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ENTREGA > Stomach > Flashcards

Stomach Flashcards

1
Q

What space lies behind the stomach?

A

Lesser sac; the pancreas lies behind the stomach

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2
Q

What is the opening into the lesser sac?

A

Foramen of Winslow

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3
Q

What are the folds of gastric mucosa called?

A

Rugae

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4
Q

What do gastric parietal cells produce?

A

HCl; intrinsic factor

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5
Q

What do gastric chief cells produce?

A

Pepsinogen

PEPpy chief

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6
Q

What do mucous neck cells produce?

A

Bicarbonate; mucus

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7
Q

What do G cells produce?

A

Gastrin

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8
Q

Where are G cells located?

A

Antrum of stomach

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9
Q

What is pepsin?

A

Proteolytic enzyme that hydrolyzes peptide bonds

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10
Q

What is intrinsic factor?

A

Protein secreted by the parietal cells that combines with vitamin B12 and allows for absorption in the terminal ileum

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11
Q

What is GERD?

A

Excessive reflux of gastric contents into the esophagus

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12
Q

What is pyrosis?

A

Medical term for heartburn

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13
Q

What are the causes of GERD?

A

Decreased LES tone; decreased esophageal motility to clear refluxed fluid; gastric outlet obstruction; hiatal hernia

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14
Q

What are the signs and symptoms of GERD?

A

Heartburn, regurgitation, respiratory problems, aspiration pneumonia, substernal pain

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15
Q

What disease must be ruled out when the symptoms of GERD are present?

A

CAD

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16
Q

What tests are included in the workup of GERD?

A

EGD; UGI contrast study with esophagogram; 24-hour acid analysis; manometry; EKG; CXR

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17
Q

What is the medical treatment for GERD?

A

Small meals; PPIs; H2 blockers; elevation of head at night and no meals prior to sleeping

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18
Q

What are the indications for surgery with GERD?

A

Intractability; respiratory problems as a result of reflux and aspiration of gastric contents; severe esophageal injury

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19
Q

What is Barrett’s esophagus?

A

Columnar metaplasia from the normal squamous epithelium as a result of chronic irritation from reflux

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20
Q

What is the major concern with Barrett’s esophagus?

A

Developing cancer

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21
Q

What type of cancer develops in Barrett’s esophagus?

A

Adenocarcinoma

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22
Q

What percentage of patients with GERD develops Barrett’s esophagus?

A

10%

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23
Q

What percentage of patients with Barrett’s esophagus will develop adenocarcinoma?

A

7%

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24
Q

What is the treatment of Barrett’s esophagus with dysplasia?

A

Nonsurgical: endoscopic mucosal resection and photodynamic therapy
Also: radiofrequency ablation, cryoablation

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25
Q

What is a Lap Nissen procedure?

A

360 degree fundoplication (2 cm long)

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26
Q

What is a Belsey mark IV procedure?

A

240-270 degree fundoplication performed through a thoracic approach

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27
Q

What is a Hill procedure?

A

Arcuate ligament repair (close large esophageal hiatus) and gastropexy to diaphragm

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28
Q

What is a Toupet procedure?

A

Incomplete (200 degree) posterior wrap often used with severe decreased esophageal motility

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29
Q

How does the Nissen wrap work?

A
  1. Increasing LES tone
  2. Elongating LES (3 cm)
  3. Returning LES into abdominal cavity
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30
Q

In what percentage of patients with GERD does Lap Nissen work?

A

85%

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31
Q

What are the post-operative complications of Lap Nissen?

A

Gas-bloat syndrome, stricture, dysphagia, spleen injury requiring splenectomy, esophageal perforation, pneumothorax

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32
Q

What is gas-bloat syndrome?

A

Inability to burp or vomit

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33
Q

What is the incidence of gastric cancer?

A

In US: 10/100,000

In Japan: 78/100,000

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34
Q

What are the associated risk factors for gastric cancer?

A

Diet (e.g. smoked meats, high nitrates, low fruits and vegetables, alcohol, tobacco).
Environment (e.g. high-risk area, poor SES, atrophic gastritis, male, type A blood, partial gastrectomy, pernicious anemia, polyps, H. pylori)

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35
Q

What is the average age at the time of discovery of gastric cancer?

A

> 60 years

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36
Q

What is the male:female ratio for gastric cancer?

A

3:2

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37
Q

Which blood type is associated with gastric cancer?

A

Type A

38
Q

What are the symptoms of gastric cancer?

A

WEAPON:

Weight loss, Emesis, Anorexia, Pain (epigastric), Obstruction, Nausea

39
Q

What are the most common early symptoms of gastric cancer?

A

Mild epigastric discomfort and indigestion

40
Q

What is the most common symptom of gastric cancer?

A

Weight loss

41
Q

What are the signs of gastric cancer?

A

Anemia, melena, heme occult, epigastric mass (advanced), hepatomegaly, coffee-ground emesis, Blumer’s shelf, Virchow’s node, enlarged ovaries, axillary adenopathy

42
Q

What does the patient with gastric cancer have if he or she has proximal colon distention?

A

Colonic obstruction by direct invasion (rare)

43
Q

What is the symptom of proximal gastric cancer?

A

Dysphagia

44
Q

What is a Blumer’s shelf?

A

Solid peritoneal deposit anterior to the rectum, forming a “shelf”, palpated on rectal exam

45
Q

What is a Virchow’s node?

A

Metastatic gastric cancer to the nodes in the left supraclavicular fossa

46
Q

What is a Sister Mary Joseph’s sign?

A

Periumbilical lymph node gastric cancer metastases.

Presents as periumbilical mass.

47
Q

What is a Krukenberg’s tumor?

A

Gastric cancer (or other adenocarcinoma) that has metastasized to the ovary

48
Q

What is “Irish’s” node?

A

Left axillary adenopathy from gastric cancer metastasis

49
Q

What is a surveillance laboratory finding in gastric cancer?

A

CEA elevated in 30% of cases (if positive, useful for post-operative surveillance)

50
Q

What is the initial workup for gastric cancer?

A

EGD with biopsy; endoscopic U/S (evaluate level of invasion); abdominal and pelvic CT (metastases); CXR; labs

51
Q

What is the histology in gastric cancer?

A

Adenocarcinoma

52
Q

What is the differential diagnosis for gastric tumors?

A

Adenocarcinoma, leiomyoma, leimyosarcoma, lymphoma, carcinoid, ectopic pancreatic tissue, gastrinoma, benign gastric ulcer, polyp

53
Q

What are the 2 histologic types of gastric cancer?

A
  1. Intestinal (glands)

2. Diffuse (no glands)

54
Q

What is the morphology of gastric cancer?

A

Ulcerative (75%)
Polypoid (10%)
Scirrhous (10%)
Superficial (5%)

55
Q

Are gastric cancers more common on the lesser or greater curvatures?

A

Lesser

56
Q

What is more common, proximal or distal gastric cancer?

A

Proximal

57
Q

Which morphologic type is named after a “leather bottle”?

A

Linitus plastica: the entire stomach is involved and looks thickened

58
Q

How do gastric adenocarcinomas metastasize?

A

Hematogenously and lymphatically

59
Q

Which patients with gastric cancer are non-operative?

A
  1. Distant metastasis (e.g. liver)

2. Peritoneal implants

60
Q

What is the role of laparoscopy in gastric cancer?

A

To rule out peritoneal implants and to evaluate for liver metastasis

61
Q

What is the genetic alteration seen in over 50% of patients with gastric cancer?

A

p53

62
Q

What is the treatment for gastric cancer?

A

Surgical resection with wide (> 5 cm checked by frozen section) margins and lymph node dissection

63
Q

What operation is performed for a gastric tumor in the antrum?

A

Distal subtotal gastrectomy

64
Q

What operation is performed for a gastric tumor in the mid body?

A

Total gastrectomy

65
Q

What operation is performed for a proximal gastric tumor?

A

Total gastrectomy

66
Q

What is a subtotal gastrectomy?

A

75% of stomach removed

67
Q

What is a total gastrectomy?

A

Stomach is removed and a Roux-en-Y limb is sewn to the esophagus

68
Q

What type of anastomosis is used in a gastrectomy?

A

Billroth II or Roux-en-Y (never Billroth I)

69
Q

When should a splenectomy be performed for gastric cancer?

A

When the tumor directly invaded the spleen or splenic hilum or with splenic hilar adenopathy

70
Q

In the treatment of gastric cancer, what is an extended lymph node dissection?

A

Usually D1 (perigastric nodes) and D2 (splenic artery, hepatic artery, anterior mesocolon, anterior pancreas, and crural nodes)

71
Q

What percentage of patients with gastric cancer are inoperable at presentation?

A

10-15%

72
Q

What is the adjuvant treatment for gastric cancer?

A

Stages II and III: post-op chemotherapy and radiation

73
Q

What is the 5-year survival rate for gastric cancer?

A

25%

74
Q

Why is it though that post-operative survival of gastric cancer is so much higher in Japan?

A

Aggressive screening and capturing early

75
Q

What is a GIST?

A

GastroIntestinal Stromal Tumor

76
Q

What was GIST originally known as?

A

Leiomyosarcoma

77
Q

What is the cell of origin in GIST?

A

Interstitial cells of Cajal

78
Q

Where are GISTs found?

A

GI tract, most commonly in stomach and small bowel

79
Q

What are the symptoms of GIST?

A

GI bleed, occult GI bleed, abdominal pain, abdominal mass, nausea, distention

80
Q

How is GIST diagnosed?

A

CT, EGD, colonoscopy

81
Q

How are distant metastases of GISTs diagnosed?

A

PET scan

82
Q

What is the tumor marker for GIST?

A

C-KIT (CD117 antigen)

83
Q

What is the treatment for GIST?

A

Resect with negative margins, +/- chemo

84
Q

Is there a need for lymph node dissection in GIST?

A

No

85
Q

What is the chemotherapy for metastatic or advanced GIST?

A

Imatinib (tyrosine kinase inhibitor)

86
Q

What is MALToma?

A

Mucosal-Associated Lymphoproliferative Tissue

87
Q

What is the most common site for MALToma?

A

Stomach (70%)

88
Q

What is the causative agent in MALToma?

A

H. pylori

89
Q

What is the medical treatment for MALToma?

A

Non-surgical: Treat for H. pylori; chemo/XRT in refractory cases

90
Q

What is gastric volvulus?

A

Twisting of the stomach

91
Q

What are the symptoms of gastric volvulus?

A

Borchardt’s triad:

  1. Distention of epigastrium
  2. Cannot pass an NGT
  3. Emesis followed by inability to vomit
92
Q

What is the treatment for gastric volvulus?

A

Exploratory laparotomy to untwist, and gastropexy

ENTREGA (40 decks)

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