other foregut issues

Question 1

Condition after distal gastrectomy wtih Roux en Y reconstruction characterized by delayed gastric emptying in the absence of mechanical obstruction:

Answer 1

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)

Question 2

First line treatment of roux syndrome:

Answer 2

promotility agents
second line: surgery to reduce size of gastric pouch
for severe complications perform total gastrectomy and resection of roux limb

Question 3

Which portions of the stomach have parietal cells (H+) and chief cells (pepsinogen)?

Answer 3

fundus and body

Question 4

Which portion of the stomach has G cells (gastrin) and D cells (somatostatin)?

Answer 4

antrum

Question 5

Criteria for metabolic syndrome:

Answer 5

1. fasting glucose >100
2. waist circumference >40cm in men and >35 cm in women
3. triglerides >150
4. HDL < 40 for men and <50 for women

Question 6

Symptoms of dumping syndrome:

Answer 6

diaphoresis, weakness, lightheadedness, tachycardia

Question 7

Early dumping syndrome (within 30 minutes) cause:

Answer 7

hyperosmotic load delivered to duodenum causes large fluid shift

Question 8

Late dumping syndrome (2-3 hours after meal) cause:

Answer 8

large fluid bolus hitting duodenum causes insulin surge of release causing hypoglycemia

Question 9

Treatment options for gastroparesis:

Answer 9

gastric pacemaker
pyloroplasty
endoscopic stent placement
feeding tube
botox injections
metoclopromide
erythromycin

Question 10

Risk factors for stress gastritis:

Answer 10

prolonged ventilation

coagulopathy

Question 11

Malignancy is more common in which types of peptic ulcers?

Answer 11

those refractory to medical therapy and those found in the stomach.

Question 12

Surgical management of gastric adenocarcinoma:

Answer 12

excision with 6cm margins and lymphadenectomy; known to have a wide lateral spread form the primary tumor

Question 13

What is afferent loop syndrome and what is the treatment?

Answer 13

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

Question 14

Ulcer caused by repetitive movement of the GE junction through the hiatus in a hiatal hernia

Answer 14

Cameron ulcer

Question 15

First steps in management of gastric volvulus:

Answer 15

NGT decompression and IV resuscitation

Question 16

Features of an abnormal gastric emptying study:

Answer 16

> 60% radiotracer present in the stomach at 2 hours or 10% present at 4 hours

Question 17

True or false. staging laparoscopy should be performed before neoadjuvant therapy for gastric cancer

Answer 17

True

Question 18

Triad of symptoms that raises concern for gastric volvulus:

Answer 18

Borchardt triad: severe epigastric pain, inability to vomit, inability to pass NGT

Question 19

What are the four major arteries that supply blood to the stomach:

Answer 19

right gastric artery
left gastric artery
right gastropepiploic
left gastroepiploic

Question 20

Which artery should be preserved in a subtotal gastrectomy?

Answer 20

left gastroepiploic artery

Question 21

Most effective surgical procedure for reversing diabetes

Answer 21

duodenal switch

Question 22

Antrum contains what type of cells

Answer 22

gastrin producing G cells and somatostatin producing D cells

Question 23

What is Peterson’s space?

Answer 23

space between Roux limb and transverse colon mesenteries

Question 24

Presentation and treatment of post vagotomy diarrhea:

Answer 24

presents with watery diarrhea and urgency with no correlation to meals; treat by increasing fiber, decreasing carbs & lactose, eliminating caffeine, and adding cholestyramine

Question 25

What does the criminal nerve of Grassi come off and innervate?

Answer 25

comes off right vagus and innervates the cardia of the stomach

Question 26

What does the hepatic branch of the vagus and the nerve of latarjet come off and innervate?

Answer 26

left vagus gives off hepatic branch and nerve of latarjet which innervates the pylorus

Question 27

True or false. A drainage procedure is necessary in a highly selective vagotomy.

Answer 27

false

Question 28

Final common pathway at the cellular level for gastric acid secretion by the parietal cell:

Answer 28

H+/K+ ATPase plus Cl- channel

Question 29

type of gastric ulcer located on lesser curve low along the body. due to decreased mucosal protection

Answer 29

type 1 ulcer

Question 30

type of gastric ulcer located on the lesser curve and duodenally; associated with high acid secretion

Answer 30

type 2 ulcer

Question 31

type of gastric ulcer located prepyloric and associated with high acid secretion

Answer 31

type 3 ulcer

Question 32

type of gastric ulcer located on the lesser curve high along the cardia; associated with decreased mucosal protection

Answer 32

type 4 ulcer

Question 33

type of gastric ulcer associated with NSAIDs

Answer 33

type 5 ulcer

Question 34

Symptoms of postosurgical gastroparesis and treatment:

Answer 34

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

Question 35

True or false. perioperative antibiotics for PEG tube insertion decreases incidences of peristomal infection

Answer 35

True

Question 36

Definition of early PEG tube dislodgement:

Answer 36

within 14 days of placement

Question 37

Occur most commonly in the setting of inflammation from H pylori infection and appear as smooth, dome shaped structures in the antrum

Answer 37

hyperplastic gastric polyps

Question 38

Risk factors for stress ulcers:

Answer 38

mechanical ventilation >24 hrs, platelet count <50,000, INR>1.5, TBI, spinal cord injuries, severe burns, high dose steroids

Question 39

Most common complication of PEG tube placement

Answer 39

infection at the PEG site

Question 40

True or False. Octreotide has been shown to be effective in the management of post-vagotomy diarrhea.

Answer 40

False. But cholestyramine is effective