STOMACH

Question 1

Stomach transit time is ___ hours

Answer 1

3-4

Question 2

what part of the stomach does peristalsis occur?

Answer 2

only in distal stomach (antrum)

Question 3

blood supply to the pylorus

Answer 3

gastroduodenal artery

Question 4

gastric mucosa is lined with ____ epithelium

Answer 4

simple columnar

Question 5

three factors that cause H+ release

Answer 5

Acetylcholine, gastrin, and histamine

Question 6

How does acetylcholine and gastrin cause H+ release?

Answer 6

activate phospholipase which increases Ca –> Ca-calmodulin acgtivagtes phosphorylase kinase –> H+ release

Question 7

MOA - PPI’s

Answer 7

blocks H+/K+ ATPase in parietal cell membrane

Question 8

Inhibitors of parietal cells (4)

Answer 8

somatostatin, prostaglandins, secretin, CCK

Question 9

Intrinsic factor binds ___ and is reabsorbed in _____

Answer 9

B12, terminal ileum

Question 10

Right branch of vagus

Answer 10

posterior –> posterior gastric and celiac branches

Question 11

L branch of vagus

Answer 11

anterior __> anterior gastric and hepatic branches

Question 12

antrum and pylorus glands secrete

Answer 12

Mucus and bicarb - protect stomach

Question 13

Where are Brunner’s glands and what do they secrete?

Answer 13

In duodenum, secrete alkaline mucus

Question 14

What are trichobezoars and what is the treatment?

Answer 14

Hair, hard to pull out, EGD generally inadequate likely need gastrostomy and removal

Question 15

What are phytobezoars and how do you treat?

Answer 15

fiber, often in diabetics with poor gastric emptying, treatment - enzymes, EGD, diet changes

Question 16

What is a dieulafoy ulcer?

Answer 16

vascular malformation - can bleed

Question 17

Gastric volvulus is associated with type ___ hernia.

Answer 17

Type 2/paraesophageal hernia

Question 18

Diagnosis/treatment for mallory-weiss tear

Answer 18

EGD with hemo-clips

Question 19

Treatment for gastric volvulus?

Answer 19

reduction and Nissen

Question 20

Usual location for mallory-weiss tear

Answer 20

tear is usually on the lesser curvature near the GE junction

Question 21

Vagotomy (both forms) effect on liquid emptying (increase or decrease)

Answer 21

decreases liquid emptying

Question 22

Effect of Truncal vagotomy on emptying of solids

Answer 22

increases emptying of solids

Question 23

effect of proximal/highly selective vagotomy on emptying of solids

Answer 23

normal emptying of solids

Question 24

Addition of pyloroplasty to a truncal vagotomy results in (increase/decrease) solid emptying

Answer 24

decrease

Question 25

Most common problem following Vagotomy. Treatment?

Answer 25

Diarrhea (40%)

Treatment - cholestyramine and loperamide

Question 26

Upper GI bleeding - what do you do if bleeding is slow and you are having trouble localizing the source?

Answer 26

Tagged RBC scan

Question 27

UGI Bleeding - What are the 3 biggest risk factors for rebleeding at the time of EGD?

Answer 27

1. spurting blood vessel
2. visible blood vessel
3. Diffuse oozing

Question 28

Duodenal ulcer is most commonly in the ___ part of the duodenum, usually (anterior/posterior)

Answer 28

1st part of the duodenum;

anterior

Question 29

What is the big risk for posterior duodenal ulcers?

Answer 29

Posterior ulcers bleed from invasion of gastroduodenal artery

Question 30

Symptoms - duodenal ulcers

Answer 30

epigastric pain radiating to the back; abates with eating but recurs 30 minutes after

Question 31

What is triple therapy for H. Pylori?

Answer 31

Bismuth salts
amoxacillin
metronidazole/tetracycline
(BAM/BAT)

Question 32

Treatment for bleeding duodenal ulcer

Answer 32

EGD first - hemoclips, cauterize, Epi injection

Question 33

Duodenal ulcer - next step if EGD treatment fails.

What if the patient has been on a PPI?

Answer 33

Duodenotomy and GDA ligation

If on a PPI - need acid reducing surgery as well