Stomach

Question 1

what do the gastric parietal cells produce?

Answer 1

HCl

intrinsic factor

Question 2

what do the chief cells produce?

Answer 2

pepsinogen

Question 3

what do the mucous neck cells produce?

Answer 3

bicarbonate

mucus

Question 4

what do the G cells produce?

Answer 4

gastrin

Question 5

where are the G cells located?

Answer 5

antrum

Question 6

what is pepsin?

Answer 6

proteolytic enzyme that hydrolyzes peptide bonds

Question 7

what is intrinsic factor?

Answer 7

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

Question 8

what is GERD?

Answer 8

excessive reflux of gastric contents into the esophagus, ‘heartburn’

Question 9

what are the causes of GERD?

Answer 9

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

Question 10

what are the signs/symptoms of GERD?

Answer 10

heartburn, regurgitation, respiratory problems/pneumonia from aspiration of refluxed gastric contents, substernal pain

Question 11

what tests are included in the work up of GERD?

Answer 11

EGD
UGI contrast study with esophagogram
24hr acid analysis
manometry, EKG, CXR

Question 12

what is the medical treatment of GERD?

Answer 12

small meals
PPIs or H2 blockers
elevation of head at night and no meals prior to sleeping

Question 13

what is Barrett’s esophagus?

Answer 13

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

Question 14

what is the major concern with Barrett’s esophagus?

Answer 14

developing cancer

Question 15

what type of cancer develops in Barrett’s esophagus?

Answer 15

adenocarcinoma

Question 16

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

Answer 16

nonsurgical: endoscopic mucosal resection and photodynamic therapy; other options include radio frequency ablation, cryoablation

Question 17

define laparoscopic nissen fundoplication

Answer 17

360deg fundoplication - 2cm long

Question 18

define toupet

Answer 18

incomplete posterior wrap often used with severe decreased esophageal motility

Question 19

how does the Nissen wrap work?

Answer 19

thought to work by improving the LES:

• increasing LES tone
• elongating LES about 3cm
• returning LES into abdominal cavity

Question 20

what are the postoperative complications of Lap Nissen?

Answer 20

• gas bloat syndrome
• stricture
• dysphagia
• spleen injury requiring splenectomy
• esophageal perforation
• pneumothorax

Question 21

what is gas bloat syndrome?

Answer 21

inability to burp or vomit

Question 22

what are the associated risk factors for gastric cancer?

Answer 22

diet - smoked meats, high nitrates, low fruits and vegetables, alcohol, tobacco
environment - high risk area, poor socioeconomic status, atrophic gastritis, male gender, blood type A. previous partial gastrectomy, pernicious anemia, polyps, H. pylori

Question 23

which blood type is associated with gastric cancer?

Answer 23

blood type A

Question 24

what are the symptoms of gastric cancer?

Answer 24

WEAPON

• weight loss
• emesis
• anorexia
• pain/epigastric discomfort
• obstruction
• nausea

Question 25

what is Blumer's shelf?

Answer 25

solid peritoneal deposit anterior to the rectum, forming a 'shelf', palpated on rectal examination

Question 26

what is a Virchow's node?

Answer 26

metastatic gastric cancer to the nodes in the left supraclavicular fossa

Question 27

what is a surveillance laboratory finding?

Answer 27

CEA elevated in 30% of cases

Question 28

what is the initial work up of gastric cancer?

Answer 28

EGD with biopsy, endoscopic U/S to evaluate the level of invasion, CT scan of abdomen/pelvis for metastasis, cxr, labs

Question 29

what is the histology of gastric cancer?

Answer 29

adenocarcinoma

Question 30

what is the differential diagnosis for gastric tumors?

Answer 30

adenocarcinoma, leiomyoma, leiomyosarcoma, lymphoma, carcinoid, ectopic pancreatic tissue, gastrinoma, benign gastric ulcer, polyp

Question 31

which morphologic type is named after a 'leather bottle'?

Answer 31

linitis plastica | - the entire stomach is involved and looks thickened

Question 32

which patients with gastric cancer are nonoperative?

Answer 32

``` distant metastasis (liver) peritoneal implants ```

Question 33

what is the role of laparoscopy?

Answer 33

to rule out peritoneal implants and to evaluate for liver metastasis

Question 34

what is the genetic alteration seen in >50% of patients with gastric cancer?

Answer 34

P53

Question 35

what is the treatment for gastric cancer?

Answer 35

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

Question 36

what operation is performed for a gastric cancer tumor in the antrum?

Answer 36

distal subtotal gastrectomy

Question 37

what operation is performed for a gastric cancer tumor in the midbody?

Answer 37

total gastrectomy

Question 38

what operation is performed for a gastric cancer tumor in the proximal stomach?

Answer 38

total gastrectomy

Question 39

what is a subtotal gastrectomy

Answer 39

75% of the stomach removed

Question 40

what is a total gastrectomy

Answer 40

stomach is removed and a Roux-en-Y limo is sewn to the esophagus

Question 41

when should a splenectomy be performed?

Answer 41

when the tumor directly invades the spleen/splenic hilum or with splenic hilarious adenopathy

Question 42

what is the adjuvant treatment for gastric cancer?

Answer 42

stages II and III: postoperative chemotherapy and radiation

Question 43

what is GIST?

Answer 43

GastroIntestinal Stromal TUmor

Question 44

what was GIST previously known as?

Answer 44

leiomyosarcoma

Question 45

what is the cell of origin of GIST?

Answer 45

CAJAL, interstitial cells of cajal

Question 46

where is a GIST found?

Answer 46

GI tract - 'esophagus to rectum' | - most commonly found in the stomach, small bowel, duodenum, rectum, colon, esophagus

Question 47

what are the symptoms of GIST?

Answer 47

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

Question 48

how is GIST diagnosed?

Answer 48

CT scan, EGD, colonoscopy

Question 49

how are the distant metastases of GIST diagnosed?

Answer 49

PET scan

Question 50

what is the tumor marker for GIST?

Answer 50

C-KIT (CD117 antigen)

Question 51

what is the prognosis of GIST?

Answer 51

local spread, distant metastasis poor long-term prognosis: - size >5cm - mitotic rate >5 per 50hpf

Question 52

what is the treatment of GIST?

Answer 52

resect with negative margins, +/- chemotherapy

Question 53

is there a need for lymph node dissection?

Answer 53

no

Question 54

what is the chemotherapy for metastatic or advanced disease?

Answer 54

imatinib - tyrosine kinase inhibitor