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Surgery PLE > Stomach > Flashcards

Stomach Flashcards

1
Q

where are the parietal cells located

A

Body of the stomach

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2
Q

largest artery to the stomach

A

left gastric artery

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3
Q

What is the nerve in the posterior fundus that is easily missed during truncal or highly selective vagotomy

A

criminal nerve of grassi

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4
Q

What nerve innervates gastric contraction

A

vagus nerve from parasympathetic fibers

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5
Q

Location of gastric ulcers associated with increase gastric acid production

A

pylorus

type II and III

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6
Q

Most serious complication of EGD

A

esophageal perforation

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7
Q

Advantage of double contrast upper GI series compared to EGD

A
  1. diverticula
  2. fistula
  3. tortuosity or stricture location
  4. size of hiatal hernia
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8
Q

Gold standard for H. pylori diagnostic

A

Histologic examination of antral biopsy with special stains

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9
Q

Test for eradication of H. pylori

A

urease breath test

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10
Q

Blood type more common duodenal ulcer

A

type O

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11
Q

Blood type more common gastric ulcer

A

Type A

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12
Q

Peptic ulcer formed after severe burn injury

A

curling ulcer

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13
Q

Peptic ulcer formed after severe brain injury

A

cushing ulcer

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14
Q

Types of ulcer associated with increased gastric acid secretion

A

Type II and III

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15
Q

Types of ulcer associated with normal or decreased gastric acid secretion

A

Type I and IV

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16
Q

Ulcer located in the Angularis Incisura

A

Type I - most common

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17
Q

Ulcer located in the angularis incisura but with accompanying duodenal ulcer

A

Type II

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18
Q

Ulcer located in the Prepyloric area

A

Type III

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19
Q

Ulcer located in the GE junction

A

Type IV

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20
Q

Ulcer caused by NSAID and can occur anywhere

A

Type V

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21
Q

Indications of endoscopy in PUD

A
  1. patient > 45 y.o
  2. patient regardless of age with alarm symptoms
    a. weight loss
    b. dysphagia
    c. anemia
    d. bleeding
    e. recurrent vomiting
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22
Q

Location of High risk ulcer for massive bleeding

A
  1. lesser curvature of stomach with erosion to left gastric artery
  2. posterior duodenal ulcer with erosion to gastroduodenal artery
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23
Q

This surgery is done by severing the proxial 2/3 of vagal supply to the stomach, preserves the antrum and pylorus and remaining abdominal viscera

A

highly selective vagotomy
parietal cell vagotomy
proximal gastric vagotomy

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24
Q

This is a posterior truncal vagotomy and anterior seromyotomy

A

Taylor procedure

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25
Q

This procedure is useful for patients who require pyloroduodenotomy to deal with the ulcer complication

A

truncal vagotomy + pyloroplasty

26
Q

This is a good choice in patients with gastric outlet obstruction

A

truncal vagotomy + gastrojejunostomy

27
Q

Where is gastrin produced

A

antral G cells

28
Q

What is the most potent inhibitor of gastrin

A

luminal acid

29
Q

what is the most potent stimulatn of gastrin

A

luminal peptide and amino acid

30
Q

Where does 90% of Zollinger Ellison Syndrome occur

A

Pasaro’s Triangle

Gastrinoma triangle

31
Q

What are the boundaries of Pasaro’s Triangle

A
  1. junction of cystic and common bile duct
  2. 2nd and 3rd segment of duodenum
  3. junction of body and neck of pancreas
32
Q

Confirmatory Test for ZES

A

Posivie secretin stimulation test

33
Q

What other laboratory test are needed to check for ZES

A

serum calcium and PTH to rule out MEN1

  • parathyroid
  • pituitary
  • pancreatic or duodenal tumors
34
Q

What is the preoperative imaging of choice for gastrinoma

A

Somatostatin receptor scintigraphy

35
Q

Where is somatostatin produced

A

D cells located through out the gastric mucosa

36
Q

Major stimulus for somatostatin release

A

antral acidification

37
Q

What inhibits somatostatin release

A

acetylcholine

38
Q

A type of ulcer that is due to inadequate gastric mucosal blood flow

A

Stress ulcer

39
Q

Which risk factor has no role in gastric adenocarcinoma

40
Q

Type of polyps associated with gastric carcinoma

A
  1. hyperplastic

2. adenomas

41
Q

Protective factors of gastric carcinoma

A
  1. vitamin c
  2. aspirin
  3. high in fruits and vegetables
42
Q

What is the most common precancerous lesion in gastric carcinoma

A

atrophic gastritis

43
Q

What is the most important prognosticating factor or gastric cancer

A

lymph node involvemet

depth of tumor invasion

44
Q

Another name for linitis plastica

A

Scirrhous Tumor

45
Q

A name for palpable umbilical nodule in gastric CA

A

sister mary and joseph nodule

46
Q

A name for palpable nodule in the pouch of douglas

A

blumer nodes

sign of drop metastases

47
Q

Only curative treatment of gastic cancer

A

radical subtotal gastrectomy

48
Q

goal of resecting gastric cancer

A

R0 resection

grossly negative margin of at least 5 cm

49
Q

What is the most common site for primary GI lymphoma

50
Q

Treatment of gastric lymphoma

A

chemotherapy

It is equivalent to surgery

51
Q

It is a submucosal solitary slow growing tumor arising from the interstitial cells of cajal

52
Q

Most common cell type of GIST

A

epithelial cell stromal GIST

53
Q

Marker for GIST

A

(+) c - kit

54
Q

Treatment of GIST

A

wedge resection with clear margins

55
Q

Treatmet of unresectable or metastatic GIST

A

Imatinib - tyrosine kinase inhibitor

56
Q

Mode of metastasis of GIST

A

hematogenous: liver and lungs

57
Q

Most common type of polyp

A

hyperplastic (regenerative) polyp - 75%

58
Q

What is the cause of afferent limb obstruction (blind loop syndrome)

A

billroth II - distal gastric resection followed by gastrojejunal anastomosis

59
Q

What is the treatment of afferent limb obstruction?

A

conversion of billroth II to rouy en y gastric bypass

60
Q

What is roux syndrome

A

delayed gastric emptying

Endoscopy: Bezoar formation

61
Q

This presents with hypochloremic, hypokalemic, metabolic alkalosis

A

Gastric outlet obstruction

62
Q

This disease occurs when there is delivery of a hyperosmolar load into the small bowel

A

Dumping Syndrome

Surgery PLE (16 decks)

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