Stomach

Question 1

Vagotomy for PUD – what at the two main divisions?

Answer 1

Left –> Anterior –> hepatic and nerve of Latarej (pylorus)

Right –> Posterior –> high branching, Criminal nerve which innervates the cardia,

Question 2

Three types of vagotomy

Answer 2

Truncal
Selective
Highly selective

Question 3

Tx bile reflux inBII

Answer 3

lifestyle, cholestyramine, metoclopramide, conversion to Roux en Y with at least 40 Roux limb length

Question 4

h/o bariatric surgery with new obstructing mass (and no h/o trichophagia) is a ohaytophytobezoar. Tx?

Answer 4

Tx is chemical dissolution

Question 5

Absolute contra to PD placement (6)

Answer 5

loss of peritoneal fxn
impaired ability to use the catheter
Severe protein malnutrition
Active abdominal wall infection, 
active Crohns, UC, ischemic colitis
Frequent diverticulitis

Question 6

MALT lymphoma is strongly associated with ___ therefore the treatment is ___

Answer 6

H pylori

Antibiotics

Question 7

Late Dumping syndrome

Answer 7

• 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

Question 8

Lap Roux en Y decreases?

Answer 8

DM, HTN, and HLD

Question 9

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?

Answer 9

GIST> 2 cm size. (stromal tumor of the stomach)

wedge RESECTION
with negative margins

Question 10

PPI ppx appropriate for:

Answer 10

1. TBI
   SCI
   and Burns
   Mech vent >48 hours predisposes to stress ulcers
   Coagulopathy INR>1.5 or pats <50 inc risk
   High dose steroids

Question 11

Pt with Choledocho s/p Roux En Y surgery ? how to proceed?

Answer 11

Lap assisted ERCP

Question 12

BII with megaloblastic anemia

Answer 12

chronic afferent loop syndrome

Question 13

Why did the vertical banded gastostmy become unpopular?

Answer 13

poor weight loss

ice cream diet

Question 14

Problem with jejunoileal by[ass, it caused caused severe malabsorption and __

Answer 14

ESLD

Question 15

58 M with GERD with 6 mos PPI and EGD with Barrett no dysplasia. next step in mgmt?

Answer 15

Fundoplication

Question 16

t#n1 gastric adeno. Most appropriate technique for staging laparoscopy?

Answer 16

send washings for cytology from the left and right paracolic gutters and pelvis and bx of any suspicious nodules

Question 17

which weight lossw surgery is the most affective in curing diabetes?

Answer 17

Biliopncreqatic diversion with duodenal switch

Question 18

S/P antrectomy with truncal vagotomy with new dysphagia? which of the following is correct re: post op dysphagia

Answer 18

peri-esophageal fibrosis and lower esophageal denervation in the main underlying pathology

Question 19

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?

Answer 19

Antibiotics – MALT with marginal B zone lymphoma - usually caused by H pylori

Question 20

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?

Answer 20

EGD with balloon dilation

Question 21

s/p biliopancreatic diversion POD 14 with tachycardia andperigastric air fluid collection. Dx and next best step in mgmt?

Answer 21

I R

Question 22

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

Answer 22

gastric sleeve