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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
Risk factors for an UGI rebleed after endoscopy
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
Johnson's classification of ulcers
1Type I: lesser curvature Type II: lesser curvature plus duodenum Type III: Pre-pyloric Type IV: close to GEJ Type V: NSAID associated
27
Which Johnson type ulcers are associated with hypersecretion of acid
Types II and III
28
Which Johnson type ulcers are more likely to be malignant?
Types I and IV
29
Most important factor in PUD
H. pylori infection
30
3 consequences of H. pylori infection
1. Gastric or duodenal ulcers 2. Adenocarcinoma of the stomach 3. gastric lymphoma
31
Bilroth I connects stomach to _______ while Bilroth II connects stomach to _______.
duodenum, jejunum
32
Duodenal ulcers in posterior wall bleed from which artery?
Gastroduodenal artery
33
PUD surgeries can be classified into 3 categories
1, Vagotomy: truncal, highly selective 2. Drainage procedures: pyloroplasty or gastrojejunostomy 3. Antrectomy
34
Most effective surgery at preventing ulcer recurrence
Antrectomy plus vagotomy
35
What is the Zollinger Ellison syndrome
Gastrinoma> excess gastrin> PUD. Gastrinomas are commonly malignant. Are either duodenal or pancreatic. MEN I syndrome.
36
4 mechanisms of post-gastrectomy syndromes
1. Reservoir function limited 2. Hormone secretion altered 3. Altered motility 4. Altered innervation
37
Early versus late dumping
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
Which are the 2 syndromes of disordered motility
1. Alkaline reflux 2. Roux stasis syndrome
39
Post Roux-n-Y with intermittent abdominal pain, bloating and vomiting; 2 d/dx
1. Afferent limb obstruction 2. Long afferent limb
40
What is a marginal ulcer
Gastrojej; jejunal ulcer close to anastomosis due to exposure to low pH
41
3 mechanisms of diarrhea post vagotomy
1. Small reservoir 2. Mal-absoption 3. Altered motility
42
5 types of polyps and their premalignant potential
a. Neoplastic * Adenomas (premalignant) * Fundic polyps (premalignant) b. Non-neoplastic * Hyperplastic (premalignant if > 2 cm) * Hamartomatous * Inflammatory
43
Classification of gastric cancer by gross appearance
1. Polypoid without ulcer 2. Fungating 3. Ulcerative 4. Scirrhous/ diffuse
44
Define: a. Virchow's node/ Troisier's sign b. Blummer's shelf c. Kruckenberg tumor d. Sister Mary Joseph nodule
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
Premalignant condition for gastric CA
1. Atrophic gastritis 2. Polyps: adenoma, fundic, large hyperplastic 3. Post antrectomy or gastrojejunostomy stomach 4. Diffuse hereditary gastric cancer
46
Progression of intestinal type gastric cancer
Normal mucosa> Introduction of irritating agent> Chronic gastritis> atrophic gastritis > intestinal metaplasia > Dysplasia > CA
47
What is the role of staging laparoscopy in treatment of gastric cancer?
20-30% of patients with T2 or greater tumors with negative CT scans have occult mets
48
GISTs originate from which cell type
Interstitial cell of Cajal
49
GISTs demonstrate which anomaly? They are amenable to treatment with?
c-kit positive (tyrosine kinase mutation); treated with imatinib a tyrosine kinase inhibitor
50
First line treatment of gastric lymphoma is?
H. pylori eradication

General Surgery (2 decks)

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