GI Section 1: Luminal (Misc. Gastric Conditions)

Question 1

“Multiple gastric ulcers”

Answer 1

Chronic Aspirin Therapy

Obviously this is non- specific, but some sources say it occurs in 80% of patient’s with chronic aspirin use.

Question 2

Aspirin on Duodenal ulcers:

Answer 2

aspirin does NOT cause duodenal ulcers.

Question 3

If you see multiple duodenal ulcers (most duodenal ulcers are solitary) you should think

Answer 3

Zollinger- Ellison.

Question 4

This is a normal fine reticular pattern seen on double contrast

Answer 4

Areae Gastricae

Question 5

when does Areae Gastricae “enlarge ” ?

Answer 5

in elderly and patient’s with H. Pylori.

Also it can focally enlarge next to an ulcer.

It becomes obliterated by cancer or atrophic gastritis.

Question 6

It’s an idiopathic gastropathy, with regular rugal thickening that classically involves the fundus and spares the antrum.

Answer 6

Menetrier’s Disease

+FUNDUS

• ANTRUM

Question 7

Involves the fundus, and spares the antrum.

Answer 7

Menetrier’s Disease

Question 8

Answer 8

Ram’s Horn Deformity (Pseudo Billroth I)

Tapering of the antrum causes the stomach to look
like a Ram’s Horn

Seen in:
Scarring in peptic ulcers
Granulomatous diseases:
Crohns, Sarcoid, TB, Syphillis
Scirrhous Carcinoma

Question 9

The stomach is the most common GI tract location for what disease?

Answer 9

Sarcoid

Question 10

Gastric Volvulus two types

Answer 10

Organo axial and mesenteroaxial

Question 11

Greater Curvature flips over the lesser curvature

Answer 11

Organoaxial Gastric volvulus

Question 12

Twisting over the mesentery

Answer 12

Mesenteroaxial Gastric volvulus

Question 13

Gastric Antrum BELOW the GE Junction

Answer 13

Organoaxial Gastric volvulus

Question 14

Gastric Antrum ABOVE the GE Junction

Answer 14

Mesenteroaxial Gastric volvulus

Question 15

Answer 15

Gastric diverticulum (common in the posterior fundus)

Mistaken for an adrenal mass (find the normal adrenal)

Question 16

splenic vein thrombus causing isolated gastric varices

Answer 16

Gastric Varices

Question 17

the most common complication of Gastric Band

Answer 17

Stomal stenosis = band too tight

Question 18

Pylorus is removed and the proximal stomach is sewed directly to the duodenum.

Answer 18

Billroth 1

Question 19

Partial gastrectomy, but this time the stomach is attached to the jejunum.

Answer 19

Billroth 2

Question 20

Indications for Billroth 1

Answer 20

Gastric CA
Pyloric Dysfunction or ulcers

Less Post Op Gastritis but MORE early post op complications vs Billroth 2

Question 21

Indications for Billroth 2

Answer 21

Gastric CA or Ulcers (distal stomach)

Risks
Dumping Syndrome
Afferent loops syndrome
Increased risk of gastric CA post surgery

Question 22

Stomach is divided to make a “pouch.” This gastric pouch is attached to the jejunum. The excluded stomach attaches to the duodenum as per normal. The jejunum is attached to the other
jejunum to form the bottom of the Y.

Answer 22

Roux-en-Y

Question 23

Indications of Roux-en-Y surgery

Answer 23

For obesity
Billtroth alternative for Gastric CA if with direct invasion of the duodenum or head of the pancreas

Less reflux, less risk for recurrent gastric CA

risks: leaks, fistulas, gallstones and hernias