Stomach Flashcards
history of partial gastrectomy with persistent GERD despite therapy + type 1 hiatal hernia. Best Surgical option?
Hill esophagogastropexy
What is a Dor fundoplication?
An ANTERIOR 180 to 200 degree fundoplication with division of the short gastric vessels via abdominal approach
What is a Hill esophagogastropexy?
Plication of the lesser gastric curvature around the right side of the esophagus with an esophagogastropexy to the median arcuate ligament.
Intraoperative manometry is required for success.
What procedure is commonly associated with a laparoscopic Heller esophagomyotomy for achalasia?
Dor fundoplication (anterior 180 to 200 degree ANTERIOR fundoplication with division of short gastric vessels
What is the key difference between a modified Nissen fundoplication and a traditional Nissen?
Division of the short gastric vessels (Not originally described)
+
circumferential 360-degree wrap of the fundus around the lower portion of the sophagus to recreate the Angle of His (original)
What is a Toupet fundoplication?
a POSTERIOR 270 degree fundoplication with division of the short gastric vessels
What is a Belsey Mark IV fundoplication?
Name one key distinction comparing it to other approaches.
an ANTERIOR 240 degree fundoplication buttressed by the diaphragmatic crura via TRANSTHORACIC APPROACH (Left posterolateral thoracotomy)
One key distinction = partial anter fundoplication is over 4cm no traditional 2cm length)
In GERD, what 4 risk factors are concerning for poor reponse to medical therapy?
1) Nocturnal reflux on 24-hour esophageal pH study
2) structurally deficient LES
3) mixed reflux of gastric and duodenal juice
4) mucosal injury at presentation
Parietal Cell
Which part of stomach?
Secretes?
Fundus and Body of stomach
Produces H+/Intrinsic Factor
G Cell
Which part of stomach?
Secretes?
Antrum
Secretes Gastrin
What is included in the criteria for Metabolic Syndrome?
waist circumference > 40 inches (men) or > 35 inches (women) PLUS at least 2 of the following:
- SBP > 130mmHg or DBP > 85 mmHg
- Triglyceride > 150 mg/dL
- Decreased HDL cholesterol < 40 (men) and < 50 (women)
- Fasting glucose > 100 mg/dL or diagnosed type 2 DM
What is the treatment for H. pylori?
PPI + clarithromycin + flagyl
Typically want PPI + 2 antibiotics (amoxicillin, clarithromycin, metranidazole, tetracycline)
Pneumomediastinum … what is the recommend study of choice? any particular contrast?
Swallow esophogram - First with gastrograffin. If no leak seen then use dilute barium.
Early dumping syndrome.
Symptoms?
Mechanism?
Symptoms: 30 minutes after eating = diaphoresis, weakness, light-headedness, tachycardia
Mechanism: hyperosmotic load being delivered ot the duodenum due to absence of a pylorus == large fluid shift
Late dumping syndrome.
Symptoms?
Mechanism?
Symptoms: 2 to 3 hours after eating w/ diaphoresis, weakness, light-headednes, tachycardia [hypoglycemic episode]
Mechanism: large insulin release due to large bolus of food hitting duodenum
