Stomach Flashcards by Ailah M

Stomach is derived from the

Foregut

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Most superior portion of the stomach

Fundus

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Separates fundus from the esophagus

Angle of his

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Strongest layer of the gastric wall

Submucosa

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Submucosal plexus

Meissner’s

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Myenteric plexus

Auerbach’s plexus

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Smooth muscle sublayer that is unique to the stomach

Inner oblique layer

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Cells that produce pepsinogen

Chief cells

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Secretes HCl and IF

Parietal cells

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Secrete mucous and HCO3

Mucous neck cell

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Secreted by Kulchitsky cells

Serotonin

Enterochromaffin cells

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

Left gastric artery

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Supplies the distal portion of the lesser curvature.

Right gastric artery:

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Supplies the proximal portion of the greater curvature

Left gastroepiploic artery

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Supplies the distal greater curvature and pylorus.

Right gastroepiploic artery

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

Short gastric arteries

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Drainage of right and left gastric veins

Portal vein

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Drainage of right gastriepiploic vein

Splenic vein

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Drainage of left gastroepiploic vein

SMV

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Also calles as coronary vein

Left gastric vein

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Left vagus runs anterior or posterior to the stomach?

Right -posterior

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Criminal nerve of grassi is a branch of

Right vagus nerve

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

Criminal nerve of grassi

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Exacerbated by food intake: gastric vs duodenal ulcer

Gastric

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Relieved by food intake: gastric vs duodenal ulcer

Duodenal

Type I gastric ulcer is associated with what blood type

Type A

Type II gastric ulcer is associated with what blood type

Type O

The most cost-effective diagnostic test for PUD

UGI contrast study But UGI endoscopy will allow obtaining biopsy

Most common location of perforation in PUD

Posterior

Hemorrage due to PUD involves what artery

Gastroduodenal artery

Ulcer at the distal portion of lesser curvature

Type I Nl / ↓ HCl

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

Type II ↑ HCl

Gastric ulcer at prepyloric or pyloric

Type III ↑ HCl

Gastric ulcer at proximal portion of lesser curvature

Type IV Nl / ↓ HCl

NSAID induced gastric ulcer

Type V normal HCl; occurs anywhere

Treatement of diarrheal post-vagotomy syndrome

Cholestyramine If refractory; reverse segment jejunal interposition

Hormonal diagnostic test for ZES

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

Gastrinoma triangle

Pancreatic neck Porta hepatis Thirp portion of the duodenoma Common location of gastrinoma in ZES

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

Dieulafoy’s Lesion

Clinical triad of ZES

Hypersecretion of HCl Severe PUD Gastrinoma

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

Nissen fundoplication (open or laparoscopic)

Surgery for GERD involving 180° wrap

Toupet

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

Belsey Mark IV

Most common complication of antireflux procedures

Pneumothorax

Most common form of gastric cancer.

Gastric Adenocarcinoma

Gastric adenomacarcinoma type that is NOT attributed to H. pylori

Diffuse type Intestinal type - H. pylori

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

Linitis plastica Adenocarcinoma

The only potentially curative therapeutic modality for gastric adenocarcinoma

Surgical resection with a 6-cm resection margin

Surgical treatment for proximal gastric adenocarcinoma

Total gastrectomy

Surgical treatment for distal gastric adenocarcinoma

Subtotal gastrectomy

5-year survival rate for gastric adenocarcinoma

10-20%

Submucosal, mesenchymal tumors arising from interstitial cells of Cajal.

Gastrointestinal Stromal Tumors

Most common location of GIST

Stomach

Protooncogen mutation involved in GIST

KIT (tyrosine kinase mutation)

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

Virchow’s

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

Sister Mary Joseph’s

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

Blumer’s shelf

Characteristic lymphadenopathy and metastases of gastric cancer at the ovary

Krukenberg tumor

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.

Dumping, early If 2-3 hours, late

Treatment of dumping

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

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

Afferent loop syndrome

Treatment of afferent loop syndrome

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

Postgastrectomy syndrome characterized by abdominal pain, bilious vomiting and distension

Efferent loop syndrome

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

Roux syndrome

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

Billroth II reconstructions

Surgical treatment for GIST

en bloc resection with (-) margin No LND

Medication given for metastatic, unresectable, or recurrent GIST

imatinib mesylate (a tyrosine kinase inhibitor)

Most common site for 1° GI lymphoma

Stomach

Treatment of gastric lymphoma or MALToma

Chemoradiation

Bariatric surgery is a surgical treatment of

Morbid obesity

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

Gastric inhibitory peptide, CCK

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

Types I or IV.

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

Type III

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?

Pars flaccida technique