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*OldSurgery > Stomach and Duodenum > Flashcards

Stomach and Duodenum Flashcards

1
Q

do all people with hiatal hernia have reflex

A

no, but there is a high association

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2
Q

innervation of stomach

A

parasympathic- vagus

sympathetic- spinal segments T5-T10

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3
Q

where are the oxynitic glands

A

fundus and body

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4
Q

where are the antral glands

A

mucosa of distal stomach and pyloric channel

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5
Q

what tell your parietal cells to produce acid?

A

gastrin
histamine
Ach

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6
Q

what do antral glands contain

A

produce gastrin

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7
Q

what does gastrin do?

A

Stimulates acid secretion from gastric parietal cells of the oxyntic glands
Controls GI mucosal growth

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8
Q

what is the most important stimulant of gastrin

A

a meal- protein

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9
Q

is regulation of acid and gastrin release – inhibitory

A

stomatostatin

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10
Q

2 big causes of gastric ulcers

A

H. Pylori

NSAIDs

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11
Q

gastric ulcers can harbor what

A

underlying malignancy

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12
Q

what type gastric ulcer is a hypersecreter of accid in teh gastric body and duondeal.

A

type II

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13
Q

what type of gastric ulcer is in the body and has normal or low acid secretion

A

type I

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14
Q

what type gastric ulcer is a hypersecreter of acid, prepyloric, perforation/hemorrhage frequent

A

type III

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15
Q

type of gastric ulcer that is high on lesser curvater, low acid serction

A

type IV

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16
Q

what type gastric ulcer is NSAID-induced

A

type V

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17
Q

most common symptom of gastric ulcers

A

epigastric pain
gnawing or burning sensation, occurs after meals
may radiate to the back

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18
Q

associated symptoms w/ gastric ulcers

A

anorexia, weight loss, N/V, melena, hematochezia, hematemesis

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19
Q

what may a PE look like with uncomplicated PUD

A

Epigastric tenderness
Guaiac-positive stools
Anemia

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20
Q

diagnostics for gastric ulcers

A

CBC < LFTs, amylase, lipas, US

upper endoscopy- BIOPSY (can be malignant)

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21
Q

tx for gastric ulcer

A

avoid NSAIDs, ASA, tobacco, steroids, EtOH

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22
Q

ways to eradicate H. Pylori

A

PPI + abxs for 10-14 days then acid suppression for 6-8 weeks long

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23
Q

when do you treat sx for PUD

A

only for complications

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24
Q

symptoms w/ duodenal ulcers

A

2 – 3 hours after meals
Worsened by fasting – food can relieve – weight gain
Wakens from sleep
Relief with anti-acids

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25
Q

complications of PUD

A

hemorrhage
perforation
obstruction
intractability

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26
Q

do you have to biopsy duodenal ulcers?

A

no (don’t harbor malignancy)

27
Q

leading cause of death associated w/ PUD

A

hemorrhage

28
Q

first tx for vomiting blody

A

endoscopy

29
Q

surgery for duodenal hemorrhage

A

Duodenotomy with direct ligation of the bleeding vessel within the base of the ulcer (gastroduodenal artery)
+/- procedure for acid production

30
Q

surgery fo gastric ulcer

A

Excision or oversewing of bleeding ulcer
+/- procedure for acid production
Biopsy Biopsy Biopsy

31
Q

tx for perf of duodenal ucler

A

omental patch- Graham patch

+/- procedure for acid

32
Q

tx for gastric ulcer perf

A

Ulcer excision with omentoplasty
+/- procedure for acid production
Always Always Always biopsy GUs

33
Q

if you see free air on an x-ray what do you do

A

go to the OR immediately

34
Q

what can occur acutely or chronically in patients w/ DU dz caused by inflammation and edma

A

gastric outlet obstruction (GOO)

35
Q

tx fo acute GOO

A

Treated with NPO, NGT, rehydration and IV antisecretoty drugs

36
Q

what causes chronic gastric outlet obstruction

A

repeated episodes of ulceration and healing which can lead to pyloric scarring

37
Q

tx for chronic GOO

A

upper endo to exclude cancer and balloon dilation

sx to tx underlying dz

38
Q

mucosal healing refractory to medical treatment
Initial healing is delayed, so that ulceration persists at 3 months despite active drug therapy
ulcers recur w/i 1 year of therapy
cycles of prolonged activity w/ remission

A

intractability

39
Q

operative procedure for PUD (decrease gastric acid)

A

Truncal vagotomy and drainage (pyloroplasty) (tx acid by stopping Ach)
Truncal vagotomy and antrectomy (take out gastric cells)
Proximal vagotomy

40
Q

what is postgastrectomy syndromes

A

dumping, early filling, cramping

improves w/ dietary changes

41
Q

after truncal vagotomy and pyloroplasty or antrectomy
Clinical triad of postprandial epigastric pain often associated with nausea and vomiting, evidence of reflux into the stomach and histologic evidence of gastritis

A

alkaline reflux gastritis

42
Q

tx for alkaline reflux gastritis

A

is conversion to Roux-en-Y gastrojejunostomy with an intestinal limb of 50 – 60 cm

43
Q

will have abdominal pain, diarreah with PUD or diarrhea alone. Can have esophageal symptoms.

A

Zollinger-Ellison Syndrome

44
Q

what is MEN1 (Werner’s)

A

Parathyroid tumor
Pancreatic islet call tumors
Pituitary tumors

45
Q

What is MEN2a (sipple)

A

Medullary thyroid cancer
Pheochromocytoma
Parathyroid hyperplasia

46
Q

What is MEN2b?

A

Medullary thyroid cancer
Pheochromocytoma
Mucosal neuromas

47
Q

diagnosis of Zollinger-Ellison syndrome?

A

gastrin levels >200 if >1000 virtually diagnostic

check w/o antisecretory meds

48
Q

tx of zollinger-ellison

A

long term acid suppression w/ high dose PPI
resection (first line- take out gastrinoma)
chemo/ octreotide

49
Q

where is bleed with hematemesis usually?

A

Proximal to the LOT (usually the stomach or esophagus)

Denotes a more rapidly bleeding lesion

50
Q

Blood has been in stomach long enough for gastric acid to convert hgb to methemoglobin
Non-active bleeding

A

Coffee-ground emesis

51
Q

bleeding Usually UGI source but can be LGI

black or tarry stools

A

melena

52
Q

Bright-red blood per rectum
Usually LGI source
Can be UGI source if brisk bleed

A

hematochezia

53
Q

risk factors for carcinoma of the stomach

A 
high salt, cured and smoked foods
Smoking
Infection with H. Pylori
Previous gastric surgery
Gastric ulcers
Family history
Pernicious anemia, atrophic gastritis, gastric polyps
Radiation exposure
Obesity
54
Q

protective for carcinoma of the stomach

A

diet that includes fruits and vegetables rich in vitamin C may have a protective effect

55
Q

symptoms of carcinoma of the stomach

A

Indigestion, nausea or vomiting, dysphagia, postprandial fullness, loss of appetite, melena, hematemesis, and weight loss

56
Q

late complications of carcinoma of the stomach

A

pathologic peritoneal and pleural effusions, GOO, obstruction of the GE junction; bleeding in the stomach from esophageal varices

57
Q

where is an Irish node found?

A

anterior axillary

58
Q

ovarian metastasis (from gastric cancer) palpated on pelvic exam

A

Krukenberg’s tumor

59
Q

if someone comes in with abdominal pain and has a positive stool guiac what should be done next?

A

gastro-enterologist doctor should see them, probably need a endoscopy

60
Q

labs to get for carcinoma of stomach

A

CEA, CA19-9
CBC for anemia, malnutition, LFTs
upper endoscopy establishes the diagnosis
CXR for mets

61
Q

tx for carcinoma of the stomach

A

surgical resection

palliation- surgical/ chemo

62
Q

what type gastric polyps have increased risk of adenocarcinoma w/ increased size

A

adenomatous polyps

63
Q

Arises within 2 cm of the distal end of the CBD, where it passes through the wall of the duodenum and ampullary papilla
Obstruct early on and present early w/ jaundice and can have GI bleeding
Courvoisier sign

A

Cancer of the ampulla Vater

64
Q

tx for cancer of the amuppla of Vater

A

Whipple if large

if small- endoscopy

*OldSurgery (22 decks)

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