Stomach 2

Question 1

Secretin stimulation test - Test for? How?

Answer 1

ZES

Give two units per kilogram of secretin. Positive if Increase in gastrin by 120 pg/ml in 5-10 minutes

Question 2

Patients with features of ZES and a normal gastrin level - check this lab? To look for?

Answer 2

CCK

CCKoma

Question 3

Elevation in gastrin due to a PPI?

Answer 3

<3xULN

Question 4

Secretin stimulation test must be off this medication? Effects of being taken off the medication?

Answer 4

PPI

Exaggerated rebound gastric acid hypersecretion (nausea, vomiting, abdominal pain, perforation)

During initial gastrinoma growth, pancreatic secretion of bicarbonate gradually increases to buffer acid. PPI therapy decreases acid, decreasing pancreatic buffer.

Question 5

How to wean ppi prior to ZES testing?

Answer 5

Gradually wean

switch to high-dose H2 blockers for 3 to 5 days

Stop H2-blockers and give only anti-acid 24 hours prior to the test

Question 6

If secretin test is suggestive of ZES, next step?

Answer 6

Search for primary tumor using imaging (CT, MRI, EUS, somatostatin PET, octreoscan)

Question 7

Gastrinoma triangle?

Answer 7

Junction of CBD and cystic duct
Junction of 2nd/3rd portion of the duodenum
Junction of head and neck of the pancreas

Question 8

Patients with gastrinoma should be evaluated for?

Answer 8

MEN type 1

Question 9

Fundic gland polyps are associated with this medication?

Answer 9

Chronic PPI therapy

Question 10

Fundic gland polyps are associated with these genetic conditions?

Answer 10

FAP; MUTYH

Question 11

Management when encountering fundic gland polyps?

Answer 11

• Always biopsy or select gastric polyps to rule out adenoma‘s
• resection of polyps 1+ cm
• screening colonoscopy in patients with multiple fundic gland polyps
• routine EGD screening not recommended

Question 12

Most common gastric location for a hyperplastic polyp?

Hyperplastic gastric polyps that should be respected if over this size?

Answer 12

Antrum

5mm

Question 13

Gastric adenocarcinoma usually arises from these pre-malignant lesions?

Answer 13

Gastric adenomas in large hyperplastic polyps

Question 14

Physical exam findings suggestive of G.I. malignancy?

Answer 14

Virchow’s node (L Superclavicular node)

Lesser-Trélat - sudden onset of multiple seborrheic keratoses

Acanthosis nigricans

Question 15

Name for a hyper coagulable state and DVT’s that are associated with cancer?

Answer 15

Trousseau syndrome

Question 16

Classification system for gastric adenocarcinoma?

Answer 16

Lauren classification

Question 17

Subtypes of gastric adenocarcinoma? Difference in age, location, Endoscopy appearance?

Answer 17

Diffuse and Intestinal

Younger versus younger

proximal versus Distal stomach

diffuse gastric thickening versus Polypoid/fungating mass

Question 18

Diffuse versus interstitial Gastric adenocarcinoma - associated with? Histologic features?

Answer 18

loss of E-cadherin
Versus Atrophic gastritis, H pylori

poorly differentiated with signet ring cells versus Well differentiated

Question 19

When is EMR an option for early gastric cancer?

Answer 19

<1.5 cm in size,
Moderate or well differentiated,
no penetration beyond submucosa

Question 20

Hereditary diffuse gastric cancer - defined by?

Gene Involved?

Answer 20

2+ cases in first or second degree relatives (one under age 50)

3+ cases in first or second degree relatives (Any age)

E-cadherin (CDH1)or alpha-E-catenin

Question 21

CDH1 mutation - management?

Answer 21

Prophylactic total gastrectomy

Annual mammogram at 35 (Increase risk of lobular breast cancer)

Question 22

Endoscopic patterns for gastric lymphoma?(3)

Answer 22

Exophytic type - polyploid-like mass

Ulcerated type

Hypertrophic type - Large gastric folds

Question 23

Staging system for G.I. lymphoma?

Answer 23

luago staging

Question 24

Buspirone - Mechanism of action?

Answer 24

5-HT1a agonist - Relaxes stomach and approves gastric accommodation