other foregut issues Flashcards
Condition after distal gastrectomy wtih Roux en Y reconstruction characterized by delayed gastric emptying in the absence of mechanical obstruction:
Roux syndrome - presents with abdominal pain, N/V, weight loss; diagnosed by gastric emptying study which may show reverse motility in roux limb (moving food toward stomach)
First line treatment of roux syndrome:
promotility agents
second line: surgery to reduce size of gastric pouch
for severe complications perform total gastrectomy and resection of roux limb
Which portions of the stomach have parietal cells (H+) and chief cells (pepsinogen)?
fundus and body
Which portion of the stomach has G cells (gastrin) and D cells (somatostatin)?
antrum
Criteria for metabolic syndrome:
- fasting glucose >100
- waist circumference >40cm in men and >35 cm in women
- triglerides >150
- HDL < 40 for men and <50 for women
Symptoms of dumping syndrome:
diaphoresis, weakness, lightheadedness, tachycardia
Early dumping syndrome (within 30 minutes) cause:
hyperosmotic load delivered to duodenum causes large fluid shift
Late dumping syndrome (2-3 hours after meal) cause:
large fluid bolus hitting duodenum causes insulin surge of release causing hypoglycemia
Treatment options for gastroparesis:
gastric pacemaker pyloroplasty endoscopic stent placement feeding tube botox injections metoclopromide erythromycin
Risk factors for stress gastritis:
prolonged ventilation
coagulopathy
Malignancy is more common in which types of peptic ulcers?
those refractory to medical therapy and those found in the stomach.
Surgical management of gastric adenocarcinoma:
excision with 6cm margins and lymphadenectomy; known to have a wide lateral spread form the primary tumor
What is afferent loop syndrome and what is the treatment?
afferent loop becomes partially or completely obstructed from excessive length of the afferent loop; surgery to convert a Billroth 2 to a Roux en Y is the tx
Ulcer caused by repetitive movement of the GE junction through the hiatus in a hiatal hernia
Cameron ulcer
First steps in management of gastric volvulus:
NGT decompression and IV resuscitation
Features of an abnormal gastric emptying study:
> 60% radiotracer present in the stomach at 2 hours or 10% present at 4 hours
True or false. staging laparoscopy should be performed before neoadjuvant therapy for gastric cancer
True
Triad of symptoms that raises concern for gastric volvulus:
Borchardt triad: severe epigastric pain, inability to vomit, inability to pass NGT
What are the four major arteries that supply blood to the stomach:
right gastric artery
left gastric artery
right gastropepiploic
left gastroepiploic
Which artery should be preserved in a subtotal gastrectomy?
left gastroepiploic artery
Most effective surgical procedure for reversing diabetes
duodenal switch
Antrum contains what type of cells
gastrin producing G cells and somatostatin producing D cells
What is Peterson’s space?
space between Roux limb and transverse colon mesenteries
Presentation and treatment of post vagotomy diarrhea:
presents with watery diarrhea and urgency with no correlation to meals; treat by increasing fiber, decreasing carbs & lactose, eliminating caffeine, and adding cholestyramine
What does the criminal nerve of Grassi come off and innervate?
comes off right vagus and innervates the cardia of the stomach
What does the hepatic branch of the vagus and the nerve of latarjet come off and innervate?
left vagus gives off hepatic branch and nerve of latarjet which innervates the pylorus
True or false. A drainage procedure is necessary in a highly selective vagotomy.
false
Final common pathway at the cellular level for gastric acid secretion by the parietal cell:
H+/K+ ATPase plus Cl- channel
type of gastric ulcer located on lesser curve low along the body. due to decreased mucosal protection
type 1 ulcer
type of gastric ulcer located on the lesser curve and duodenally; associated with high acid secretion
type 2 ulcer
type of gastric ulcer located prepyloric and associated with high acid secretion
type 3 ulcer
type of gastric ulcer located on the lesser curve high along the cardia; associated with decreased mucosal protection
type 4 ulcer
type of gastric ulcer associated with NSAIDs
type 5 ulcer
Symptoms of postosurgical gastroparesis and treatment:
sxs of abdominal pain, postoprandial nuasea/vomiting and weight loss months after gastric resection; surgical treatment is most effective by eliminating gastric reservoir with near completion gastrectomy with RNY gastrojejunostomy
True or false. perioperative antibiotics for PEG tube insertion decreases incidences of peristomal infection
True
Definition of early PEG tube dislodgement:
within 14 days of placement
Occur most commonly in the setting of inflammation from H pylori infection and appear as smooth, dome shaped structures in the antrum
hyperplastic gastric polyps
Risk factors for stress ulcers:
mechanical ventilation >24 hrs, platelet count <50,000, INR>1.5, TBI, spinal cord injuries, severe burns, high dose steroids
Most common complication of PEG tube placement
infection at the PEG site
True or False. Octreotide has been shown to be effective in the management of post-vagotomy diarrhea.
False. But cholestyramine is effective
