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Surgery Boards Set 2 > Stomach > Flashcards

Stomach Flashcards

1
Q

Eponym of the left vagal trunk

A

Continues as nerve of Latarjet

Gives hepatic branch

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2
Q

Eponym for right vagal trunk

A

Continues as the criminal nerve of Grassi
Gives celiac branch
*culprit in ulcer recurrences following truncal vagotomy?

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3
Q

Produces somatostatin

A

D cells

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4
Q

Produces serotonin

A

Enterochromaffin cells

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5
Q

Products of parietal cells

A

“Oxyntic cells”
Hydrochloric acid
Intrinsic factor

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6
Q

Products of chief cells

A

“Zymogenic cells”
Pepsinogen
Gastric lipase
Leptin

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7
Q

Majority of gastrinomas are found here

A 
Passaro triangle
“Peptic-Causing Disease”
Pancreas (junction of neck and body)
Cystic duc and CBD jxn
Duodenum 2 & 3 junction
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8
Q

Diagnostics for gastrinoma

A
  1. Elevated fasting serum gastrin and BAO (Basal Acid Output)
  2. Confirmatory test: secretin stimulation test (gastrin >200 pg/mL after IV secretin administration)
  3. Rule out the presence of MEN1 – Ca and PTH levels
  4. Preoperative imaging/localization: octreotide scan
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9
Q

Treatment of gastrinoma

A

Sporadic cases: resection

Familial cases: surgical debulking to ameliorate symptoms

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10
Q

Algorithm for forrest classification

A

Ia-IIb: endoscopic treatment, intensive PPI, clear fluids for ~ 2 days, hospitalize 3 days
IIc: no endoscopic threapy, OD PPI, clear fluids for ~ 1 day, hospitalize for ~1-2 days
III: no endoscopic therapy, OD PPI, REGULAR DIET, DISCHARGE after endoscopy

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11
Q

Define INTENSIVE PPI

A 
Intravenous bolus (80 mg) followed by infusion (8 mg/h) for 3 days; 3️⃣
or oral or intravenous bolus (e.g., 80 mg) followed by intermittent high doses (e.g., 40–80 mg  bid or 40 mg tid) for 3 days 3️⃣
Then twice-daily PPI on days 4–14 followed by once-daily PPI.
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12
Q

Pharmacologic treatment for bleeding esophageal varices

A

Intravenous 50 mcg bolus followed by 50 mg/h infusion for 2–5 days.

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13
Q

Dumping syndrome

A

Caused by destruction of the pyloric sphincter causing abrupt delivery hyperosmolar load to the small intestines
Early dumping
-15-30mins post-ptrandial
-shock-like symptoms d/t peripheral and splanchnic vasodilation
Relieved by saline or recmbency
-diarrhea then follows
Late dumping (2-3 hours post-prandial
-due to hyperinsulinemia with reacitve hypolgycemia
-relieved by glucose administration

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14
Q

Treatment for dumping syndrome

A 
Nonsurgical
Earl dummping: octreotide
Late dumping: a-glucosidase
Surgical
Conversion to roux-en-y anastomosis
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15
Q

Triad of bile relfux gastritis

A

Constant epigastric pain, nausea, bilious emesis
*most commonly assoc’d with billroth II gastrojejunostomy
Surgery: braun entero-enterostomy

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16
Q

Classification used in gaastric adenocarcinoma

A

Lauren classification

17
Q

Discuss gastric lymphoma

A
  • more than 50% of GI lymphomas arise from the stomach
  • > 95% are non-Hodgkin type
  • over half of patients with non-hodkin lymphoma have involvement of the GI tract
  • most are B-cell type, thought to arise in mucosa assoc’d with MALT
18
Q

Mgt of gastric lymphoma

A

Low-grade: first line is h pylori eradication

High-grade: chemoradiation

19
Q

Tumor markers used for GIST

A

c-KIT (CD117) and CD34

20
Q

Gastric carcinoids arise from

A

ECL cells

21
Q

GIST arise from

A

Interstitial cells of cajal

22
Q

Describe GIST

A

It’s a mesenchymal tumor (submucosal) hence it’s not uncommon for endoscopic biospy results to show normal gastric mucosa.
-dougnut sign or target sign on barium study significies ulceration

23
Q

Hypertrophic gastropathy

A

“Menetrier Disease”

  • assoc’d with protein losing enteropathy and hypochlorydia
  • presentation: middle-aged men with epigastric pain, weight loss, diarrhea and hypoproteinemia
  • increased risk of cancer
  • biopsy: diffuse hyperplasia of surface mucus-secreting cells and decrease parietal cells
  • tx: Cetuximab (edgf receptor blockade) or resectiotn
24
Q

Watermelon stomach

A

GASTRIC ANTRAL VASCULAR ECTASIA (GAVE)

  • dilated mucosal vessels in the distal stomach
  • elderly women with chornic GI blood loss
  • ass’d with autoimmunice connective disorder
  • tx: estrogen and progesterone, endoscopic tx, antrectomy, TIPS if with portal htn
25
Q

unually large tortuous SUBMUCOSAL ARTERY

A

Dieulafoy lesion
-presentation: men with UGIB which is usually intermittent
Tx: endoscopic hemostasis, angiographic embolizatiotn oversew or resection
*normal-appearing gastric mucosa is usual

26
Q

Electrolyte abnormalities in pyloric stenosis

A

Hypokalemic hypochlormic metabolic alkalosis

27
Q

Surgical mgt for pyloric stenosis

A

Fredet-Ramstedt pyloromyotomy

Surgery Boards Set 2 (5 decks)

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