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Yr3 - General Surgery > Stomach > Flashcards

Stomach Flashcards

1
Q

Define hiatus hernia

A

Protrusion of a whole or part of an organ from the abdominal cavity into the thorax through the oesophageal hiatus

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2
Q

Describe the two classifications of hiatus hernia

A

Sliding - 80%
- the GOJ and cardia of stomach slide up through the diaphragmatic hiatus
Rolling
- upward movement of gastric fundus to lie alongside normally positioned GOJ

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3
Q

Risk factors for hiatus hernia

A

Age, pregnancy, obesity and aceites lead to

  • loss of diaphragmatic tone
  • increasing intrabdominal pressure
  • increased size of diaphragmatic hiatus
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4
Q

Clinical features of hiatus hernia

A 
Asymptomatic
GORD symptoms
Vomiting
Weight loss
Bleeding
Dysphagia
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5
Q

Investigations for hiatus hernia

A

OGD

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6
Q

Conservative management of hiatus hernia

A 
PPIs
Lifestyle modification
- weight loss
- alteration of diet
Smoking cessation
Reduce alcochol intake
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7
Q

Surgical management of hiatus hernia

A

Cruroplasty

Fundoplication

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8
Q

Indications for surgical management of hiatus hernia

A

Remaining symptomatic
Increased risk of strangulation/volvulus
Nutritional failure

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9
Q

Complications of hiatus hernia

A 
Incarceration
Strangulation
Gastric volvulus -> Borchardt's triad
- severe gastric pain
- retching without vomiting
- inability to pass an NG tube
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10
Q

Define a peptic ulcer

A

Break in the lining of the gastrointestinal tract

- extends through to the muscular layer

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11
Q

Where are peptic ulcers commonly found?

A

Lesser curvature of the proximal stomach

First part of duodenum

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12
Q

How to peptic ulcers occur?

A

Imbalance between damaging and protective factors
Commonly
- Helicobacter pylori
- NSAID use

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13
Q

How do NSAIDs cause peptic ulcers?

A

Inhibit prostaglandin synthesis

Reduced secretion of glycoprotein, mucous and phospholipids by gastric epithelial cells

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14
Q

How does H.Pylori cause peptic ulcers?

A

Invoking cytokine and interleukin-driven inflammatory response
Increasing gastric acid secretion in both the acute and chronic phases of infection by inducing the release of histamine which acts on parietal cells
Damaging host mucous secretion by degrading surface glycoproteins and down-regulating bicarbonate production

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15
Q

Risk factors for peptic ulcers

A 
H.pylori infection
Prolonged NSAID use
Corticosteroid use
Previous gastric bypass surgery
Physiological stress
Zollinger-Ellison syndrome
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16
Q

Clinical features of peptic ulcers

A 
Asymptomatic
Epigastric or retrosternal pain
Nausea
Bloating
Post-prandial discomfort
Early satiety
17
Q

Investigations for peptic ulcer disease

A 
Non-invasive H. Pylori testing
- carbon-13 urea breath test
- serum antibodies
- stool antigen test
OGD
- biopsy
- rapid urease test (CLO)
18
Q

Conservative management of peptic ulcer disease

A

Lifestyle advice

  • smoking cessation
  • weight loss
  • reduce alcohol consumption
  • avoid/reduce NSAID use
19
Q

Medical management of peptic ulcer disease

A 
PPI for 4-8 weeks
- reduce acid production
Triple eradication therapy for those H.pylori positive - 7 days
- PPI
- amoxicillin
- clarithromycin
20
Q

Surgical management of peptic ulcer disease

A

Rare - emergencies or severe/relapsing disease

  • partial gastrectomy
  • selective vagotomy
21
Q

Complications of peptic ulcer disease

A

Perforation
Haemorrhage
Pyloric stenosis

22
Q

What is the most common type of gastric cancer?

A

Adenocarcinoma

23
Q

Risk factors for gastric cancer

A 
Male gender
H.pylori infection
Increasing age
Smoking
Alcohol consumption
Salt in diet
Family history
Pernicious anaemia
24
Q

What classification is H.pylori?

A

Gram negative helical bacterium

25
Q

What enzyme does H.pylori produce?

A

Urease enzyme

- breaks down urea into CO2 and ammonia

26
Q

Clinical features of gastric cancer

A

Vague and non-specific - often presents at an advance stage

  • dyspepsia
  • dysphagia
  • early satiety
  • vomiting
  • malena
27
Q

Investigations for gastric cancer

A

Routine bloods - FBC, LFTs
Urgent upper GI endoscopy + biospy
- histology
- CLO test
- HER2/neu protein expression - targeted monoclonal therapies
CT Chest-Abdo-Pelvis and staging laparoscopy

28
Q

Curative treatment for gastric cancer

A

Peri-operative chemotherapy
Total gastrectomy - proximal gastric cancers
Subtotal gastrectomy - distal gastric cancers

29
Q

Palliative management for gastric cancer

A

Chemotherapy
Best supportive care
Stenting
Palliative surgery - distal gastrectomy or bypass surgery

30
Q

Complications of gastric cancer

A

Gastric outlet obstruction
Iron-deficiency anaemia
Perforation
Malnutrition

Yr3 - General Surgery (17 decks)

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