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Oral Boards > Stomach > Flashcards

Stomach Flashcards

1
Q

Stigmata of high risk gastric ulcers prone to re-bleeding

A

Active bleeding vessel visible vessel Adherent clot

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2
Q

Reason for biopsies during endocscopy for bleeding uler

A

Cancer (4% of ulcers) H. Pylori

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3
Q

Modified Johnson classfication for gastric ulcers

A
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4
Q

Indication for (and type of gastric ulcers) vagotomy and antrectomy (or pyloroplasty)

A

Type II or III (acid hypersecretion) ulcers resistant to PPI or H.pylori eradication.

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5
Q

vessels needing divided in distal gastrectomy

A

Right gastroepiploic near GDA

Right gastric

Branches of left gastric

(divide duodenum, stomach 1/2 way between duo and GE junction)

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6
Q

Definition of failure of nonoperatie managmeent for bleeding gastroduodenal ulcers

A
  1. HD instability despite 6 units of blood
  2. Failure of endoscopic management x 2
  3. Failure or inability of IR to embolize
  4. slow ooze with > 3 units of blood per day despite endoscopy and IR
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7
Q

Three points of suture for bleeding posterior duodenal ulcer plus other surgical principles

A
  1. superior
  2. inferior
  3. medial

Taking care not to injure CBD (may need bile duct probe through cystic duct). Generous Kocher maneuver. Longitudinal pyloroduodenotomy. Biopsies of ulcer bed if possible. Approximation of defect. Close transversely (Heineke).

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8
Q

Jaboulay pyloroplasty

A

does NOT cross the pylorus

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9
Q

Finney pyloroplasty

A

Crosses the pylorus

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10
Q

Vagotomy location to ensure Criminal nerve of Grassi is included

A

4-6 cm proximal from GE junction.

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11
Q

Work up for gastric cancer (essentially same as esophageal cancer)

A
  1. EGD w biopsy
  2. CT C/A/P
  3. PET
  4. EUS
  5. CBC, bmp, Her testing
  6. Siewart classification
  7. Possible diagnostic laparoscopy (really for all getting pre operative therapy)
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12
Q

Surveillance for gastric cancer

A

same as colon cancer except CT C/A/P annually up to 5 years

PET as indicted

watch for B12 and iron deficiency

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13
Q

Unresectable (aside from metastatic disease) for gastric cancer

A

Invasion of root of mesentery or positive para-aortic LN

Invasion of arterial structures (excpet for splenic artery)

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14
Q

D1 reseaction

A

Perigastric LN with greater and lesser omentum

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15
Q

D2 resection

A

D1 + LN dissection along celiac axis (commong hepatic, splenic, left gastric, and celiac) Do not do splenectomy.

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16
Q

Genetic syndromes pre-disposed to gastric cancer

A
  1. Hereditary diffuse gastric cancer - CDH1 - AD
  2. Lynch syndrome - AD
  3. Juvenile polyposis syndrome - AD
  4. Peutz Jeghers - AD
  5. FAP and attenuated FAP - AD
  6. Bloom syndrome
  7. Hereditary breast cancer syndrome
  8. Ataxia telangiectasia
  9. Li fruemeni
  10. Xeroderma pigmentosum
  11. Cowden syndrome
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17
Q

Hereditary diffuse gastric cancer prophylacitc surgery

A

CDH1

prophylactic gastrectomy (without D2 LN dissection) between 18-40 with frozen sections of esophageal and duodenal margin to ensure gastric tissue removed.

18
Q

Screening needed for gastric cancer

A
  1. Juvenile polyposis - age 15 - annual if polyps otherwise 2-3 years
  2. peutz jeghers - late teens - every 2-3 years
  3. FAP - no need for stomach, but need duodenum starting 25-30 yo
19
Q

STage II gastric cancer

A
  1. T1, T2 any N
  2. T3, T4 (N0)
20
Q

Perioperative therapy for gastric cancer (T2 or above)

A

OS in FLOT vs ECF was 50 vs 35 months

Perioperative FLOT (5FU, Leucovorin, Oxaliplatin, Docetaxol) if good performance status

Perioperative FOLFOX of moderate performance status

Post operative chemoradiation if recieve less than D2 LN dissection.

21
Q

Stomach NETs (3 types and treatment)

A
  1. Associated with atrophic gastritis - indolent course - Endoscopic resection or antrectomy for growing lesions
  2. Associated with separate gastrinoma - need to resect gastrinoma, endoscopic resection of gastric NET, antrectomy for growing lesions
  3. Non gastrin-associated, aggressive, need radical resection with LAD
22
Q

BMI with higher Nissen failure rates (should consider R n Y)

A

BMI > 35

23
Q

Nerve of Laterjet

A

Anterior division of anterior vagus (innervates the anterior stomach)

24
Q

Bismuth quadruple therapy (10-14 day treatment)

A

Bismuth, flagyl, tetracycline, PPI

25
Q

Triple therapy (treatment for 10-14 days)

A

Amoxicillin/flagyl, clarithromycin, PPI (reduced clearance rates compared to quadruple therapy)

26
Q

Forrest IA and chance of rebleeding

A

Arterial or spurting hemorrhage; 90%

27
Q

Forrest IIA and chance of rebleeding

A

visible vessel; 50%

28
Q

Forrest IIB and chance of rebleeding

A

Adherent clot; 30%

29
Q

Forrest III and chance of rebleeding

A

clean ulcer base; 5%

30
Q

Indications for adjuvant therapy with Gleevac for GIST

A

> 3cm and > 5 mitoses per HPF

31
Q

Minimal size for “giant” ulcer/perforation

A

> 2 cm (not appropriate for Graham patch)

32
Q

Stitch pattern for bleeding duodenal ulcer

A
33
Q

Treatment for gastric carcinoid (polyps) and hypergastrinemia

A

antrectomy

34
Q

Percent of duodneal ulcers, gastric ulcers with H. pylori. Percent of H.pyorli infection causing ulcer

A

100%, 70%, 20%

35
Q

Time course for early dumping syndrome (hyperosmolar load)

A

30 min

36
Q

Time course for late dumping syndrome (high insuling)

A

2-3 hours

37
Q

Agent for dissolution of phytobezoar

A

cola

38
Q

3 types of Gastric carcinoid; associations; aggressivness

A

Type I: atrophic gastritis, small polyps; not aggressive - antrectomy

Type II: ZE; MEN1; slow growing, but can metastasize

Type III: not associated with gastrin; large; aggressive and metastasize

39
Q

most common extranodal site of non-hogkins lymphoma. What are the two most common types

A

Stomach: large B cell followe by MALT oma

40
Q

3 factors predicting risk of tumor recurrence after GIST resection

A

size (> 5 cm)

mitotic rate (> 5/50 HPF)

location (stomach, small bowel, colon)

Oral Boards (23 decks)

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