Stomach Flashcards
Blood supply of the lesser curvature of stomach
Right gastric artery from common hepatic artery
Left gastric artery from celiac trunk
Blood supply of greater curvature
Right gastroepiploic artery from gastroduodenal artery
Left gastroepiploic artery from splenic artery
Blood supply of fundus
Short gastric artery from splenic artery
Protective mucus layer that contains bicarbonate and glyco protein
Surface mucous cells
Cells that contain pepsinogen
Mucus neck cell
Produces HCl and Intrinsic Factor
Parietal (oxyntic) cell
Stimuli of HCL secretion
Histamine
Gastrin
Acetylcholine
Chief cells produces?
Gastric lipase
Pepsinogen
Leptin
Release serotonin
Enterochromaffin cells
Release Histamine
Enterochromaffin LIKE cells
Release somatostatin
D cells
Release Gastrin
G cells
Alarm symptoms
Weight loss
Bleeding
Recurrent vomiting
Anemia
Dysphagia
Purpose of biopsy in ulcers
Rule out carcinoma
Document h pylori infection
Test of choice for h.pylori detection if endoscopy is not indicated
Serology
Most common complication of ulcers
Bleeding presented as melena or hematemesis
Indications for surgery
Persistent bleeding/rebleeding after endoscopic therapy
Significant bleeding (> 4 units/24hr)
Elderly px with co-morbidities
Ulcers located at posterior duodenal bulb or greater curvature
High risk of rebleeding based on endoscopic findings
A post gstrectomy problem caused by destruction of pyloric sphincter causing abrupt delivery of hyperosmolar load to the small intestines
Dumping syndrome
2 types fo dumping syndrome
Early dumping (15-30 mins post prandial)
Late dumping (2-3 hours post prandial)
Early dumpling is due to?
Peripheral and splanchnic vasodilation leadinh to shock like sx that is relieved by saline or recumbancy
Non surgical tx for early dumping
Octreotide
Late dumping syndrome is due to?
Hyperinsulinemia with reactive hypoglycemia
Non surgical tx for late dumping secretion
Alpha glucosidase inhibitor
Triad of bile or alkaline reflux gastritis
Constant epigastric pain
Nausea
Bilious emesis
Endoscopy result of bile or alkaline reflux gastritis
Inflammation
Beefy red
Friable gastric mucosa
Results from functional obstruction due to disruption of normal propagation of pacesetter potentials in roux limb as well as altered motility in gastric remnant
Roux stasis syndrome
Clinical manifestations of roux stasis syndrome
Chronic abdominal pain
Nausea
Vomiting that is aggravated by eating
Non operative tx for roux stasis syndrome
Pro-motility drugs
Uncontrolled secretion of gastrin by a pancreatic or duodenal neuroendocrine tumor
Gastrinoma (zollinger ellison)
Most common pancreatic tumor in patients with MEN1
Gastrinoma (zollinger-ellison)
Most important risk factors for Gastric Adenocarcinoma
H.pylori infection
Atrophic gastritis
Family history
Most common etiologic lesions that create an environment for gastric inflammation to develop
H. Pylori infection
Autoimmune gastritis
2 types of hitological adenocarcinoma
Intestinal type
Diffused type
Paraneoplastic syndrome seen in gastric adenocarcinoma
Trosseau syndrome (migratory thrombophlebitis)
Acanthosis nigrans
Treatment for low grade gastric lymphoma
Nonsurgical
1st line is H. Pylori eradication
GIST arise from
Interstitial cells of Cajal
Prognostic factors for GIST
Tumore size and mitotic count
Tumor marker for GIST
C-KIT (CD117)
CD34
Treatment for GIST
Wedge resection with negative margins
Tx for unresectable GIST
Imatinib
Carcinoid triad
Diarrhea
Flushing
Right sided heart failure
Associated with protein losing enteropathy and hypochlorhydia commonly presents in middle aged men with epigastric pain, weight loss, diarrhea and hypoproteinemia
Hypertrtophic gastropathy / menetrier’s disease
Biopsy findings in menetrier’s disease
Diffuse hyperplasia of surface mucus secreting cells and decrease parietal cells
