reflux

Question 1

Surgical treatment of perforated duodenal ulcer is:

Answer 1

graham patch repair

Question 2

What patients should get a vagotomy + pyloroplasty in perforated ulcers?

Answer 2

Those who have failed medical therapy and are negative for H. pylori

Question 3

Factors that predict failure of treatment for a MALToma after H. pylori eradication:

Answer 3

1. transmural tumor extension
2. nodal involvement
3. transformation into a large cell phenotype
4. BCL-10 or t(11;18) expression

Question 4

What is therapy for H.pylori?

Answer 4

PPI, clarithromycin, and augmentin (or metronidazole) for 12 weeks

Question 5

Bile reflux is most commonly associated with which surgical procedure?

Answer 5

Billroth II

Question 6

Bile reflux from a B2 is surgically controlled with conversion to what?

Answer 6

roux en y gastrojejunostomy with at least 40 cm of alimentary limb

Question 7

First line management of duodenal stump leak after B2?

Answer 7

ex lap and control of leak

Question 8

Postoperative delayed gastric emptying should be treated medically for at least a year before what surgical procedure is considered?

Answer 8

near total gastrectomy with Roux en Y reconstruction

Question 9

What type of gastric carcinoids are assumed to be malignant?

Answer 9

sporadic

Question 10

what two risk factors place patients at highest risk for stress ulcers?

Answer 10

head trauma and coagulopathy

Question 11

True or false. Low dose PPIs are advised for Barrett’s esophagus.

Answer 11

false. high dose PPI is advised

Question 12

gold standard treatment of achalasia

Answer 12

laparoscopic Heller myotomy

Question 13

Optimal surgical management for a HDS patient with a perforated prepyloric ulcer:

Answer 13

antrectomy with or without vagotomy and Billroth 1 reconstruction

Question 14

Surgical management of a large (>3cm) perforated duodenal ulcer:

Answer 14

place jejunal serosal patch, temporary pyloroplasty and gastrojejunostomy

Question 15

What is an abnormal Demeester score

Answer 15

> 14.72

Question 16

What causes 90% of duodenal ulcer disease?

Answer 16

H. pylori

Question 17

In antireflux surgery, what structures are susceptible to injury during dissection of the gastrohepatic ligament?

Answer 17

aberrent left hepatic artery and hepatic branch of vagus nerve

Question 18

Critical steps of Heller myotomy

Answer 18

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

Question 19

most potent stimulator of gastrin release

Answer 19

amino acids

Question 20

Which peptic ulcer procedure most commonly leads to bile reflux gastritis?

Answer 20

Billroth 2

Question 21

What procedures can be used to diagnose bile reflux gastritis?

Answer 21

HIDA (usually diagnostic) and esophageal impedence

Question 22

Greatest risk factor for bleeding peptic ulcer:

Answer 22

NSAID use