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Surgery M4 part 2 > hematemesis > Flashcards

hematemesis Flashcards

1
Q

What lies anterior to the surface of the stomach?

A

left lateral segment of the liver

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2
Q

What attaches the stomach to the transverse colon?

A

gastrocolic omentum

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3
Q

What does the gastro-hepatic ligament attach?

A

the lesser omentum attaches the lesser curvature to the liver

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4
Q

after subtotal gastrectomy where the right & left gastric arteries & the right & left gstro-epiploic arteries are ligated, what supplies the rest of the stomach?

A

short gastric arteries

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5
Q

What is the main stimulus for gastrin secretion?

A

meals -> gastric distention

stimulates secretion of HCL
pH <3 inhibits its secretion, alkaline environment stimulates its secretion
somatostatin inhibits it

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6
Q

What should u ask in history taking of a patient presenting with hematemesis with suspected gastric cancer?

A
  • weight loss
  • decreased food intake
  • anorexia
  • early satiety
  • abdominal pain
  • nausea & vomiting
  • bloating
  • dysphagia
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7
Q

What will be found on physical examination of patient that has suspected gastric cancer?

A
  • chronic occult blood loss
  • Virchow’s node (left supraclavicular)
  • abdominal mass
  • Krukenberg’s tumor of the ovary
  • Sister Joseph’s nodule (umbilical mass in subcutaneous tissue)
  • malignant ascites
  • Blumer shelf (pouch of douglas)
  • Trousseau’s syndrome (thrombophlebitis)
  • Acanthosis nigricans
  • peripheral neuropathy
  • cachexia
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8
Q

What is the first step that should be preformed in order to diagnose the cause of hematemesis?

A

1- esophagogastrodudonoscopy + biopsy
if afraid of obstruction you can start with upper abdominal series
2- CT -> to detect metastases

last step before operation -> laparoscopy

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9
Q

What are the 2 modules of investigation that we can use to diagnose & take a biopsy?

A

EGD

EUS

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10
Q

What are the 3 most common primary malignant gastric neoplasms?

A

adenocarcinoma 95%
lymphoma 4%
malignant GIST 1%

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11
Q

Hematogenous metastasis to the stomach is more likely to occur from?

A

Melanoma

Breast

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12
Q

Who is more commonly diagnosed with gastric cancer?

A

elderly

if young -> diffuse, large, aggressive, poorly differentiated, LINTIS PLASTICA

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13
Q

What is the pathogenesis of gastric cancer?

A

aggregating factor (ex H.pylori) -> chronic superficial gastritis -> atrophic gastritis -> intestinal metaplasia -> dysplasia -> cancer

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14
Q

an E-cadherin gene is associated with?

A

LINTIS PLASTICA
(diffuse gastric cancer)

consider prophylactic total gastrectomy

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15
Q

Menetrier disease is a risk factor for?

A

adenocarcinoma

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16
Q

What is the gold standard for monitoring patients with hereditary risk of developing gastric carcinoma?

A

EGD

17
Q

What are the types of presentation of gastric cancer?

A
  • polypoid -> doesn’t ulcerate
  • fungating -> can ulcerate
  • ulcerative -> ulcer within mass
  • scirrhous -> linitis plastica (entire thickness & large area)
18
Q

Where does the majority of gastric cancers develop?

A

distal stomach

19
Q

What is the classification of gastric polyps?

A
  • BENIGN GASTRIC POLYPS:
    neoplastic (adenoma) or nonneoplastic (hyperplastic, inflammatory, or hamartomatous)
  • LARGE HYPERPLASTIC POLYPS (>2cm):
    harbors dysplasia or carcinoma in situ
    associated with chronic inflammation
  • GASTRIC ADENOMAS
    premalignant
    patients with FAP (familial adenomatous polyposis) are at 10 times higher risk of developing adenocarcinoma
    needs screening (EGD)
  • POLYPS >1cm
    remove to confirm diagnosis & eliminate risk of malignant degeneration
    if associated with FAP -> periodic screening
  • FUNDIC GLAND POLYPS
    benign lesions associated with PPI use
    doesn’t require excision, regular surveillance, or cessation of therapy
20
Q

What is the most common precursor for intestinal subtype gastric cancer?

A

ATROPHIC GASTRITIS
more in older age groups
H. pylori is involved in its pathogenesis

21
Q

What is the only curative treatment for gastric cancer?

A

RADICAL SUBTOTAL GASTRECTOMY -> R0 resection
proximal, distal, & radial margins should be atleast 5cm (freeze & send to pathology)
EN-BLOC RESECTION

22
Q

How many lymph nodes are required for proper staging of gastric cancer?

A

15 or more

23
Q

How does the reconstruction of the bowel continuity occur after the radical subtotal gastrectomy?

A

Billroth II OR Roux-en-Y Gastro-jejunostomy

24
Q

How is proximal gastric cancer treated?

A

total gastrectomy

25
Q

When is neoadjuvant therapy indicated?

A

in Stage 3 & above

- 5-FU, Cisplatin & docetaxel

26
Q

Radiotherapy is useful in which stages?

A

stage II & III

27
Q

When is endoscopic mucosal resection (EMR) indicated?

A

curative in early gastric cancer

- in differentiated mucosal cancer <2cm without ulceration, is node negative, & confined to mucosa (seen by EUS)

28
Q

What is the prognosis of gastric cancer?

A

Stage I -> 75%
Stage II -> 50%
Stage III -> 25%

29
Q

What is the most common site for primary GI lymphoma & what is the most common type?

A

STOMACH in the antrum
95% is non-hodgkin

responds well to chemotherapy

30
Q

what is the cause behind low-grade MALT?

A

chronic gastritis from H.pylori

31
Q

How does high grade MALToma present?

A

like gastric cancer:

  • weight loss
  • decreased food intake
  • anorexia
  • early satiety
  • abdominal pain
  • nausea & vomiting
  • bloating
  • dysphagia
32
Q

How is MALToma treated?

A

chemotherapy & radiotherapy
CHOP
cyclophosphamide, hydroxydaunomycin, oncovin (vincristine), prednisone

33
Q

Which tumor arises from the interstitial cells of Cajal?

A

GIST

  • epithelial cell stromal type more common than cellular spindle type
  • any lesion >1cm behaves like malignancy
34
Q

Which type of gastric cancer expresses C-KIT?

A

GIST

35
Q

How is GIST treated?

A
  • leiomyoma -> enucleation
  • GIST or leiomyosarcoma -> resection with negative margins
  • Imatinib -> chemo of choice
36
Q

What type of gastric cancer arises from ECL cells?

A 
GASTRIC CARCINOID (neuroendocrine tumor) 
Somatostatin analogs are used to control symptoms (octreotide, sandostatin)
37
Q

how is leiomyoma managed?

A
  • <2cm or asymptomatic (benign) -> obserce or enucleate

- >2cm or symptomatic (malignant) -> wedge resection

Surgery M4 part 2 (36 decks)

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