occult spread of tumor to lymph nodes in mesorectum (taken during LAR)

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18
Q

How do you treat a Phytobezoar?

A

chemical dissolution and endoscopic fragmentation as first line

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19
Q

How do you treat a Trichobezoar?

A

Surgical intervention…hair gets tangled

20
Q

Which weight loss surgery has been abandoned because it causes end-stage liver disease?

A

Jejunal bypass

21
Q

Which weight loss surgery has been abandoned because of malnutrition and high rate of marginal ulcers?

A

Biliopancreatic diversion

  • there is a duodenal switch which can be added on to this procedure to improve complication rate
22
Q

how do you treat a low grade mucosa-associated lymphoma?

A

Clarithromycin and Amoxicillin

23
Q

how do you treat high grade mucosa-associated lymphoma?

A

chemotherapy and radiation

24
Q

When would surgery be indicated for MALT?

A

perforation or uncontrolled bleeding

25
Q

sub epithelial mass in stomach biopsy shows CD117 expression

A

GIST

26
Q

what genetic mutation are GISTs associated with?

A

mutation in the KIT proto-oncogene

27
Q

Treatment for locally advanced GIST

A

Imatinib - a tyrosine kinase inhibitor

used to shrink tumor to allow for resection

28
Q

expected weight loss after sleeve gastrectomy

A

50-60% of EXCESS body weight

29
Q

expected weight loss from roux-en-y gastric by pass

A

80% of EXCESS body weight

30
Q

patient 1 year out form Roux-en-y gastric bypass, complaining of bloating steatorrhea fatigue with positive fecal fat study and microcytic anemia…what is going on

A
  • blind loop syndrome
31
Q

confirmatory test for blind loop syndrome

A

carbohydrate breath test

32
Q

patient post-op from roux-en-y gastric bypass has diaphoresis after meals, whats going on?

A

gastric dumping syndrome

33
Q

test to perform when suspecting gastric dumping syndrome

A

monitored glucose test

34
Q

ladder of care for upper GI bleed, in stable patient

A
  • endoscopy x2
  • IR embo
  • surgery
35
Q

etiology of type II ulcer

A

hyperacid secretion

36
Q

location of type II ulcer

A
  • antrum

- first part of the duodenum

37
Q

location of type III ulcer

A

pre-pyloric

38
Q

etiology of type III ulcer

A

acid hyper secretion

39
Q

Radiologic evidence suggests diagnosis of a GIST 1.5 cm in size located along greater curvature. What is the next best step?

A

resect as this surgery would not cause too much morbidity, this will be a diagnostic and potentially therapeutic resection

40
Q

Radiologic evidence shows a 2.1 cm potential GIST at the GEJ, next step?

A
  • Biopsy for 2 reasons 1) size is greater than 2 cm, 2) location would necessitate an aggressive surgery
  • goal is to assess for genetic mutations which potentially can be treated with neoadjuvant therapy to reduce size of tumor
41
Q

pathophysiology of early dumping syndrome

A
  • 30 minutes after a meal
  • epigastric pain, fullness, diarrhea
  • result of large food bolus into duodenum causing large fluid shift into the GI tract
42
Q

pathophysiology of late dumping syndrome

A
  • large food bolus into duodenum, causes large release of insulin
  • 2-3 hours later patient feels palpitations, weakness, diaphoresis
  • the hypoglycemia from the insulin release causes catecholamine release from the adrenals
43
Q

how do you test for eradication of H. pylori

A
  • breath test, fecal test, or repeat EGD
  • 4 weeks after completing treatment
  • hold PPI for 2 weeks prior
44
Q

Greatest stimulator of gastrin release

A

Amino acids

45
Q

underlying pathophysiology of dysphagia after antrectomy and vagotomy

A

peri-esophageal fibrosis and denervation

but its usually only temporary

True Learn Studying 2021 (27 decks)

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