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Surgery > Stomach > Flashcards

Stomach Flashcards

1
Q

Stomach is derived from the

A

Foregut

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2
Q

Most superior portion of the stomach

A

Fundus

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3
Q

Separates fundus from the esophagus

A

Angle of his

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4
Q

Strongest layer of the gastric wall

A

Submucosa

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5
Q

Submucosal plexus

A

Meissner’s

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6
Q

Myenteric plexus

A

Auerbach’s plexus

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7
Q

Smooth muscle sublayer that is unique to the stomach

A

Inner oblique layer

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8
Q

Cells that produce pepsinogen

A

Chief cells

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9
Q

Secretes HCl and IF

A

Parietal cells

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10
Q

Secrete mucous and HCO3

A

Mucous neck cell

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11
Q

Secreted by Kulchitsky cells

A

Serotonin

Enterochromaffin cells

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12
Q

Supplies the proximal portion of the lesser curvature and gives off small branches to the diaphragm and distal esophagus.

A

Left gastric artery

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13
Q

Supplies the distal portion of the lesser curvature.

A

Right gastric artery:

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14
Q

Supplies the proximal portion of the greater curvature

A

Left gastroepiploic artery

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15
Q

Supplies the distal greater curvature and pylorus.

A

Right gastroepiploic artery

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16
Q

■ : Originate from the splenic artery. Contribute to theblood supply of the proximal stomach.

A

Short gastric arteries

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17
Q

Drainage of right and left gastric veins

A

Portal vein

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18
Q

Drainage of right gastriepiploic vein

A

Splenic vein

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19
Q

Drainage of left gastroepiploic vein

A

SMV

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20
Q

Also calles as coronary vein

A

Left gastric vein

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21
Q

Left vagus runs anterior or posterior to the stomach?

A

Anterior

Right -posterior

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22
Q

Criminal nerve of grassi is a branch of

A

Right vagus nerve

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23
Q

If this nerve is undivided during vagotomy, recurrents ulcers will occur

A

Criminal nerve of grassi

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24
Q

Exacerbated by food intake: gastric vs duodenal ulcer

A

Gastric

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25
Q

Relieved by food intake: gastric vs duodenal ulcer

A

Duodenal

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26
Q

Type I gastric ulcer is associated with what blood type

A

Type A

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27
Q

Type II gastric ulcer is associated with what blood type

A

Type O

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28
Q

The most cost-effective diagnostic test for PUD

A

UGI contrast study

But UGI endoscopy will allow obtaining biopsy

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29
Q

Most common location of perforation in PUD

A

Posterior

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30
Q

Hemorrage due to PUD involves what artery

A

Gastroduodenal artery

31
Q

Ulcer at the distal portion of lesser curvature

A

Type I

Nl / ↓ HCl

32
Q

Gastric ulcer at the distal portion of lesser curvature and associated with duodenal ulcer

A

Type II

↑ HCl

33
Q

Gastric ulcer at prepyloric or pyloric

A

Type III

↑ HCl

34
Q

Gastric ulcer at proximal portion of lesser curvature

A

Type IV

Nl / ↓ HCl

35
Q

NSAID induced gastric ulcer

A

Type V

normal HCl; occurs anywhere

36
Q

Treatement of diarrheal post-vagotomy syndrome

A

Cholestyramine

If refractory; reverse segment jejunal interposition

37
Q

Hormonal diagnostic test for ZES

A

Secretin challenge

(+) if increase in serum gastrin level > 200 pg/ml

38
Q

Gastrinoma triangle

A

Pancreatic neck
Porta hepatis
Thirp portion of the duodenoma

Common location of gastrinoma in ZES

39
Q

Large, tortuous, submucosal artery usually in the proximal stomach; Pulsations cause ulceration of the overlying mucosa, leading to intraluminal bleeding.

A

Dieulafoy’s Lesion

40
Q

Clinical triad of ZES

A

Hypersecretion of HCl
Severe PUD
Gastrinoma

41
Q

The most commonly performed operation for GERD and involves a 360° wrap.

A

Nissen fundoplication (open or laparoscopic)

42
Q

Surgery for GERD involving 180° wrap

A

Toupet

43
Q

Surgery for GERD involving 270° wrap; performed through the chest

A

Belsey Mark IV

44
Q

Most common complication of antireflux procedures

A

Pneumothorax

45
Q

Most common form of gastric cancer.

A

Gastric Adenocarcinoma

46
Q

Gastric adenomacarcinoma type that is NOT attributed to H. pylori

A

Diffuse type

Intestinal type - H. pylori

47
Q

A diffuse neoplasm involving the entire stomach to give a “leather bottle” appearance.

A

Linitis plastica

Adenocarcinoma

48
Q

The only potentially curative therapeutic modality for gastric adenocarcinoma

A

Surgical resection with a 6-cm resection margin

49
Q

Surgical treatment for proximal gastric adenocarcinoma

A

Total gastrectomy

50
Q

Surgical treatment for distal gastric adenocarcinoma

A

Subtotal gastrectomy

51
Q

5-year survival rate for gastric adenocarcinoma

A

10-20%

52
Q

Submucosal, mesenchymal tumors arising from interstitial cells of Cajal.

A

Gastrointestinal Stromal Tumors

53
Q

Most common location of GIST

A

Stomach

54
Q

Protooncogen mutation involved in GIST

A

KIT (tyrosine kinase mutation)

55
Q

Characteristic lymphadenopathy and metastases of gastric cancer at the right supraclavicular lymph node.

A

Virchow’s

56
Q

Characteristic lymphadenopathy and metastases of gastric cancer at the periumbilical lymph node.

A

Sister Mary Joseph’s

57
Q

Characteristic lymphadenopathy and metastases of gastric cancer at the peritoneal lymph nodes (palpable on rectal examination).

A

Blumer’s shelf

58
Q

Characteristic lymphadenopathy and metastases of gastric cancer at the ovary

A

Krukenberg tumor

59
Q

Postgastrectomy characterized by explosive diarrhea, abdominal pain, nausea, vomiting, ↑ HR, syncope, diaphoresis within 20-30 minutes of eating. Caused by rapid passage of high osmolarity food from stomach to SI → H20 shift into SI lumen.

A

Dumping, early

If 2-3 hours, late

60
Q

Treatment of dumping

A

Small meal (high protein, low simple carbohydrate)
Supine position after eating
Octreotide

And possible conversion of Billroth to Roux-en-Y or reversed intestinal segment

61
Q

Postgastrectomy syndrome characterized by postprandial pain and fullbess, bilious, projectile vomiting (without food)

A

Afferent loop syndrome

62
Q

Treatment of afferent loop syndrome

A

Conversion of Billroth II to Billroth I or to Roux-en-Y with vagotomy

63
Q

Postgastrectomy syndrome characterized by abdominal pain, bilious vomiting and distension

A

Efferent loop syndrome

64
Q

Postgastrectomy syndrome characterized by epigastric pain, vomiting, weight loss due to abnormal gastric emptying (abnormality in motility)

A

Roux syndrome

65
Q

Afferent loop syndrome and alkaline reflux gastritis are more common after what gastric reconstruction?

A

Billroth II reconstructions

66
Q

Surgical treatment for GIST

A

en bloc resection with (-) margin

No LND

67
Q

Medication given for metastatic, unresectable, or recurrent GIST

A

imatinib mesylate (a tyrosine kinase inhibitor)

68
Q

Most common site for 1° GI lymphoma

A

Stomach

69
Q

Treatment of gastric lymphoma or MALToma

A

Chemoradiation

70
Q

Bariatric surgery is a surgical treatment of

A

Morbid obesity

71
Q

What GI hormones are involved in the regulation of insulin release?

A

Gastric inhibitory peptide, CCK

72
Q

A 55-year-old woman is found to have PUD without ↑ HCl secretion. What types of gastric ulcers may be present?

A

Types I or IV.

73
Q

What type of gastric ulcer is often not responsive to highly selective vagotomy?

A

Type III

74
Q

What technique is used for laparoscopic band placement during which the gastrohepatic ligament is divided, a plane between the right diaphragmatic crus, and the overlying fat pad is dissected?

A

Pars flaccida technique

Surgery (10 decks)

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