Stomach Flashcards
Stomach is derived from the
Foregut
Most superior portion of the stomach
Fundus
Separates fundus from the esophagus
Angle of his
Strongest layer of the gastric wall
Submucosa
Submucosal plexus
Meissner’s
Myenteric plexus
Auerbach’s plexus
Smooth muscle sublayer that is unique to the stomach
Inner oblique layer
Cells that produce pepsinogen
Chief cells
Secretes HCl and IF
Parietal cells
Secrete mucous and HCO3
Mucous neck cell
Secreted by Kulchitsky cells
Serotonin
Enterochromaffin cells
Supplies the proximal portion of the lesser curvature and gives off small branches to the diaphragm and distal esophagus.
Left gastric artery
Supplies the distal portion of the lesser curvature.
Right gastric artery:
Supplies the proximal portion of the greater curvature
Left gastroepiploic artery
Supplies the distal greater curvature and pylorus.
Right gastroepiploic artery
■ : Originate from the splenic artery. Contribute to theblood supply of the proximal stomach.
Short gastric arteries
Drainage of right and left gastric veins
Portal vein
Drainage of right gastriepiploic vein
Splenic vein
Drainage of left gastroepiploic vein
SMV
Also calles as coronary vein
Left gastric vein
Left vagus runs anterior or posterior to the stomach?
Anterior
Right -posterior
Criminal nerve of grassi is a branch of
Right vagus nerve
If this nerve is undivided during vagotomy, recurrents ulcers will occur
Criminal nerve of grassi
Exacerbated by food intake: gastric vs duodenal ulcer
Gastric
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
