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Absite Review > Stomach and Bowel > Flashcards

Stomach and Bowel Flashcards

1
Q

management of large mesenteric cysts?

A

excision and resection of associated bowel , high risk of recurrence if marsupialize

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2
Q

management of gastric cardia adenocarcinoma?

A

total gastrectomy

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3
Q

margins for gastric adenocarcinoma?

A

resection with at least 5cm margins (subtotal gastrectomy can be done win distal tumors but proximal tumors usually require total)

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4
Q

when do you give neoadjuvant chemotherapy in gastric adenocarcinoma?

A

lesions >T2 or any N

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5
Q

what are the recommendations for lymph node dissections for gastric adenocarcinoma?

A

D1 or D2 resection of at least 15 lymph nodes

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6
Q

what’s the difference between D1 and D2 dissection in lymph node dissection w gastric adenocarcinoma?

A 
D1 = gastrectomy + the greater and lesser omental lymph nodes
D2 = all that plus the omental bursa, leaf of the transverse mesocolon, and corresponding arteries
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7
Q

when is a splenectomy performed during resection of gastric adenocarcinoma?

A

for a D2 dissection for proximal gastric tumors

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8
Q

what is the cell of origin of a GIST?

A

interstitial cells of cajal: aka the pacemaker cells

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9
Q

what is the cell of origin of a carcinoid tumor?

A

enterochromaffin cells aka Kulchitsky cells

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10
Q

what is the cell origin of pheochromocytomas?

A

neuroectodermal cells of the adrenal medulla

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11
Q

what are th 3 different pattens of inflammation associated with H. Pylori infection?

A
  1. diffuse* MC, not assoc w PUD
  2. antral
  3. stomach-body related
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12
Q

how does gastrin stimulate acid secretion? (2 ways)

A
  1. stimulation of the synthesis and release of histamine from enterocrhomaffin-like cells which bind to H2 receptors on parietal cells
  2. from parietal cells via cholecystokinin B receptor
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13
Q

side effect of metoclopramide?

A

tardive dyskinesia

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14
Q

two different types of dumping syndrome and causes

A
  1. Early dumping: 30 min after eating and due to hyperosmotic load causing large fluid shift
  2. Late dumping: 2-3 hours after eating and due to large insulin release from large fluid bolus hitting the duo
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15
Q

what is the best test to determine a) diagnosis and b) eradication of h pylori?

A

a) serology: IgG

b) urea breath test

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16
Q

treatment of low versus high grade MALToma?

A 
low = abx alone
high = CHOP
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17
Q

what is triple therapy for H pylori?

A

PPI, clarithromycin, flagyl (metronidazole)

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18
Q

where is protein mostly absorbed?

A

mostly jejunum

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19
Q

what does the terminal ileum absorb?

A

bile salts, vitamin B12, fat soluble vitamins (ADEK)

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20
Q

where are the majority of small bowel adenocarcinomas found?

A

duodenum

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21
Q

what is the most common neoplasm of small bowel?

A

metastasis: MC melanoma, lung, breast, cervix, sarcoma, colon

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22
Q

most common PRIMARY small bowel neoplasm?

A

NET

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23
Q

UC or Crohns: Granulomas

A

Crohns

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24
Q

UC or Crohns: Rectal Involvement

A

UC

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25
Q

UC or Crohns: Cobblestone appearance

A

Crohns

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26
Q

UC or Crohns: Transmural involvement

A

Crohns

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27
Q

UC or Crohns: Patchy areas of bowel

A

Crohns

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28
Q

whats a finney stricturoplasty and when do you use it?

A

indicated for strictures 7-15cm, fold the diseased bowel on itself and create a large opening between the two loops

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29
Q

what is a Heineke-Mikulicz stricturoplasty and when is it used?

A

strictures <7cm, MC, make a longitudinal incision on the antimesenteric side of the bowel and close transversely

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30
Q

what are the different types of enterocutaneous fistulas?

A

Low output: <200mL/day
Moderate: 200-500mL/day
High output: >500mL/day

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31
Q

what are the sympathetic fibers for gastroduodenal pain?

A

afferent sympathetic fibers T5-10

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32
Q

cell type of mucosal lining of stomach?

A

simple columnar epithelium

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33
Q

where is the pacemaker (SA) node of the stomach?

A

Cardia

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34
Q

chief cells release what?

A

pepsinogen

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35
Q

Parietal cells release what?

A

H+ and intrinsic factor

36
Q

what are 3 factors that stimulate H+ release from parietal cells of stomach?

A
  1. Acetylcholine (vagus nerve)
  2. Gastrin (from G cells in antrum)
  3. Histamine (from mast cells)
37
Q

mechanism of how acetylcholine and gastrin increase H+

A

activate phospholipase which increases Ca (PIP -> DAG + IP3 to increase Ca), Ca-Calmodulin activates phosphorylase kinase -> increases H+

38
Q

mechanism of how histamine increases H+

A

histamine activates adenylate cyclase -> cAMP -> activates protein kinase A -> increase H+ release

39
Q

MOA omeprazole

A

blocks the H/K ATPase in parietal cell membrane (final pathway of H+ release)

40
Q

what are 4 major inhibitors of parietal cells?

A

Somatostatin, prostaglandins (PGE1), secretin, CCK

41
Q

intrinsic factor: released from? function? reabsorbed?

A

Released from parietal cells in gastric antrum
binds vitamin B12
reabsorbed in terminal ileum

42
Q

what are brunner’s glands?

A

located in duodenum, secrete alkaline mucus

43
Q

what is menetrier’s disease?

A

mucous cell hyperplasia, increase in rugal folds

44
Q

tx of gastric volvulus?

A

reduction and Nissen fundoplication

45
Q

where is the tear usually in Mallory-weiss?

A

lesser curvature of stomach near GE junction

46
Q

truncal vagotomy versus proximal vagotomy?

A

truncal: divides vagus at level of esophagus, increases emptying of solids
proximal: highly selective, divides individual fibers, normal emptying of solids

47
Q

most common problem following vagotomy, tx

A

diarrhea: caused by sustained MMCs (migrating motor complex) forcing bile into the colon and leading to osmotic diarrhea
tx: cholestyramine and loperamide

48
Q

how do you diagnose gastroparesis?

A

gastric emptying study- normal should have <10% in stomach at 4 hours, if more then + gastroparesis

49
Q

what are the biggest risk factors for rebleeding at time of EGD? like what do you see and assoc risk of rebleeding

A
  1. Spurting blood vessel (60% chance)
  2. Identifiable blood vessel (40% chance)
  3. Diffuse oozing (30% chance)
50
Q

what is triple therapy for H. pylori?

A

bismuth salts, amoxicillin, metronidazole/tetracycline

BAM or BAT

51
Q

what is ZES?

A

gastric acid hypersecretion, peptic ulcers, gastrinoma

52
Q

what are 3 surgical options for acid-reducing surgery? assoc recurrence rate of ulcers?

A
  1. proximal vagotomy: 10-15% recurrence, 0.1% mortality
  2. Truncal vagotomy w pyloroplasty: 5-10% recurrence, 1% mortality
  3. truncal vagotomy w antrectomy: 1-2% recurrence, 2% mortality, reconstruct w RNYGB* v B1 v B2
53
Q

how do you perform GDA ligation for bleeding duodenal artery?

A

3 suture ligation: proximal GDA, distal GDA and U stitch to transfix the pancreatic branch

54
Q

best test for H pylori?

A

histiologic examination of biopsies from antrum

55
Q

best test for h pylori eradication?

A

urea breath test

56
Q

what are the 5 types of gastric ulcers?

A

type 1: lesser curvature, near antrum, nml acid
type 2: both gastric and duodenal, high acid
type 3: prepyloric, high acid
type 4: near GEjxn, nml acid
type 5: assoc w NSAIDs

57
Q

cushing ulcer vs curling ulcer

A

cushing ulcer: head trauma and gastric ulcer

curling ulcer: burn patient and duodenal ulcer

58
Q

where does a stress gastric ulcer appear first?

A

fundus

59
Q

two types of chronic gastritis

A

type A: fundus, assoc w pernicious anemia and autoimmune disease
type B: antral, assoc w h pylori

60
Q

40% of gastric cancers are located where?

A

antrum

61
Q

what blood type increases risk of gastric cancer?

A

type A

62
Q

risk of cancer in gastric adenoamtous polyp?

A

15%, tx: endoscopic resection

63
Q

two types of gastric cancer?

A

intestinal type: japan, rare in US, histology shows glands, need 10cm margins, attempt subtotal gastrectomy
Diffuse gastric type: linitis plastica, MC in US, no glands on histology, tx total gastrectomy

64
Q

MC benign gastric neoplasm

A

GIST (but can also be malignant)

65
Q

what does biopsy of GIST show?

A

C-kit positive staining

66
Q

when do you consider a GIST malignant?

A

> 5cm or >5 mitoses/50 HPF

67
Q

tx of GIST

A

resection w 1 cm margin, no nodal dissection

tx: imatinib if malignant

68
Q

MOA imatinib

A

gleevac: tyrosine kinase inhibitor

69
Q

tx if MALT lymphoma doesnt regress w h pylori tx?

A

XRT

70
Q

MC location for extra-nodal lymphoma?

A

stomach!

71
Q

stomach lymphoma is usually what type?

A

non-hodgkins lymphoma, B cell

72
Q

tx for gastric lymphoma?

A

chemotherapy and XRT

73
Q

what comorbidity does NOT get better after bariatric surgery?

A

PAD

74
Q

where is Fe absorbed?

A

duodenum

75
Q

vitamin deficiencies after RNYGB?

A

B12 (intrinsic factor) and Fe (bypass duo)

76
Q

MC cause of leak in RNYGB?

A

ischemia

77
Q

why does dumping syndrome occur?

A

rapid entering of carbohydrates into the small bowel

78
Q

what are 2 phases of dumping syndrome?

A

hyperosmotic load causes fluid shift into bowel (hypotension, diarrhea, dizziness), then (rare phase) hypoglycemia from reactive increase in insulin and decrease in glucose

79
Q

what is blind loop syndrome? dx and tx?

A
  • seen with B2 of RNYGB, caused by poor motility and bacterial overgrowth (GNR, Ecoli) from stasis in afferent limb
    dx: EGD of afferent limb
    tx: tetracycline or flagyl, reglan to improve motility, or can shorten afferent limb to 40cm
80
Q

what is afferent loop obtsruction?

A

w B2 or RNYGB, mechanical obstruction of afferent limb

tx: dilation or reanastomosis w shorter afferent limb

81
Q

what is efferent limb obstruction?

A

obstruction of efferent loop, can balloon dilate or reoperate

82
Q

what is MOA of infliximab and one particular use?

A

TNF alpha inhibitor, shown to help close fistulas in Crohn’s disease

83
Q

what’s triple therapy for H pylori?

A

PPI and 2abx: choose from amoxicillin, metronidazole, tetracycline, clarithromycin

84
Q

which organ has the highest secretion of K?

A

colon

85
Q

MC location of small bowel carcinoid?

A

ileum

86
Q

where in the bowel are lymphoid follicles most prominent?

A

ileum (thats why small bowel lymphoma is most frequently there)

87
Q

what is the Forest classification?

A

classification of risk for bleeding based on endoscopic findings in bleeding ulcers
High risk = active bleeding and visible vessel
medium risk = adherent clot
low risk = black spot or clean base

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