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Surgery > GI Surgery > Flashcards

GI Surgery Flashcards

1
Q

FIRST diagnostic test in patients with suspected esophageal disease

A

Barium swallow

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2
Q

Can be used when patient complains of dysphagia and no obstruction is seen on barium swallow

A

Barium-impregnated marshmallow, bread, hamburger

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3
Q

Diagnostic test for patients complaining of dysphagia with normal radiographic study

A

Endoscopy

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4
Q

Diagnostic test for patients when a motor abnormality is considered and barium swallow and endoscopy are normal

A

Manometry

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5
Q

Essential tool in preoperative evaluation of patients before antireflux surgery

A

Manometry

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6
Q

MOST DIRECT method of measuring increased esophageal exposure to gastric juice (NOT REFLUX)

A

24-hour ambulatory pH monitoring

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7
Q

GOLD STANDARD for diagnosis of GERD

A

24-hour ambulatory pH monitoring

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8
Q

MOST SPECIFIC symptom of foregut disease

A

Dysphagia

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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

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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

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11
Q

MOST IMPORTANT consideration affecting competence of GEJ

A

Intraabdominal sphincter length less than 1 cm

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12
Q

Grading of esophagitis: Small, circular, non confluent erosions

A

Grade I

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13
Q

Grading of esophagitis: Linear erosions lined with granulation tissue that bleeds easily when touched

A

Grade II

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14
Q

Grading of esophagitis: Linear erosions coalesce into circumferential loss of epithelium

A

Grade III

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15
Q

Grading of esophagitis: Cobblestone mucosa

A

Grade III

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16
Q

Grading of esophagitis: Stricture

A

Grade IV

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17
Q

Incidence of esophagitis in patients with GERD

A

10-15%

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18
Q

End stage of natural history of GERD

A

Barrett esophagus

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19
Q

HALLMARK of Barrett esophagus

A

Intestinal metaplasia

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20
Q

Earliest sign for malignant degeneration of Barrett esophagus

A

Severe dysplasia or intramucosal adenoCA

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21
Q

Fraction of patients with BE that present with malignancy

A

1/3

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22
Q

Barrett esophagus surveillance frequency

A

1) Every 2 years

2) Every 6 months if with low-grade dysplasia

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23
Q

Most important etiologic factor for the development of esophageal adenoCA

A

Barrett esophagus

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24
Q

Management for uncomplicated GERD

A

12-week empiric treatment with antacid

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25
Q

Most important factor predicting failure of medical therapy for GERD

A

Structurally defective LES

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26
Q

GERD surgery: Abdominal or thoracic 360-degree circumferential wrap of gastric fundus

A

Nissen fundoplication

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27
Q

GERD surgery: Chest approach; 280 degree anterior wrap

A

Belsey operation

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28
Q

GERD surgery: Abdominal approach; 180 degree wrap

A

Hill

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29
Q

GERD surgery: Esophageal lengthening

A

Collis gastroplasty

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30
Q

GERD surgery: Horseshoe-shaped silastic device placed around distal esophagus, keeping it in the abdomen

A

Angelchik prosthesis

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31
Q

GERD surgery: Pressure of distal esophageal sphincter should be restored to a level ___x the resting gastric pressure

A

2

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32
Q

Diaphragmatic hernia: Structure that herniates into thorax in sliding hernia

A

Cardia

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33
Q

Diaphragmatic hernia: Structure that herniates into thorax in paraesophageal hernia

A

Fundus

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34
Q

Sliding vs rolling diaphragmatic hernia: Phrenoesophageal ligament stretched but intact

A

Sliding

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35
Q

Weak in a Zenker diverticulum

A

Cricopharyngeus muscle (Killian area/triangle)

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36
Q

Sliding vs rolling diaphragmatic hernia: Most common

A

Sliding

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37
Q

Sliding vs rolling diaphragmatic hernia: Can evolve into a type III hernia

A

Sliding

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38
Q

Men vs women: Rolling esophageal hernia

A

Women

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39
Q

Type of diaphragmatic hernia: GEJ in the mediastinum

A

Type 3

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40
Q

Type of diaphragmatic hernia: Whole stomach migrates up into the chest by rotating 180 degrees around its longitudinal axis

A

Type 4

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41
Q

Acquired diaphragmatic hernia: Most common complications (3)

A

1) Occult GI bleeding from gastritis
2) Ulceration in herniated portion
3) Gastric volvulus

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42
Q

Triad of gastric volvulus

A

Borchardt’s triad

1) Pain
2) Nausea with inability to vomit
3) Inability to pass NGT

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43
Q

Diagnostic procedure that detects paraesophageal hernia

A

Barium esophagogram

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44
Q

Diagnostic procedure that detects pouch lined with gastric rugal folds lying 2 cm or more above margins of diaphragmatic crura

A

Fiber-optic esophagoscopy

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45
Q

Surgical management for esophageal hernia that can reduce recurrence rates if the hernia is > 8cm

A

Use of mesh

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46
Q

Diagnostic procedure for Boerhaave syndrome

A

Water-soluble (gastrografin) contrast esophagogram

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47
Q

Most common esophageal diverticulum

A

Zenker’s diverticulum

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48
Q

True vs false diverticulum: Zenker diverticulum

A

False

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49
Q

Achalasia: Classic triad

A

1) Dysphagia
2) Regurgitation
3) Weight loss

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50
Q

Infection that can cause achalasia

A

T. cruzi infection

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51
Q

Destroyed by T. cruzi, causing achalasia

A

Auerbach’s plexus

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52
Q

Chance of developing CA in achalasia

A

10%

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53
Q

Surgical management of achalasia

A

Heller myotomy

54
Q

Most common primary esophageal motility disorder

A

Nutcracker esophagus

55
Q

Characterized by peristaltic esophageal contractions with peak amplitudes >2 SD above normal value

A

Nutcracker esophagus

56
Q

T/F Achalasia = hypertensive LES

57
Q

Diverticula formed due to increase in pressure

58
Q

Diverticula formed due to inflammatory disorder, not associated with increase in pressure

59
Q

Key to optimum management of Boerhaave

A

Early diagnosis

60
Q

Most favorable outcome of Boerhaave is obtained if primary closure is done within

61
Q

Cervical vs thoracic vs distal esophageal CA: Frequently unresectable because of early invasion

62
Q

Alkali vs acid: More severe injury to esophagus

63
Q

Strength of esophageal contractions is weakest at

A

Striated-smooth muscle junction

64
Q

Striated-smooth muscle junction vs lower portions: More severely affected by caustic ingestion

A

Striated-smooth muscle junction

65
Q

Phases of caustic injury (3)

A

1) Acute necrotic phase
2) Ulceration and granulation phase
3) Cicatrization and scarring phase

66
Q

Removed in Ivor-Lewis procedure

A

(Radical) All LN with lesser curvature

67
Q

Phases of caustic injury: Ulceration and granulation begins

A

3-5 days after injury

68
Q

Phases of caustic injury: Quiescent period

A

Ulceration and granulation phase

69
Q

Phases of caustic injury: Period that the esophagus is weakest

A

Ulceration and granulation

70
Q

Phases of caustic injury: Ulceration and granulation lasts

A

10-12 days

71
Q

Phases of caustic injury: Cicatrization and scarring begins

A

3rd week following injury

72
Q

Phases of caustic injury: Characterized by dysphagia

A

Cicatrization and scarring

73
Q

Esophageal Ca: Most common presenting symptom

74
Q

T/F Dysphagia is an EARLY symptom of esophageal CA

75
Q

Management of esophageal CA: Cervical esophagus

A

Radiation + chemo

76
Q

Management of esophageal CA: Thoracic esophagus

A

VATS +- thoracotomy

77
Q

Management of esophageal CA: Distal esophagus

A

Curative resection

78
Q

Surgery primarily for middle esophageal lesion

A

Ivor-Lewis

79
Q

Largest artery to the stomach

A

Left gastric

80
Q

Vagus nerve forms ___ branches at the esophageal hiatus as it descends from the mediastinum

A

LARP

1) Left anterior
2) Right posterior

81
Q

Standard test to confirm eradication of H. pylori post-treatment

A

Urease breath test

82
Q

Nerves of Laterjet: Branches to the

A

Body of stomach

83
Q

Nerves of Laterjet: Terminate near the

A

Incisura angularis

84
Q

Nerves of Laterjet: Terminates as the

85
Q

Posterior branch of the vagus (stomach)

A

Criminal nerve of Grassi

86
Q

Laterjet vs Grassi: Easily missed during truncal or highly selective vagotomy

A

Criminal nerve of Grassi

87
Q

Gastric contraction is due to

A

Vagal stimulation

88
Q

Gastric relaxation is due to (3)

A

1) CCK
2) Distention of duodenum
3) Glucose in duodenum

89
Q

Alarm symptoms that indicate need for upper endoscopy (5)

A

1) Recurrent vomiting
2) Dysphagia
3) Weight loss
4) Bleeding
5) Anemia

90
Q

Length of fasting before EGD

91
Q

EGD vs double contrast upper GI series: More sensitive

92
Q

Most serious complication of EGD

A

Esophageal perforation

93
Q

Double contrast upper GI series is better than EGD in detecting

A

1) Diverticula
2) Fistula
3) Tortuosity or stricture location
4) Size of hiatal hernia

94
Q

Gold standard for H. pylori diagnosis

A

Antral mucosal biopsy

95
Q

Urease secreted by H. pylori converts urea to

A

Ammonia + bicarbonate

96
Q

Tests that can be used to confirm cure from H. pylori

A

1) Urease breath test

2) Fecal antigen test

97
Q

H. pylori: Gastric vs duodenal

A

Duodenal > gastric

98
Q

Largest predictor of PUD risk

99
Q

Males vs females: Duodenal ulcer

100
Q

Peptic ulcer formed after severe brain damage

A

Cushing ulcer

101
Q

Associated blood type: Duodenal ulcer

102
Q

Associated blood type: Gastric ulcer

103
Q

Classification of gastric ulcer

A

Modified Johnson

104
Q

Modified Johnson classification of gastric ulcer

105
Q

Modified Johnson classification of gastric ulcer: Located near incisura angularis on lesser curvature; normal or decreased acid secretion

106
Q

Modified Johnson classification of gastric ulcer: Located near incisura angularis on lesser curvature; associated active or quiescent duodenal ulcer

107
Q

Modified Johnson classification of gastric ulcer: Located near incisura angularis on lesser curvature; normal or increased acid secretion

108
Q

Modified Johnson classification of gastric ulcer: Prepyloric

109
Q

Modified Johnson classification of gastric ulcer: Increased vs decreased gastric acid secretion, type III

A

Normal or increased

110
Q

Modified Johnson classification of gastric ulcer: Near GEJ

111
Q

Modified Johnson classification of gastric ulcer: Increased vs decreased gastric acid secretion, Type IV

A

Normal or decreased

112
Q

Modified Johnson classification of gastric ulcer: NSAID induced anywhere in stomach

113
Q

Peptic ulcer formed after severe burn injury

A

Curling ulcer

114
Q

Gastric vs duodenal ulcer: H. pylori

115
Q

Gastric vs duodenal ulcer: NSAID overuse

116
Q

Gastric vs duodenal ulcer: Increased acid production

117
Q

Gastric vs duodenal ulcer: Steroid overuse

118
Q

2nd most common complication of PUD

A

Perforation

119
Q

Why all gastric ulcers must undergo endoscopy and biopsy

A

To rule out cancer and test for H. pylori

120
Q

Management for gastric ulcer

A

Triple therapy, antacids

121
Q

Management for duodenal ulcer

A

Triple therapy, stop smoking and alcohol consumption

122
Q

Most common symptom of PUD

A

Abdominal pain

123
Q

Indications for endoscopy in PUD

A

1) Symptomatic >= 45 y/o

2) Symptomatic any age if with alarm symptoms

124
Q

Mainstay of therapy for PUD

125
Q

PUD: Indications for surgery

A

1) Bleeding
2) Perforation
3) Obstruction
4) Intractability

126
Q

T/F Best/First-line management for non healing ulcer is surgery

A

F, consider other differentials for non healing PUD first

127
Q

Surgery for nonhealing PUD is only considered if

A

1) Multiple recurrences
2) >2 cm
3) (+) complications
4) Suspected malignancy

128
Q

Most common gastric ulcer type

129
Q

Gastric ulcer types associated with acid hypersecretion

A

II and III

130
Q

PUD: Most common cause of ulcer related death

131
Q

Most common cause of UGIB in admitted patients

Surgery (33 decks)

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