Stomach Flashcards
Vagotomy for PUD – what at the two main divisions?
Left –> Anterior –> hepatic and nerve of Latarej (pylorus)
Right –> Posterior –> high branching, Criminal nerve which innervates the cardia,
Three types of vagotomy
Truncal
Selective
Highly selective
Tx bile reflux inBII
lifestyle, cholestyramine, metoclopramide, conversion to Roux en Y with at least 40 Roux limb length
h/o bariatric surgery with new obstructing mass (and no h/o trichophagia) is a ohaytophytobezoar. Tx?
Tx is chemical dissolution
Absolute contra to PD placement (6)
loss of peritoneal fxn impaired ability to use the catheter Severe protein malnutrition Active abdominal wall infection, active Crohns, UC, ischemic colitis Frequent diverticulitis
MALT lymphoma is strongly associated with ___ therefore the treatment is ___
H pylori
Antibiotics
Late Dumping syndrome
- Occurs 2-3 hours after a meal
- large food bolus enters the small bowel, causing a large insulin release on hypoglycemia
- HYPOGLYCEMIA Leads to inc in catecholes, diaphoresis, tremulousness, weakness, lightheadedness
Lap Roux en Y decreases?
DM, HTN, and HLD
4 cm subethilelial mass on stomach , bx with low grade stromal tumoe exp CD 117 and muttion in the KIT gene. Dx and next step in mgmt?
GIST> 2 cm size. (stromal tumor of the stomach)
wedge RESECTION
with negative margins
PPI ppx appropriate for:
- TBI
SCI
and Burns
Mech vent >48 hours predisposes to stress ulcers
Coagulopathy INR>1.5 or pats <50 inc risk
High dose steroids
Pt with Choledocho s/p Roux En Y surgery ? how to proceed?
Lap assisted ERCP
BII with megaloblastic anemia
chronic afferent loop syndrome
Why did the vertical banded gastostmy become unpopular?
poor weight loss
ice cream diet
Problem with jejunoileal by[ass, it caused caused severe malabsorption and __
ESLD
58 M with GERD with 6 mos PPI and EGD with Barrett no dysplasia. next step in mgmt?
Fundoplication
t#n1 gastric adeno. Most appropriate technique for staging laparoscopy?
send washings for cytology from the left and right paracolic gutters and pelvis and bx of any suspicious nodules
which weight lossw surgery is the most affective in curing diabetes?
Biliopncreqatic diversion with duodenal switch
S/P antrectomy with truncal vagotomy with new dysphagia? which of the following is correct re: post op dysphagia
peri-esophageal fibrosis and lower esophageal denervation in the main underlying pathology
60 M evaluated for epigastric pain EGD with bx showing lymphocytic infiltration of lamina propia with lymphoepithelial lesions positive for CD 20. whats the best treatment?
Antibiotics – MALT with marginal B zone lymphoma - usually caused by H pylori
53 M with only able to eat liquids, upper GI with gastric dilation and pyloric narrowing. EGD negative for Cancer. What is the first line tx?
EGD with balloon dilation
s/p biliopancreatic diversion POD 14 with tachycardia andperigastric air fluid collection. Dx and next best step in mgmt?
I R
POst op 1 month from duodenal switch for obesity, tachy and febrile. CT with oral contrast shows intraabdominal contrast pooling, MC leak site for BP diversion after duodenal switch
gastric sleeve
