Brainscape's Knowledge GenomeTM

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


See full index

Gastrointestinal > Stomach > Flashcards

Stomach Flashcards

1
Q

Give a differential for thickened, lobular folds in the body and antrum

A

Gastritis - H. pylori
Zollinger-Ellison
Lymphoma

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

Which ulcer is h. pylori more associated with?

A

Duodenal (90%) vs Gastric (70%)

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

Give a differential for small, round, filling defects with a small central collection of barium

A 
Erosive (varioloform) gastritis
Barium precipitate (dont have mound of edema)
Crohns (will have other lesions)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the features of a benign gastric ulcer

A

Round or oval crater
Folds that CROSS the mound of surrounding edema
Symmetric and smooth filling defect surrounding the crater
Extension of the ulcer beyond the normal gastric lumen contour
Smooth and symmetric radiating gastric folds

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

Where do most benign ulcers occur

A

Along the lesser curvature or posterior wall of the antrum/body

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

Benign ulcers along the greater curvature are associated with what

A

aspirin coated medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a hamptons line

A

Line of nonulcerated acid-resistant mucosa around the ulcer crater - BENIGN feature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does a healing ulcer presents? When do they start to heal?

A

Linear configuration
Can split into 2 smaller crates as reepitheliazation occurs
8 weeks

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

What are the signs of a healed ulcer?

A

Radiating folds with retraction indicates fibrosis

Area gastricae in the scarred region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a benign sump ulcer? Differentiate between an intramural diverticulum.

A

An ulcer crater in the dependent stomach along the distal greater curvature (like a sump collection)

Usually due to medication

Smooth surfaced and tapers gradually. Surrounding edema has abrupt margins

Diverticulum will change shape with peristalsis and not have surrounding edema

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

What size is a giant ulcer? Is there any prognostic indication based on size? multiplicity?

A

> 3cm
Size doesnt matter
Multiple favor benign cause, but should be evaluated individually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the major complications of gastric ulcers?

A

Bleeding - most common
Perforation
Obstruction
Perforation with fistula formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the most common cause of gastrocolic fistulas?

A

Primary carcinoma of stomach or colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Differentail for enlarged rugal folds, hypersecretion, peptic ulcers, and thickened folds in the proximal small bowel

A

Zollinger - ellison
Lymphoma
Gastric Ca - focal mass or narrowing
Menetrier - proximal stomach only

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

What is zollinger - ellison syndrome?

Pathology
How many are malignant?
What associated sydrome? How many?

Symptoms

Diagnostic test?

A

Gastric secreting islet cell neoplasm

Marked hypersecretion of HCl with peptic ulcer disease

50% are malignant
1/4 have MEN1 (parathyroid, pitiutary, pheochromocytoma)

Intracatble peptic ulcer disease with malabsorption

Paradoxical increase in gastrin with secretin injection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is an aphthous ulcer? What is it seen in ?

A

Central ulceration with surrounding mound of edema

Crohns (will have other GI involvement)
Erosive gastritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Markedly enlarged gastric folds in the proximal stomach?

A

Menetrier disease (hypertrophic gastropathy)

Hyperplasia of surface epithelial cells with abundant mucus cells. Results in achlorhydria due to replacement of parietal cells.

Folds will be organized and follow distribution of normal rugae (unlike lymphomatous proliferation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is a differentiating feature between hyperplastic and adenomatous gastric polyps?

What do multiple small polyps designate?

A

Hyperplastic - multiple, 1cm, usually carry malignant potential if >2cm

Innumerable - FAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What types of gastric polyp is seen in FAP? Duodenal polyp?

A

Gastric - hyperplastic

Duodenal - adenomatous

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

What are the two main variations of FAP?

A

Gardner - FAP, desmoid tumors, osteoma, epidermoid cysts, papillary thyroid

Turcot - FAP, CNS tumor (gliomas, medulloblastomas)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What type of polyp is seen in FAP associated symdromes?

The other polyposis syndromes? (canada chronkite, peutz jeugher)

A

Hyperplastic

Hamartomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the following syndromes?

Mucocutaneous pigmentation, GI malignancy, gynecologic malignancy

Mucocutaneous lesions, thyroid abnormalities, breast abnormalities

Stomach, small bowel, colon, ectodermal changes (skin, hiar, nails)

A

Peutz-Jeugher

Cowden

Cronkhite-Canada

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Differential for well demarcated, smooth surfaced mass

A

Submucosal tumor

GIST (most common submucosal gastric tumpor)
Lipoma
Fibroma
Carcinoid
Neurogenic tumors, leiomyoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What characteristics help differentiate a malignant GIST?

A

Size - >10cm
Irregular shape
Central necrosis

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

Differentiate a lipoma/GIST from an ectopic pancreatic rest

A

EPR will have a central ulceration and be near the antrum

26
Q

What are characteristics of malignant gastric ulcer?

A

Fold clubbing, tapering, interruption, and fusion

Nodular adjacent tissue
Abrupt transition between the surrounding tissue and normal gastric tissue
Crater doesnt project beyond expected location of the gastric wall
Radiating folds stop at the crater edge and do not reach the crater edge
Carter is wider than deep

27
Q

What is the carmen meniscus sign?

A

Seen when a malignant ulcer straddles the lesser curvature and compression aposes both surfaces of the surrounding tumor.

Appears as a crescent (half moon) on the lesser curvature with nodular tumor surrounding the periphery

28
Q

What are the risk factors for gastric carcinoma

A

High starch diets
Polycyclic hydrocarbons (smoked meats)
Nitrosamines (processed meats)

29
Q

Nodular appearance of the gastric serosa indicates what

A

Extension to the omentum

30
Q

What are the common nodal groups for gastric mets

lymphomaspecifically?

A

Parapancreatic, paraaortic, middle colic

Gastrohepatic (lesser and greater curvature)

31
Q

Where are 4 common spots for peritoneal metastases

A

Pouch of douglas
Sigmoid mesocolon
Right paracoloic gutter
Small bowel mesentery

32
Q

At what level does lymphadenopathy indicate lymphoma vs gastric carcinoma?

A

At or below the level of the renal pedicles

33
Q

What is the most common nonnodal site for nonhodgkins lymphoma

A

Stomach

34
Q

What are features that suggest gastric lymphoma over adenocarcinoma?

A

Multiplicity, submucosal, extesnion beyond the pylorus

35
Q

What is the differential for a solitary ulcerated lesion in the stomach

A 
GIST
Primary gastric adenocarcinoma
lymphoma
ectopic pancreatic rest
Metastatic melanoma
36
Q

What is a bezoar

A

Concretions of ingested material

Mottled soft tissue mass which is not attached to a gastric wall and through which is interspersed barium

Differentiated by its free movement

37
Q

What is the incidence of ectopic pancreatic rests?

How do the appear radiographically

A

14%

Umbilicated submucosal nodule with the distal stomach usually

38
Q

What are two causes of gastric varices

A

Portal venous hypertension

Splenic vein occlusion

39
Q

How can one differentiate splenic vein occlusion as the source of varices from portal hypertension?

A

Splenic vein occlusion will not have esophageal varices, because of the secondary drainage via short gastric veins. Blood will flow to thw gastric fundus plexus and return to the portal system via the left gastric

40
Q

Smooth, symmetric tapering at the antrum suggests what 4 dx? “Rams horn” appearance

A

Scarring from PUD
Granulomatous disease - distal (antrum) stomach most commonly affected
Scirrhous carcinoma
Metastatic breast cancer (Scirrhous appearance)

41
Q

Nodularity and narrowing of the distal stomach and nodular fold thickening in the small bowel suggests what?

Where is the best site for biopsy? Tx?

A

Eosinophlic gastroenteritis (Nodular appearance separates from other granulomatous diseases)

Antrum

Self limited

42
Q

What is the differential for a featureless stomach?

A

Overdistension

Atrophic gastritis

43
Q

What are the two types of atrophic gastritis?

A

Type A - autoimmune antibodies to parietal cells and intrinsic factor. usually affects the BODY and FUNDUS

Type B - H. pylori associated. usually affects the ANTRUM

44
Q

Differentiate caustic stricture of the antrum from granulomatous disease.

A

Caustic will have a classic history of ingestion, lesions in the esophagus and duodenum, and be ABRUPT in margination

Granulomatous will be a smooth tapered narrowing.

45
Q

What is a linitis plastica appearance? What is the pathology?

A

“Leather bottle” appearance, carcinomatous spread along the submucosa causes a desmoplastic reaction that looks like a narrowed water bottle.

46
Q

What are the types of gastric adenocarcinoma? What is the difference?

A

Polypoid and ulcerative do not enhance

Scirrhous will enhance and is submucosal

47
Q

What 4 entities can have a “linitis plastica” appearance?

A

Scirrhous gastric cancer
Metastatic BREAST cancer
Omental mets (lymphoma) alont the gastrocolic ligament
Granulomatous disease

48
Q

What is a marginal/stomal ulcer? Where do they usually occur?

A

Perianastomotic ulcer developing after a gastorenterostomy.

Usually occur on the EFFERENT limb of the JEJUNUM, within 2 cm of the stoma.

49
Q

Marginal ulcers should raise suspicion of what conditions

A

Incomplete vagotomy, retained gastric antrum (parietal cells), zollinger-ellison, hypercalcemia, smoking

50
Q

What is afferent loop syndrome?

A

Dilated, fluid filled duodenum s/p billroth II

51
Q

What is blind loop syndrome?

A

A sequelae of afferent loop syndrome, whereby obstruction leads to bacterial overgrowth, vitamin B12 deficiency, and megaloblastic anemia

52
Q

What is a blown duodenal stump?

A

Breakdown or leakage of the afferent limb (duodenum) after a billroth II

53
Q

Which limb more commonly intussucepts after billroth II?

A

Jejunal (efferent)

54
Q

What are the two appearances of postgastrectomy carcinoma?

A

Constricting and diffuse, which will cause narrowing

Polypoid

55
Q

What is the timeline for gastric remnant carcinoma vs primary tumor appearance

A

Remnant - several months

Primary - 20-30years

56
Q

What are the 3 steps in a traditional gastric bypass

A
  1. creation of a small gastric pouch
  2. jejunogastrostomy using a jejunal roux limb with a small gastric stomal opening
  3. Side-to-side anastamosis of the excluded limb with the antegrade jejunal roux limb
57
Q

What is the timeline and percentage of anastomotic leak postop gastric bypass

A

1-2 days, 1-5%

58
Q

What is the incidence of internal hernia after gastric bypass? What are the imaging findings? Where is the most common defect?

A

2%

Clustered bowel loops, visible entrance and exit limbs, displaced jejunojejunal suture line, change in bowel configuration, stasis within herniated loops

Transverse mesocolon

59
Q

Where do most gastric diverticula arise?

A

Posterior surface of fundus near GE junction

Will contain mucosal folds and change with peristalsis

60
Q

Differentiate gastric ulcer and partial diverticulum

A

Diverticulum will change with peristalsis, usually located along greater curvature

61
Q

Asymptomatic intramural pneumatosis is seen with what

A

Corticosteroid use

62
Q

What are the two gastric volvuli? How do they differ? Which on is worse?

A

Organoaxial - along longitudinal axis of stomach, more common. Associated with hiatal hernia. Greater curvature is located superior and GE junction is in normal location

Mesenteroaxial - folds stomach in half, GE junction is displaced superiorly. More prone to ischemia.

Gastrointestinal (13 decks)

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