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General Surgery > Stomach > Flashcards

Stomach Flashcards

1
Q

Which is the largest artery supplying the stomach?

A

Left gastric

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2
Q

The coronary vein is a confluence of right and left gastric veins?

A

False. The left gastric is also called the coronary.

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3
Q

Name the two vessels through which the splenic artery supplies the stomach

A
  1. Short gastrics
  2. Left gastroepiploic
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4
Q

Name the two vessels through which common hepatic artery supplies the stomach.

A
  1. Right gastric
  2. Right gastroepiploic
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5
Q

The right gastroepiploic vein drains into ______ while the left gastroepiploic vein drains into __________.

A

Superior mesenteric vein, splenic vein

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6
Q

The left vagus nerve is also known as the _______ while the right vagus nerve is also known as ____________.

A

anterior, posterior

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7
Q

The criminal nerve of Grassi is a branch of the _________ and supplies the ___________ of the stomach.

A

right vagus, fundus

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8
Q

The terminal branches of the vagi are also known as ______ and supply the __________.

A

crow’s foot, antrum

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9
Q

Sympathetic nervous system is from which nerve roots

A

T5-12 through celiac plexus

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10
Q

Name the four layers of the stomach

Define subconstituents in each layer

A
  1. Mucosa: epithelium, lamina propria, muscularis mucosae
  2. Submucosa
  3. Muscularis propris: inner incomplete oblique, middle complete transverse, outer complete longitudinal
  4. Serosa
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11
Q

Regarding the enteric nervous system, the submucous layer contains the _________ while the muscularis propria contains the ____________.

A

Meissner’s, Auerbach’s

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12
Q

Parietal cells secrete what, and are found where in stomach

A

Secretions: intrinsic factor, acid, HCO3 into intercellular space
Found in fundus/ body

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13
Q

Gastrin is secreted by ______ cells, abundant in ________ of the stomach

A

G cells, antrum

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14
Q

Chief cells secrete ________ and are found in _______ of stomach

A

Pepsinogen. fundus/body

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15
Q

Ghrelin controls ______ while leptin controls ________

A

hunger, satiety

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16
Q

4 roles of gastrin

A
  1. Stomach: motility and secretions
  2. Small gut motility
  3. Ileocolic junction relaxation
  4. Colon mass movements
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17
Q

Phases of acid stimulation and their triggers

A

1, Cephalic: senses
2. Gastric: food in stomach
3. Intestinal: food in small gut

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18
Q

Electrolyte/ acid base anomalies in severe vomiting or NG drainage

A
  1. Hypochloremia
  2. Metabolic alkalosis
  3. Hypokalemia
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19
Q

4 factors that contribute to gastric acid barrier

A
  1. Blood flow
  2. Mucous/ HCO3 from goblets
  3. Cell membrane/ tight junctions
  4. Rapid replacement of cells
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20
Q

Migratory motor complex occurs during meals? Which part of gut is involved? Which hormone stimulates MMC.

A

Occurs in between meals. Entire gut motility. Stimulated by motilin.

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21
Q

2 modes through which metoclopramide works

A
  1. Dopamine antagonist> Ach release
  2. Serotonin agonist
22
Q

Erthromycin is a dopamine antagonist?

A

False. It is a motilin agonist.

23
Q

In diagnosing H pylori infection, which is the gold standard test and which are other sensitive tests?

A

Gold standard: histology with special stains
Others:
1. Urea breath test
2. Stool antigen test

24
Q

There is a role of NG placement in upper GI bleed

A

False. It does not add value and might be harmful

25
Q

Risk factors for an UGI rebleed after endoscopy

A
  1. Hemodynamic instability
  2. Organ dysfunction: liver, kidney
  3. Anticoagulation
  4. Endoscopic findings suggestive of a recent or high risk bleed
  5. Age > 60
  6. Elevated BUN/ creatinine
26
Q

Johnson’s classification of ulcers

A

1Type I: lesser curvature
Type II: lesser curvature plus duodenum
Type III: Pre-pyloric
Type IV: close to GEJ
Type V: NSAID associated

27
Q

Which Johnson type ulcers are associated with hypersecretion of acid

A

Types II and III

28
Q

Which Johnson type ulcers are more likely to be malignant?

A

Types I and IV

29
Q

Most important factor in PUD

A

H. pylori infection

30
Q

3 consequences of H. pylori infection

A
  1. Gastric or duodenal ulcers
  2. Adenocarcinoma of the stomach
  3. gastric lymphoma
31
Q

Bilroth I connects stomach to _______ while Bilroth II connects stomach to _______.

A

duodenum, jejunum

32
Q

Duodenal ulcers in posterior wall bleed from which artery?

A

Gastroduodenal artery

33
Q

PUD surgeries can be classified into 3 categories

A

1, Vagotomy: truncal, highly selective
2. Drainage procedures: pyloroplasty or gastrojejunostomy
3. Antrectomy

34
Q

Most effective surgery at preventing ulcer recurrence

A

Antrectomy plus vagotomy

35
Q

What is the Zollinger Ellison syndrome

A

Gastrinoma> excess gastrin> PUD. Gastrinomas are commonly malignant. Are either duodenal or pancreatic. MEN I syndrome.

36
Q

4 mechanisms of post-gastrectomy syndromes

A
  1. Reservoir function limited
  2. Hormone secretion altered
  3. Altered motility
  4. Altered innervation
37
Q

Early versus late dumping

A

Early occurs within minutes; presumed due to osmolar gut contents reducing circulatory volume.
Late occurs within hours and is due to reactive hypoglycemia in response to large insulin dose after huge sugar load absorbed.

38
Q

Which are the 2 syndromes of disordered motility

A
  1. Alkaline reflux
  2. Roux stasis syndrome
39
Q

Post Roux-n-Y with intermittent abdominal pain, bloating and vomiting; 2 d/dx

A
  1. Afferent limb obstruction
  2. Long afferent limb
40
Q

What is a marginal ulcer

A

Gastrojej; jejunal ulcer close to anastomosis due to exposure to low pH

41
Q

3 mechanisms of diarrhea post vagotomy

A
  1. Small reservoir
  2. Mal-absoption
  3. Altered motility
42
Q

5 types of polyps and their premalignant potential

A

a. Neoplastic
* Adenomas (premalignant)
* Fundic polyps (premalignant)
b. Non-neoplastic
* Hyperplastic (premalignant if > 2 cm)
* Hamartomatous
* Inflammatory

43
Q

Classification of gastric cancer by gross appearance

A
  1. Polypoid without ulcer
  2. Fungating
  3. Ulcerative
  4. Scirrhous/ diffuse
44
Q

Define:
a. Virchow’s node/ Troisier’s sign
b. Blummer’s shelf
c. Kruckenberg tumor
d. Sister Mary Joseph nodule

A

a. Supraclavicular node< mets through thoracic duct
b. POD/ rectovesical pouch mets on DRE or VE
c. Mets to ovaries of gastric CA
d. Umbilical node

45
Q

Premalignant condition for gastric CA

A
  1. Atrophic gastritis
  2. Polyps: adenoma, fundic, large hyperplastic
  3. Post antrectomy or gastrojejunostomy stomach
  4. Diffuse hereditary gastric cancer
46
Q

Progression of intestinal type gastric cancer

A

Normal mucosa> Introduction of irritating agent> Chronic gastritis> atrophic gastritis > intestinal metaplasia > Dysplasia > CA

47
Q

What is the role of staging laparoscopy in treatment of gastric cancer?

A

20-30% of patients with T2 or greater tumors with negative CT scans have occult mets

48
Q

GISTs originate from which cell type

A

Interstitial cell of Cajal

49
Q

GISTs demonstrate which anomaly? They are amenable to treatment with?

A

c-kit positive (tyrosine kinase mutation); treated with imatinib a tyrosine kinase inhibitor

50
Q

First line treatment of gastric lymphoma is?

A

H. pylori eradication

General Surgery (2 decks)

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