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ABSITE Flashcards > Stomach > Flashcards

Stomach Flashcards

1
Q

MALT is a precursor to?

A

Gastric lymphoma

Regresses with H.pylori tx

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2
Q

Clo test detects?

A

Urease from H pylori

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3
Q

Gastric ulcers: type I, II, III, IV, V

A 
I: lesser curve
II: 2 ulcers (lesser curve and duodenal)
III: prepyloric
IV: high lesser curve
V: anywhere a/w NSAID use
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4
Q

Risk factors for gastric adenocarcinoma?

A

Adenoma > 2 cm
Nitrosamines
Chronic atrophic gastritis/pernicious anemia

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5
Q

Gastric lymphoma tx

A

Chemo and radiation

Surgery for complications

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6
Q

Types of hiatal hernia

A 
-	Type 1: sliding hiatal hernia
o	If asymptomatic, can observe
-	Type 2: paraesophageal hernia
o	Always needs repair
-	Type 3: sliding hiatal hernia + paraesophageal hernia
o	Always needs repair
-	Type 4: entire stomach + organ in chest
o	Always needs repair
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7
Q

Repair of hiatal hernia

A

o Reduce hernia sac and brought back into esophagus
o Mesh, operator dependent
o Permanent suture to close crura
o Fundoplication
o Colles gastropexy í if unable to get length of esophagus freed

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8
Q

Types of gastric ulcers:

A
  • Type 1: lesser curve
  • Type 2: gastric ulcer a/w duodenal ulcer
    o A/w high acid output
  • Type 3: pre-pyloric (distal)
    o A/w high acid output
  • Type 4: ulcer near GEJ
  • Type 5: anywhere, NSAID related
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9
Q

High risk recurrent GI bleed

A

o Active bleeding pulsatile vessel
o Visible vessel
o Adherent clot
o Clean ulcer base

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10
Q

Surgery for bleeding gastric ulcer

A

Midline laparotomy, anterior gastrotomy, oversew the bleeding area, make sure to bx, close gastrotomy

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11
Q

Surgery for bleeding duodenal ulcer

A

longitudinal anterior duodenotomy, control bleeding with sutures placed in superior and inferior positions of the ulcer to avoid CBD, ligate GDA above duodenum if bleeding continues after that, approximate ulcer crater and close the duodenotomy transversely

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12
Q

Ulcer Perforation tx

A

Antibiotics: broad-spectrum, +fungal
Surgical management: omental patch repair
Contained leak: non-op is reasonable if HDS

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13
Q

Refractory ulcer disease tx

A

Truncal vagotomy and pyloroplasty
Selective vagotomy
Vagotomy and antrectomy with Billroth reconstruction

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14
Q

Siewart-Stein classifications for GEJ cancers

A
  • Type 1: distal esophagus, 1-5 cm above GEJ
  • Type 2: cardia, within 1 cm above or below GEJ
  • Type 3: 2-5 cm below GEJ in the stomach
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15
Q

Gastric volvulus associated with

A

paraesophageal hernia

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16
Q

Gastric volvulus rotations

A
  • Organo-axial: rotates along the axis of the stomach from GEJ to the pylorus (vertical, coronal plane)
  • Meso-axial rotation: along the short axis of stomach, bi-secting the lesser and greater curvature
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17
Q

Gastric volvulus tx

A
  • Tx: emergent surgery
    o Reduce the hernia
    o Crural repair
    o Gastropexy
    o If needed, partial gastrectomy for de-vitalized tissue
    o If not fit for surgery: endoscopic decompression, double-PEG tube
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18
Q

Alarm sx of GERD

A

dysphagia, odynophagia, weight loss, GI bleeding

W/u with EGD

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19
Q

DeMeester score:

A

% of time that pH in esophagus is <4, % of upright time with pH <4, % of supine time with pH <4, number of reflux episodes >5 min, and the longest reflux episode

> 14.72 = reflux

20
Q

Bile reflux test

A

Impedence testing

Tx: roux-en-y

21
Q

Surgical goals of anti-reflux surgery

A

” Restore normal anatomic position of the stomach and GEJ within the abdomen
“ Recreate anti-reflux valve, with negative intrathoracic pressure
“ Reduce hiatal hernia
“ Free esophagus in mediastinum
“ Close crura
“ 2 cm long fundoplication

22
Q

Partial wraps useful in?

A

Motility disorders

23
Q

Dor

A

Anterior partial fundoplication

24
Q

Toupe

A

Posterior partial fundoplication

25
Q

Tension capnothorax management

A

Enlarge pleural tear to prevent tension, red rubber catheter from pleura into abdomen to equalize pressures, needle decompression

26
Q

Severe dysphagia, not handling secretions well post-fundoplication surgery

A

redo in OR

27
Q

Retained antrum syndrome

A

retained antral tissue in the duodenal stump after a gastric resection
o G-cells cause continuous acid release -> ulceration in remnant stomach
o Tx: PPI, refer for vagotomy and resection of retained antrum

28
Q

Late vs early dumping syndrome

A

o Early dumping syndrome
“ 20-30 min after a meal
“ Due to abrupt hyperosmolar load to small intestine
o Late dumping syndrome
“ 1-4 hrs after a meal
“ Rapid carb load in small intestine
“ Large insulin surge with rebound hypoglycemia

29
Q

Bile reflux tx

A

o Dx: impedence studies
o Tx: medical management (pro-kinetics, bile-acid binding resins)
“ Surgical management: roux-en-y
“ 50 cm of roux limb to prevent bile reflux

30
Q

Afferent loop syndrome

A

o Acute or chronic obstruction of afferent loop from Billroth II
o Sx: obstructive jaundice, cholangitis, pancreatitis
o Most concerning for duodenal stump blowout
o Bacterial overgrowth in limb in chronic afferent loop syndrome í can lead to steatorrhea, B12 deficiency, malnutrition due to deconjugation of bile acids from bacteria
“ Tx: antibiotics
“ Often need to convert to roux-en-y
“ Often present with bowel obstruction syndromes, if concerned about dilation/obstruction of afferent loop í Billroth II patients need emergent surgery

31
Q

CDH1 gene

A

autosomal dominant familial gastric cancer

“ Need to do prophylactic gastrectomy

32
Q

Role of Staging laparoscopy with peritoneal washings in gastric cancer?

A

Clinical stage > T1b tumors if chemoradiation or surgery being considered

33
Q

T stages in gastric cancer

A 
o	T1a: before submucosa
o	T1b: invades submucosa
o	T2: muscularis propria
o	T3: invades subserosa
o	T4: invades through serosa into adjacent structures
34
Q

Unresectable gastric cancers

A

o Peritoneal involvement
o Distal mets
o Root of mesentery or paraortic nodal disease
o Encasement of any major vascular structures (splenic not included)

35
Q

Who get neoadjuvant in gastric cancer?

A

o Patient with any nodal involvement

o T2 or higher

36
Q

Number of LN needed in resection for gastric cancer?

A

15

37
Q

Margins for resection in gastric cancer?

A

4-5 cm

38
Q

D1/D2 nodes

A

D1: peri-gastric nodes along greater or lesser curve
“ Nodal station 1-6
D2: peri-gastric nodes + LN around vessels
“ Nodal station 1-11
“ Increased morbidity with this in the US, improved survival in Asia

39
Q

Surgical options in gastric cancer

A

o Total gastrectomy: proximal tumors
“ Esophagojejunostomy
o Subtotal gastrectomy: preferred for distal lesions
o Splenectomy: not performed unless spleen or hilum has tumor involvement

40
Q

Who gets adjuvant tx?

A

o T3 or T4 or node positive disease, R0 resection -> adjuvant 5-FU chemo

41
Q

Zollinger-Ellison syndrome

A

gastrin >1000, multiple duodenal ulcers

42
Q

MALToma histology and tx

A

expansion of marginal zone and development of neoplastic lymphoid cells, tx with antibiotics for H pylori, often regress

43
Q

Parietal cell function

A

Produce acid when 1 or more of 3 receptors are stimulated:

  • Acetylcholine receptor (vagus nerve)
  • gastrin receptor (D cells)
  • histamine receptor (enterochromaffin like cells)
44
Q

Where is acid produced in the stomach?

A

Proximal stomach - parietal cells

Antrum produces gastrin

45
Q

Slipped gastric band treatment

A

HDS - removal of fluid from the band to give symptomatic relief and schedule for elective revision of gastric band

Unstable patient - need to rule out gastric incarceration, urgent laparoscopy

Ideal angle of band: 45 degrees

46
Q

Dieulafoy lesion

A

Vascular malformations along lesser curve of the stomach, within 6 cm of GEJ

Caused by mucosal erosion into submucosal vessel, usually difficult to identify unless actively bleeding

47
Q

Watermelon stomch

A

gastric antral vascular ectasia
Series of dilated vessels appearing as a longitudinal linear red streak on the antrum mucosa

Tx- endoscopic treatment, antrectomy if refractory bleeding

ABSITE Flashcards (19 decks)

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