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Surgery – Questions > Lange - Upper GI > Flashcards

Lange - Upper GI Flashcards

0
Q

Patient with combination of acute abdomen with upright CXR showing free air under diaphragm – next step in diagnosis?

A

Take to OR for exploration (no other test needed)

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1
Q

Highly selective vagotomy? Difference from other vagotomies?

Effect on complication rate? Recurrence rate?

A

Nerve supply to the pylorus left intact – no drainage procedure is necessary

Lower complication rate but higher recurrence rate

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2
Q

Treatment for perforation?

A

If benign clinical presentation or improving, consider antibiotics with nasogastric decompression (nonsurgical)

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3
Q

Necessary procedure following truncal vagotomy?

A

pyloroplasty (Drainage procedure)

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4
Q

Typical complications after vagotomy?

A
  1. Diarrhea
  2. Delayed gastric emptying
  3. Dumping syndrome
  4. Intussusception
  5. Afferent Loop syndrome
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5
Q

Dumping syndrome? Types?

A

Early dumping – occurs within 30 minutes, caused by rapid gastric emptying of hyperosmolar load to small bowel

Late dumping – 1-3 hours after eating with vasomotor symptoms (related to excess release of insulin in response to postprandial glucose rise)

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6
Q

When to surgically treat prolapse of gastric mucosa into duodenum?

A

Obstructive symptoms (vomiting)

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7
Q

Most common blood type in patients with duodenal ulcer disease?

A

Group O

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8
Q

Post gastrectomy – nutrient absorption that is most affected?

A

Iron – acid needed to release ferric iron from food

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9
Q

Billroth I?

A

Partial gastrectomy with gastroduodenal anastomosis

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10
Q

Treatment of gastric ulcer vs duodenal ulcer?

A
  1. Biopsy for malignancy
  2. Biliroth I (partial gastrectomy with gastroduodenal anastomosis)
  3. Vagotomy – gastric ulcers not associated with acid hypersecretion
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11
Q

Can provoke increase in gastrin levels in patient with ZES by giving?

A

Calcium or secretin

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12
Q

Complication of chronic duodenal ulcer?

A

Pyloric obstruction due to scarring and stenosis of duodenum

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13
Q

Gastrin produced where?

Stimulates?

A

Antrum and small intestine.

Stimulates parietal cells to secrete acid; stimulates chief cells to secrete pepsinogen

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14
Q

Treatment for:

  1. Early gastric cancer
  2. Antral gastric cancer
  3. GIST
A
  1. Gastric resection or endoscopic resection

2. Distal subtotal gastrectomy with the lymph node dissection and chemoradiation

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15
Q

GISTs do not respond to?

A

Radiation or chemotherapy

16
Q

Location of:

  1. Eosinophilic gastroenteritis?
  2. Menetrier’ disease?
A

gastric antrum

proximal stomach

17
Q

Incisura?

A

Where body of the stomach ends and antrum begins

18
Q

Treatment of choice for gastric lymphoma?

A

Chemotherapy and radiation (surgery)

19
Q

Characteristics sign of a GIST on barium studies?

A

Donut sign

20
Q

Type of polyp that is unlikely to become carcinoma? Other type of polyp? Location?

A

Hyperplastic

Adenomatous – Antrum

21
Q

Gastric volvulus associated with?

A

Paraesophageal hiatal hernia

22
Q

Symptoms of an acute gastric distention? Best treatment?

A

Vasovagal reaction ; Nasogastric decompression

23
Q

Autoimmune metaplastic atrophic gastritis associated with?

A

hypochlorhydria parietal cell antibodies and high gastrin

24
Q

Patient gets truncal vagotomy – also needs? Types?

A

Drainage procedure

Pyloroplasty, gastrojejunostomy, antrectomy

25
Q

Difference in management of older patient with peptic ulcer bleeding? Why?

A 
Surgery indicated earlier stage – #vessels atherosclerotic and less likely to stop bleeding spontaneously 
#diminished perfusion less well-tolerated

Oversew gastroduodenal artery, vagotomy, drainage

26
Q

Patient presents with RUQ pain. Sonogram cannot distinguish?

A

Acute cholecystitis

27
Q

Treatment for GIST?

A

Resection of mass or Gleevec

28
Q

Pernicious anemia associated with?

A

Anchlorhydra and gastric carcinoma

29
Q

Between what muscles does a Zenker. Diverticulum emerge?

A

Cricopharyngeus and inferior constrictor muscle

Killian’s triangle

30
Q

Surgical treatment for symptomatic pharyngeal esophageal diverticulum? Etiology ?

A

Myomectomy (if asymptomatic, no treatment)

Failure of cricopharyngeus muscle to relax

31
Q

Epiphrenic diverticulum associated with? Symptoms? Treatment?

A

Hiatal hernia, esophageal spasm, achalasia

Typically asymptomatic; no treatment unless symptomatic

32
Q

Plummer-Vinson syndrome?

A

Esophageal web + atrophic oral mucosa + brittle nails + Fe deficiency anemia

Surgery – Questions (8 decks)

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