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Surgery > Stomach > Flashcards

Stomach Flashcards

1
Q

What is the blood supply of the stomach?

A

Greater curvature: R and L gastroepiploic arteries (from gastroduodenal, splenic, resp.).
Lesser curvature: R and L gastric arteries (from proper hepatic, celiac, resp.).
Pylorus: gastroduodenal artery (from common hepatic).
Fundus: short gastric arteries (from splenic).

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2
Q

What is the innervation of the stomach?

A

Motor: L vagus (ant. gastric wall), R vagus (post. gastric wall)
Pain sensation: symp. afferents from T5-10.

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3
Q

What are the major cells found in the stomach?

A 
Parietal cells (fundus and body).
Chief cells (fundus and body).
G cells (antrum).
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4
Q

What do gastric parietal cells do?

A

Secrete intrinsic factor (vitamin B12 absorption).

Secrete HCl.

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5
Q

What do gastric chief cells do?

A

Secrete pepsinogen.

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6
Q

What do G cells do?

A

Secrete gastrin.

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7
Q

How can parietal cells be stimulated or inhibited?

A

Stimulation: Gastrin, Vagus nerve, Histamine.

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8
Q

How can G cells be stimulated or inhibited?

A

Stimulation: Gastrin-releasing peptide.
Inhibition: Somatostatin.

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9
Q

How can gastric bicarbonate secretion into mucous gel be inhibited?

A

NSAIDs.
Acetazolamide.
Alpha blockers.
EtOH.

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10
Q

How can the thickness of gastric gel be increased or decreased?

A

Increased: PGE.
Reduced: Steroids, NSAIDs.

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11
Q

How does H. pylori contribute to ulcer formation?

A

Produce urease which breaks down the protective mucous lining of the stomach.

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12
Q

How do NSAIDs contribute to ulcer formation?

A

Inhibit production of PGE, which stimulates mucosal barrier production.

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13
Q

What is the urease breath test?

A

1) C13/14 labeled urea is ingested.

2) If H. pylori is present, carbon isotope can be detected in breath.

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14
Q

What are the most common PPIs?

A

Omeprazole (Prilosec).
Lansoprazole (Prevacid).
Pantoprazole (Protonix).

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15
Q

What are the most common H2 blockers?

A

Cimetidine (Tagamet).
Ranitidine (Zantac).
Famotidine (Pepcid).
Nizatidine (Tazac).

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16
Q

What is a highly selective vagotomy?

A

Surgical treatment of DU.
Individual branches of anterior and posterior nerves of Latarjet in the gastrohepatic ligament going to the lesser curvature of the stomach are severed so that pyloroantral function is preserved.

17
Q

What are the 4 types of gastric ulcers?

A

Type I: ulcer in lesser curvature at incisura angularis.
Type II: simultaneous GU, DU.
Type III: prepyloric ulcer.
Type IV: ulcer in gastric cardia.

18
Q

What are the etiologies of gastritis?

A 
GNASHING:
Gastric reflux (bile or pancreatic fluids).
Nicotine.
Alcohol.
Stress.
H. pylori.
Ischemia.
NSAIDs.
Glucocorticoids.
19
Q

What are the etiologies of upper GI hemorrhage?

A 
Mallory's Vices Gave (her) An Ulcer.
Mallory-Weiss tear.
Varices.
Gastritis.
Arteriovenous malformation.
Ulcer.
20
Q

How is a bleeding scan performed?

A

Detects bleeding by infusing a radioactive colloid or radiolabeled autologous RBCs and watching for their collection.

21
Q

Why is somatostatin used in UGI bleeds?

A

Inhibits gastric, intestinal and biliary motility.

Decreases visceral blood flow.

22
Q

What is a VBG?

A

VBG = vertical banded gastroplasty.
A partitioning of the stomach into a small proximal pouch and a more distal one.
Filling of the small pouch signals to the hypothalamus that satiety has been reached.

23
Q

Describe a Roux-en-Y gastric bypass.

A

Esophagus is attached to the jejunum, bypassing the stomach, duodenum, and first part of jejunum.

24
Q

What is Krukenberg’s tumor?

A

Metastasis of gastric adenocarcinoma to the ovaries.

25
Q

What is Blumer’s shelf?

A

Metastasis of gastric adenocarcinoma to the pelvic cul-de-sac, felt on DRE.

26
Q

What is Virchow’s node?

A

Metastasis of gastric adenocarcinoma to a lymph node palpable in the L supraclavicular fossa.

27
Q

What is Sister Mary Joseph’s nodule?

A

Metastasis of gastric adenocarcinoma to the umbilical lymph nodes.

28
Q

What is the Carney triad?

A

Gastric leiomyosarcoma.
Pulmonary chondromas.
Extra-adrenal paraganglioma.

Surgery (6 decks)

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