GI Surgery Flashcards
1
Q
FIRST diagnostic test in patients with suspected esophageal disease
A
Barium swallow
2
Q
Can be used when patient complains of dysphagia and no obstruction is seen on barium swallow
A
Barium-impregnated marshmallow, bread, hamburger
3
Q
Diagnostic test for patients complaining of dysphagia with normal radiographic study
A
Endoscopy
4
Q
Diagnostic test for patients when a motor abnormality is considered and barium swallow and endoscopy are normal
A
Manometry
5
Q
Essential tool in preoperative evaluation of patients before antireflux surgery
A
Manometry
6
Q
MOST DIRECT method of measuring increased esophageal exposure to gastric juice (NOT REFLUX)
A
24-hour ambulatory pH monitoring
7
Q
GOLD STANDARD for diagnosis of GERD
A
24-hour ambulatory pH monitoring
8
Q
MOST SPECIFIC symptom of foregut disease
A
Dysphagia
9
Q
Primary cause of GERD
A
Permanent attenuation of collar sling musculature, with resultant opening of gastric cardia and loss of high-pressure zone measured in manometry
10
Q
3 characteristics of defective LES
A
1) Mean resting pressure less than 6 mmHg
2) Overall sphincter length less than 2 cm
3) Intraabdominal sphincter length less than 1 cm
11
Q
MOST IMPORTANT consideration affecting competence of GEJ
A
Intraabdominal sphincter length less than 1 cm
12
Q
Grading of esophagitis: Small, circular, non confluent erosions
A
Grade I
13
Q
Grading of esophagitis: Linear erosions lined with granulation tissue that bleeds easily when touched
A
Grade II
14
Q
Grading of esophagitis: Linear erosions coalesce into circumferential loss of epithelium
A
Grade III
15
Q
Grading of esophagitis: Cobblestone mucosa
A
Grade III
16
Q
Grading of esophagitis: Stricture
A
Grade IV
17
Q
Incidence of esophagitis in patients with GERD
A
10-15%
18
Q
End stage of natural history of GERD
A
Barrett esophagus
19
Q
HALLMARK of Barrett esophagus
A
Intestinal metaplasia
20
Q
Earliest sign for malignant degeneration of Barrett esophagus
A
Severe dysplasia or intramucosal adenoCA
21
Q
Fraction of patients with BE that present with malignancy
A
1/3
22
Q
Barrett esophagus surveillance frequency
A
1) Every 2 years
2) Every 6 months if with low-grade dysplasia
23
Q
Most important etiologic factor for the development of esophageal adenoCA
A
Barrett esophagus
24
Q
Management for uncomplicated GERD
A
12-week empiric treatment with antacid
25
Most important factor predicting failure of medical therapy for GERD
Structurally defective LES
26
GERD surgery: Abdominal or thoracic 360-degree circumferential wrap of gastric fundus
Nissen fundoplication
27
GERD surgery: Chest approach; 280 degree anterior wrap
Belsey operation
28
GERD surgery: Abdominal approach; 180 degree wrap
Hill
29
GERD surgery: Esophageal lengthening
Collis gastroplasty
30
GERD surgery: Horseshoe-shaped silastic device placed around distal esophagus, keeping it in the abdomen
Angelchik prosthesis
31
GERD surgery: Pressure of distal esophageal sphincter should be restored to a level ___x the resting gastric pressure
2
32
Diaphragmatic hernia: Structure that herniates into thorax in sliding hernia
Cardia
33
Diaphragmatic hernia: Structure that herniates into thorax in paraesophageal hernia
Fundus
34
Sliding vs rolling diaphragmatic hernia: Phrenoesophageal ligament stretched but intact
Sliding
35
Weak in a Zenker diverticulum
Cricopharyngeus muscle (Killian area/triangle)
36
Sliding vs rolling diaphragmatic hernia: Most common
Sliding
37
Sliding vs rolling diaphragmatic hernia: Can evolve into a type III hernia
Sliding
38
Men vs women: Rolling esophageal hernia
Women
39
Type of diaphragmatic hernia: GEJ in the mediastinum
Type 3
40
Type of diaphragmatic hernia: Whole stomach migrates up into the chest by rotating 180 degrees around its longitudinal axis
Type 4
41
Acquired diaphragmatic hernia: Most common complications (3)
1) Occult GI bleeding from gastritis
2) Ulceration in herniated portion
3) Gastric volvulus
42
Triad of gastric volvulus
Borchardt's triad
1) Pain
2) Nausea with inability to vomit
3) Inability to pass NGT
43
Diagnostic procedure that detects paraesophageal hernia
Barium esophagogram
44
Diagnostic procedure that detects pouch lined with gastric rugal folds lying 2 cm or more above margins of diaphragmatic crura
Fiber-optic esophagoscopy
45
Surgical management for esophageal hernia that can reduce recurrence rates if the hernia is > 8cm
Use of mesh
46
Diagnostic procedure for Boerhaave syndrome
Water-soluble (gastrografin) contrast esophagogram
47
Most common esophageal diverticulum
Zenker's diverticulum
48
True vs false diverticulum: Zenker diverticulum
False
49
Achalasia: Classic triad
1) Dysphagia
2) Regurgitation
3) Weight loss
50
Infection that can cause achalasia
T. cruzi infection
51
Destroyed by T. cruzi, causing achalasia
Auerbach's plexus
52
Chance of developing CA in achalasia
10%
53
Surgical management of achalasia
Heller myotomy
54
Most common primary esophageal motility disorder
Nutcracker esophagus
55
Characterized by peristaltic esophageal contractions with peak amplitudes >2 SD above normal value
Nutcracker esophagus
56
T/F Achalasia = hypertensive LES
F
57
Diverticula formed due to increase in pressure
Pulsion
58
Diverticula formed due to inflammatory disorder, not associated with increase in pressure
Traction
59
Key to optimum management of Boerhaave
Early diagnosis
60
Most favorable outcome of Boerhaave is obtained if primary closure is done within
24 hours
61
Cervical vs thoracic vs distal esophageal CA: Frequently unresectable because of early invasion
Cervical
62
Alkali vs acid: More severe injury to esophagus
Alkali
63
Strength of esophageal contractions is weakest at
Striated-smooth muscle junction
64
Striated-smooth muscle junction vs lower portions: More severely affected by caustic ingestion
Striated-smooth muscle junction
65
Phases of caustic injury (3)
1) Acute necrotic phase
2) Ulceration and granulation phase
3) Cicatrization and scarring phase
66
Removed in Ivor-Lewis procedure
(Radical) All LN with lesser curvature
67
Phases of caustic injury: Ulceration and granulation begins
3-5 days after injury
68
Phases of caustic injury: Quiescent period
Ulceration and granulation phase
69
Phases of caustic injury: Period that the esophagus is weakest
Ulceration and granulation
70
Phases of caustic injury: Ulceration and granulation lasts
10-12 days
71
Phases of caustic injury: Cicatrization and scarring begins
3rd week following injury
72
Phases of caustic injury: Characterized by dysphagia
Cicatrization and scarring
73
Esophageal Ca: Most common presenting symptom
Dysphagia
74
T/F Dysphagia is an EARLY symptom of esophageal CA
F, late
75
Management of esophageal CA: Cervical esophagus
Radiation + chemo
76
Management of esophageal CA: Thoracic esophagus
VATS +- thoracotomy
77
Management of esophageal CA: Distal esophagus
Curative resection
78
Surgery primarily for middle esophageal lesion
Ivor-Lewis
79
Largest artery to the stomach
Left gastric
80
Vagus nerve forms ___ branches at the esophageal hiatus as it descends from the mediastinum
LARP
1) Left anterior
2) Right posterior
81
Standard test to confirm eradication of H. pylori post-treatment
Urease breath test
82
Nerves of Laterjet: Branches to the
Body of stomach
83
Nerves of Laterjet: Terminate near the
Incisura angularis
84
Nerves of Laterjet: Terminates as the
Crow foot
85
Posterior branch of the vagus (stomach)
Criminal nerve of Grassi
86
Laterjet vs Grassi: Easily missed during truncal or highly selective vagotomy
Criminal nerve of Grassi
87
Gastric contraction is due to
Vagal stimulation
88
Gastric relaxation is due to (3)
1) CCK
2) Distention of duodenum
3) Glucose in duodenum
89
Alarm symptoms that indicate need for upper endoscopy (5)
1) Recurrent vomiting
2) Dysphagia
3) Weight loss
4) Bleeding
5) Anemia
90
Length of fasting before EGD
8 hours
91
EGD vs double contrast upper GI series: More sensitive
EGD
92
Most serious complication of EGD
Esophageal perforation
93
Double contrast upper GI series is better than EGD in detecting
1) Diverticula
2) Fistula
3) Tortuosity or stricture location
4) Size of hiatal hernia
94
Gold standard for H. pylori diagnosis
Antral mucosal biopsy
95
Urease secreted by H. pylori converts urea to
Ammonia + bicarbonate
96
Tests that can be used to confirm cure from H. pylori
1) Urease breath test
| 2) Fecal antigen test
97
H. pylori: Gastric vs duodenal
Duodenal > gastric
98
Largest predictor of PUD risk
Smoking
99
Males vs females: Duodenal ulcer
Males
100
Peptic ulcer formed after severe brain damage
Cushing ulcer
101
Associated blood type: Duodenal ulcer
O
102
Associated blood type: Gastric ulcer
A
103
Classification of gastric ulcer
Modified Johnson
104
Modified Johnson classification of gastric ulcer
Type I-V
105
Modified Johnson classification of gastric ulcer: Located near incisura angularis on lesser curvature; normal or decreased acid secretion
Type I
106
Modified Johnson classification of gastric ulcer: Located near incisura angularis on lesser curvature; associated active or quiescent duodenal ulcer
Type II
107
Modified Johnson classification of gastric ulcer: Located near incisura angularis on lesser curvature; normal or increased acid secretion
Type II
108
Modified Johnson classification of gastric ulcer: Prepyloric
Type III
109
Modified Johnson classification of gastric ulcer: Increased vs decreased gastric acid secretion, type III
Normal or increased
110
Modified Johnson classification of gastric ulcer: Near GEJ
Type IV
111
Modified Johnson classification of gastric ulcer: Increased vs decreased gastric acid secretion, Type IV
Normal or decreased
112
Modified Johnson classification of gastric ulcer: NSAID induced anywhere in stomach
Type V
113
Peptic ulcer formed after severe burn injury
Curling ulcer
114
Gastric vs duodenal ulcer: H. pylori
Both
115
Gastric vs duodenal ulcer: NSAID overuse
Gastric
116
Gastric vs duodenal ulcer: Increased acid production
Duodenal
117
Gastric vs duodenal ulcer: Steroid overuse
Gastric
118
2nd most common complication of PUD
Perforation
119
Why all gastric ulcers must undergo endoscopy and biopsy
To rule out cancer and test for H. pylori
120
Management for gastric ulcer
Triple therapy, antacids
121
Management for duodenal ulcer
Triple therapy, stop smoking and alcohol consumption
122
Most common symptom of PUD
Abdominal pain
123
Indications for endoscopy in PUD
1) Symptomatic >= 45 y/o
| 2) Symptomatic any age if with alarm symptoms
124
Mainstay of therapy for PUD
PPI
125
PUD: Indications for surgery
1) Bleeding
2) Perforation
3) Obstruction
4) Intractability
126
T/F Best/First-line management for non healing ulcer is surgery
F, consider other differentials for non healing PUD first
127
Surgery for nonhealing PUD is only considered if
1) Multiple recurrences
2) >2 cm
3) (+) complications
4) Suspected malignancy
128
Most common gastric ulcer type
Type I
129
Gastric ulcer types associated with acid hypersecretion
II and III
130
PUD: Most common cause of ulcer related death
Bleeding
131
Most common cause of UGIB in admitted patients
PUD
