Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BTK Review 2024 > Stomach > Flashcards

Stomach Flashcards

1
Q

What are the five types of gastric ulcers?

A
  • I: along the lesser curve (mucosal protection)
  • II: lesser curve and with a duodenal ulcer (acid)
  • III: pre-pyloric (acid)
  • IV: cardia (mucosal protection)
  • V: diffuse (NSAIDs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the most common type of gastric volvulus?

A

organoaxial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the three types of gastric volvulus?

A
  • organoaxial
  • mesoaxial
  • combined
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the gold standard operation for those with gastric volvulus?

A

emergent reduction, hernia repair, and gastropexy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What would be an alternative operative intervention for frail patients with gastric volvulus?

A

endoscopic decompression with double PEG fixation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are alarm symptoms for those with GERD? What should be the next step?

A
  • dysphagia, odynophagia, weight loss, anemia, GI bleeding, no response to PPI
  • require upper endoscopy to rule out malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the indications for surgical treatment of GERD?

A
  • failure of medical management
  • desire to avoid lifelong PPI
  • extra-esophageal manifestations (e.g. asthma, cough, aspiration)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is the Demeester score interpretted?

A

a score > 14.72 is consistent with reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the components of the Demeester score?

A
  • percent total time, upright time, and supine time with pH < 4
  • number of reflux episodes
  • number of episodes > 5 min
  • longest reflux episode
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How much intra-abdominal esophagus is needed during hiatal hernia repair?

A

at least 3 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the following kinds of fundoplication:
- Dor
- Nissen
- Toupet
- Thal
- Belsey

A
  • anterior 180
  • 360
  • posterior 270
  • anterior 270
  • transthoracic anterior 270
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How should you manage an intra-op capnothorax during hiatal hernia repair?

A
  • make the pleural tear larger to avoid tension
  • place RRC through tear to equalize pressure
  • bring RRC out at end and palce to water seal, then valsalva
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does an esophageal diet avoid?

A
  • meat
  • raw vegetables
  • bread
  • carbonated beverages
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How should you evaluate a patient with signifciant dysphagia after hiatal hernia repair with fundoplication?

A

get an esophagram to look for an overly tight wrap or a recurrent hernia/slipped wrap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which hiatal hernias require repair?

A
  • type II-IV should all be repaired in an reasonable surgical candidate
  • type I only need to be repair if symptomatic (use same indications as for GERD)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How often is H. pylori found in gastric and duodenal ulcers?

A
  • 75% of gastric
  • 95% of duodenal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the treatment for H. pylori?

A
  • PPI
  • clarithromycin
  • amoxicillin or flagyl
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What ar ethe risk factors for gastric stress ulcer?

A
  • prolonged ventilation > 48hrs
  • coagulopathy
  • head trauma
  • burns
  • history of PUD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Are gastric or duodenal ulcers more often associated with malignancy?

A

gastric (should biopsy all)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What endoscopic findings are indicative of re-bleeding risk after intervention?

A
  • actively bleeding vessel: 80%
  • visible vessel: 50%
  • adherent clot: 15-25%
  • clean base: < 5%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What operation can be used to stop a bleeding gastric ulcer?

A
  • laparotomy
  • anterior gastrotomy
  • oversew ulcer
  • close gastrotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the operative approach to a bleeding duodenal ulcer?

A
  • longitudinal anterior duodenotomy at bulb
  • control bleed with three-point U stitch technique (superior and inferior bites to control feeding vessel, medial to control transverse pancreatic artery)
  • can ligate GDA above duodenum if unable to control
  • transverse closure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What open stitch configuration is used to control a duodenal ulcer bleed?

A
  • superior
  • inferior
  • medial
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the two most cmmon cuases of bleeding gastric ulcer?

A

H. pylori and NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How should you approach large duodenal ulcers differently than smaller ones?

A

large ones > 3cm may benefit from jejunal serosal patch rather than omental patch

26
Q

When should you consider an acid reducing procedure for PUD?

A

patients undergoing operation for complication of PUD with a history of treatment with PPI and/or eradication of H. pylori

27
Q

How does a highly selective vagotomy differ from a truncal vagotomy?

A

highly selective does not dennervate the pylorus and so there is no need for a drainage procedure

28
Q

Which hyperplastic gastric polyps require endoscopic resection?

A

those > 5mm

29
Q

What is the most common mesenchymal tumor of the GI tract?

A

GIST

30
Q

GISTs arise from what type of cell?

A

interstitial cells of Cajal

31
Q

Describe the path (including stains) for a GIST.

A
  • spindle and/or epitheloid cells
  • CD117 positive
32
Q

What tumors are CD117 positive?

A

GIST tumors are c-kit positive

33
Q

The malignant potential of GISTs is based on what?

A

size and mitotic index

34
Q

How do GISTs tend to metastasize? Where does it usually metastasize?

A
  • hematogenously, which is why lymph node disease makes it stage IV
  • most common distant met is to the liver and peritoneal surfaces
35
Q

What features of a GIST are poor prognostic indicators?

A
  • location in esophagus, colon, or rectum
  • size > 10cm
  • high mitotic index (> 10/HPF)
  • local invasion
  • distant mets
36
Q

Describe the management of an initial GISTs.

A
  • neoadjuvant therapy with imatinib for large and/or locally advanced tumors
  • resection to negative margins (do not need lymphadenectomy)
  • adjuvant imatinib for those are moderate-to-high riks of recurrence
37
Q

What is the management of recurrent, locally advanced, or metastatic GISTs?

A

imatinib

38
Q

What is imatinib?

A

a tyrosine kinase inhibitor used to treat GISTs

39
Q

What is the treatment for imatinib-resistant GISTs?

A

sunitinib

40
Q

What are the two types of gastric cancer?

A

intestinal and diffuse

41
Q

What is the mutation that leads to hereditary diffuse gastric cancer?

A

an autosomal dominant mutation in CDH1

42
Q

How do intestinal and diffuse types of gastric cancer spread?

A

intestinal via hematogenous, diffuse via lymphatics

43
Q

What is the recommendation for managing hereditary diffuse gastric cancer?

A
  • those with this CDH1 mutation should have prophylactic gastrectomy between age 18-40
44
Q

What is the appropriate staging workup for someone with a new diagnosis of gastric adenocarcinoma?

A
  • routine labs
  • CT C/A/P
  • EUS with FNA
  • PET
  • diagnostic lap with peritoneal washing for stage T1b or greater
45
Q

How is gatric cancer staged.

A

T1a: invades muscularis mucosa
T1b: invades submucosa
T2: invades muscularis popria
T3: invades subserosa
T4: invades through serosa
N1: 1-2 nodes
N2: 3-6nodes
N3: 7+ nodes

similar to esophageal but stomach has serosa

46
Q

What features make gastric cancer unresectable?

A
  • peritoneal involvement
  • distant mets
  • involvement of root of mesentery or para-aortic nodal disease
  • encasement of major vasculature
47
Q

What are the surgical principles for an oncologic stomach resection?

A
  • need 6cm margins (or 2cm past pylorus)
  • and 16 lymph nodes
48
Q

Are GEJ tumors treated as gastric or esophageal cancers?

A

esophageal

49
Q

What degree of lymph node dissection is recommend in the US for gastric cancer?

A

recommend R0 resection with at least a D1 lymphadenectomy (along lesser and greater curve, stations 1-6)

50
Q

How do D1 and D2 gatric lymphadenectomies compare?

A

D2 without splenectomy has been shown to have a disease free survival benefit and a trend towards overall survival benefit

51
Q

Which gastric cancer patients get adjuvant therapy?

A
  • no real role for neoadjuvant
  • adjuvant for T3-T3 or node positive disease
  • use 5-FU based therapy
52
Q

What is retained antrum syndrome? How is it treated?

A
  • retained antral tissue within duodenal stump after gastric resection leads to G cells bathed in alikaline fluid and continuously release gastrin
  • check gastrin levels to rule out functional neoplasm
  • treat with PPI, vagotomy or resection
53
Q

Describe dumping syndrome. What are the two types?

A
  • tachycardia, diaphoresis, dizziness, and flushing
  • early occurs due to abrupt hyperosmolar load to small intestine
  • late occurs due to rapid carbohydrate load and the subsequent insulin surge
  • treat with small meals, no sugary drinks, and octreotide
54
Q

How is bile reflux gastritis treated?

A

with prokinetic agents, bile acid binding resins, and conversion to RXY

55
Q

How long should a roux limb be to avoid recurrent bile reflux?

A

at least 50cm

56
Q

Describe a Bilroth 1 v 2.

A
  • 1 is a duodenal anastomosis to the gastric staple line
  • 2 is a duodenal stump with loop GJ anastomosis
57
Q

Describe the pathophysiology and treatment of afferent limb syndrome.

A
  • obstrction leads to bacterial overgrowth, deconjgated bile acids, steatorrhea, malnutritoin, and vitamin B12 deficiency with megaloblastic anemia
  • start with antibiotics but treat with conversion to roux-en-y or bilrth 1
58
Q

What happens to gastrin levels with gastric outlet obstruction?

A

increase because it is driven by gastric distension

59
Q

What GIST mutation confers resistance to imatinib?

A

PDGFRA

60
Q

Gastric mass with biopsy showing expansion of marginal zone compartment with development of sheets of neoplastic small lymphoid cells?

A

MALToma, treated with antibiotics for H. pylori

61
Q

How is a MALToma treated?

A

with antibiotics for H. pylori (typically regresses with treatment)

62
Q
A

BTK Review 2024 (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions