STOMACH Flashcards
Type 1 ulcer location
Lesser curve
Type 2 ulcer location
lesser curve + duodenal (2 ulcers)
Type 3 ulcer location
Pre pyloric
Type 4 ulcer location
Proximal lesser curve (cardia)
Type 5 ulcer location
Diffuse
Type 1 EGJ tumor
distal part of esophagus located between 1-5 cm above anatomic EGJ
Type II EGJ tumor
cardia within 1 cm above and 2 cm below EGJ
Type III EGJ tumor
subcardial stomach (2-5 cm below EGJ)
Distal gastrectomy - the remnant is supplied by?
Short gastrics
Overall surgical goals in surgical mgmt of GERD
-restoration of normal anatomic position of stomach and GEJ
-recreation of anti reflux valve
-any hiatal hernia must be completely reduced which requires mediastinal dissection to ensure adequate esophageal mobilization
-any defect in crura must be closed
-complete mobilization of fundus
-2 cm long floppy fundoplication performed over large 54F bougie
Dor fundoplication
anterior 180-200
Toupet fundoplication
posterior 270
Thal fundoplication
270 anterior
Belsey fundoplication
270 anterior transthoracic
Lind fundoplication
300 posterior
Capnothorax - what do you do?
Enlarge tear to avoid tension capnothorax
Place red rubber catheter with one end into pleural tear and other end into abdomen to equalize pressures
At end of procedure bring one end outside of abdomen and place to waterseal while valsalva administered
Repair of hiatal hernia - what is the key step that decreases early recurrence?
mobilization adn excision of hernia sac
What kind of suture to close the diaphragmatic crura
Permanent
Tx of H pylori
PPI, clarithromycin and amoxicillin vs flagyl for 2 weeks OR bismuth, flagyl, tetracycline and PPI (esp if PCN allergy!!!)
Risk of rebleeding in visible vessel
up to 50%
risk of rebleeding when adherent clot
15-25%
risk of rebleeding when ulcer iwth clean base
<5%
Benefit of highly selective vagotomy
Preserves motor innervation to pylorus and eliminates need for drainage procwedure
When to consider vagotomy and antrectomy?
Higher morbidity than vagotomy and pyloroplasty or HSV secondary to need for billroth recon, but reserved for stable pts with anatomic indications like large antral ulcers, pyloric scarring