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SURGERY > STOMACH > Flashcards

STOMACH Flashcards

1
Q

Layers of the Stomach

A

MUCOSA - first and innermost layer

SUBMUCOSA - 2nd layer

  • rich in branching blood vessels, lymphatics, collagen, various inflammatory cells, and nerve fibers
  • Meissner’s autonomic submucosal plexus
  • gives strength to GI anastomoses

MUSCULARIS EXTERNA (muscularis propria) - 3rd layer
-consists of an incomplete inner oblique layer
-a complete middle circular layer (continuous with the esophageal circular muscle and the circular muscle of the pylorus)
-a complete outer longitudinal layer (continuous with the longitudinal layer of the esophagus and
duodenum)
-Auerbach’s myenteric plexus
-interstitial cells of Cajal (ICC)
-specialized pacemaker cells

SEROSA (visceral peritoneum)

  • last and outermost layer
  • provides significant tensile strength to gastric anastomoses
  • when tumors originating in the mucosa penetrate and breach the serosa, microscopic or gross peritoneal metastases are common, presumably from shedding of tumor cells that would not have occurred if the serosa had not been penetrated
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2
Q

Innervation of the Stomach

A

Parasympathetic: vagus nerve (CN X)
Sympathetic: celiac plexus (T5-T12)

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3
Q

Opening into the lesser sac

A

Foramen of Winslow

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4
Q

Parietal cells

A

HCl

IF

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5
Q

Chief cells

A

pepsinogen

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6
Q

Mucous neck cells

A

bicarbonate

mucus

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7
Q

G cells

A

gastrin

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8
Q

Location of G cells

A

antrum

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9
Q

Pepsin

A

Proteolytic enzyme that hydrolyzes peptide bonds

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10
Q

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

A

Intrinsic Factor (IF)

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11
Q

GERD

A

Excessive reflux of gastric contents into the esophagus, “heartburn or pyrosis”

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12
Q

Branch that the POSTERIOR VAGUS sends to the posterior FUNDUS

A

Criminal nerve of Grassi

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13
Q

Heartburn

A

substernal burning type discomfort

beginning in the epigastrium and radiating upward

often aggravated by meals, spicy or fatty foods, chocolate, alcohol, and coffee

can be worse in the supine position

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14
Q

Effortless return of acid or bitter gastric contents into the chest, pharynx, or mouth

A

Regurgitation

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15
Q

GERD management

A

Small meals

PPIs (proton-pump inhibitors) or H2 blockers

Elevation of head at night and no meals prior to sleeping

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16
Q

GERD indications for surgery

A

Intractability (failure of medical treatment)

Respiratory problems as a result of reflux and aspiration of gastric contents (e.g., pneumonia)

Severe esophageal injury (e.g., ulcers, hemorrhage, stricture, w/w/o Barrett’s
esophagus)

17
Q

COLUMNAR METAPLASIA from the normal squamous epithelium as a result of chronic irritation from reflux

A

Barrett’s esophagus

18
Q

Cancer develops in Barrett’s esophagus

A

Adenocarcinoma

19
Q

360 fundoplication—2 cm long (laparoscopically)

A

Lap Nissen

20
Q

240 to 270 fundoplication performed through a thoracic approach

A

Belsey Mark IV

21
Q

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

A

Hill

22
Q

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

A

Toupet

23
Q

Nissen wrap

A 
Work by improving the lower
esophageal sphincter:
1. Increasing LES tone
2. Elongating LES ~3 cm
3. Returning LES into abdominal cavity
24
Q

Nissen wrap

A 
Work by improving the lower
esophageal sphincter:
1. Increasing LES tone
2. Elongating LES ~3 cm
3. Returning LES into abdominal cavity
25
Q

Postoperative complications of Lap Nissen

A
  1. Gas-bloat syndrome
  2. Stricture
  3. Dysphagia
  4. Spleen injury requiring splenectomy
  5. Esophageal perforation
  6. Pneumothorax
26
Q

Gas-bloat syndrome

A

Inability to burp or vomit

27
Q

Gastric Cancer associated risk factors

A

Diet—smoked meats, high nitrates, low fruits and vegetables, alcohol, tobacco

Environment—raised in high-risk area, poor socioeconomic status, atrophic gastritis, MALE gender, blood type A,
previous partial gastrectomy, pernicious anemia, polyps, Helicobacter pylori

28
Q

Gastric cancer symptoms

A 
Weight loss
Emesis
Anorexia
Pain/epigastric discomfort
Obstruction
Nausea
29
Q

Most common early symptoms of gastric cancer

A

Mild epigastric discomfort and indigestion

30
Q

Symptom of PROXIMAL gastric cancer

A

Dysphagia (gastroesophageal

junction/cardia)

31
Q

Blumer’s shelf

A

Solid peritoneal deposit anterior to the rectum, forming a “shelf,” palpated on RECTAL examination

32
Q

Virchow’s nodes

A

Metastatic gastric cancer to the nodes in the LEFT SUPRACLAVICULAR FOSSA

33
Q

Sister Mary Joseph’s

sign

A

PERIUMBILICAL lymph node gastric cancer metastases

presents as periumbilical mass

34
Q

Krukenberg’s tumor

A

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

35
Q

Irish node

A

LEFT AXILLARY adenopathy from gastric cancer

metastasis

36
Q

Differential Diagnosis for gastric tumors

A 
Adenocarcinoma
leiomyoma
leiomyosarcoma
lymphoma
carcinoid
ectopic pancreatic tissue
gastrinoma
benign gastric ulcer
polyp

SURGERY (27 decks)

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