reflux Flashcards
Surgical treatment of perforated duodenal ulcer is:
graham patch repair
What patients should get a vagotomy + pyloroplasty in perforated ulcers?
Those who have failed medical therapy and are negative for H. pylori
Factors that predict failure of treatment for a MALToma after H. pylori eradication:
- transmural tumor extension
- nodal involvement
- transformation into a large cell phenotype
- BCL-10 or t(11;18) expression
What is therapy for H.pylori?
PPI, clarithromycin, and augmentin (or metronidazole) for 12 weeks
Bile reflux is most commonly associated with which surgical procedure?
Billroth II
Bile reflux from a B2 is surgically controlled with conversion to what?
roux en y gastrojejunostomy with at least 40 cm of alimentary limb
First line management of duodenal stump leak after B2?
ex lap and control of leak
Postoperative delayed gastric emptying should be treated medically for at least a year before what surgical procedure is considered?
near total gastrectomy with Roux en Y reconstruction
What type of gastric carcinoids are assumed to be malignant?
sporadic
what two risk factors place patients at highest risk for stress ulcers?
head trauma and coagulopathy
True or false. Low dose PPIs are advised for Barrett’s esophagus.
false. high dose PPI is advised
gold standard treatment of achalasia
laparoscopic Heller myotomy
Optimal surgical management for a HDS patient with a perforated prepyloric ulcer:
antrectomy with or without vagotomy and Billroth 1 reconstruction
Surgical management of a large (>3cm) perforated duodenal ulcer:
place jejunal serosal patch, temporary pyloroplasty and gastrojejunostomy
What is an abnormal Demeester score
> 14.72
What causes 90% of duodenal ulcer disease?
H. pylori
In antireflux surgery, what structures are susceptible to injury during dissection of the gastrohepatic ligament?
aberrent left hepatic artery and hepatic branch of vagus nerve
Critical steps of Heller myotomy
longitudinal myotomy down to the level of the submucosa that should extend 5-6 cm on the esophagus proximally, and 2-3 cm distally on the stomach; partial wrap should be performed to avoid reflux
most potent stimulator of gastrin release
amino acids
Which peptic ulcer procedure most commonly leads to bile reflux gastritis?
Billroth 2
What procedures can be used to diagnose bile reflux gastritis?
HIDA (usually diagnostic) and esophageal impedence
Greatest risk factor for bleeding peptic ulcer:
NSAID use
