Stomach, Duodenum, Esophagus Flashcards

1
Q

Why is a drainage procedure necessary when performing vagotomy?

A

Because the vagus nerve helps innervate the pylorus. Gastric drainage is required (either pyloroplasty or gastroeterostomy via laparoscopy)

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2
Q

T/F: Fulminant diarrhea is a potential post-vagotomy syndrome

A

True

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3
Q

T/F: Bile emesis is usually spontaneous.

A

True. Probably due to bile gastritis due to intestinalization of gastric mucosa

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4
Q

What is the most common blood group in patients with duodenal ulcers, especially BLEEDING duodenal ulcers?

A

Type O

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5
Q

Why is it possible to develop iron deficiency as a result of gastrectomy?

A

An acid environment is needed to release ferric ion from food and make it available for absorption in the intestine

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6
Q

In ZES, gastrin release can be prompted with secretin or ________

A

calcium

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7
Q

Where is gastrin produced?

A

antrum, duodenum, small intestine (distal gastrectomies lead to a significant decrease in gastrin)

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8
Q

A barium study showing massive gastric folds in the proximal stomach is associated with (high/low) albumin.

A

= Hypertrophic gastritis/Menetrier’s disease. Low protein! A massive loss of plasma protein occurs through the affected gastric mucosa. (Can be managed by adequate nutrition)

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9
Q

How are the etiologies of duodenal and gastric ulcers different?

A

Duodenal ulcers = increased acid production
Gastric ulcers = impaired mucosal defense mechanisms; much more likely to harbor cancer (should be biopsied)

This means that vagotomy is not as helpful in preventing gastric ulcers

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10
Q

What makes early gastric cancer “early”?

A

It involves only the mucosa and not the muscular wall of the stomach. Treat with gastrectomy (or endoscopic mucosal resection).

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11
Q

What is the treatment of antral gastric cancer?

A

Distal gastrectomy with lymph node dissection and possible postop chemo

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12
Q

What is the “incisura”?

A

Located at the distal end of the the lesser curvature, it separates where the body of the stomach ends and the antrum begins

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13
Q

What is a gastrointestinal stromal tumor?

A

Rare GI tumors = leiomyosarcomas. Overlying mucosa remains intact. Not responsive to radiation or chemotherapy. Characteristic “doughnut” sign on barium studies

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14
Q

What is the second most common malignancy of the stomach?

A

Lymphoma (it is the highest site of extranodal non Hodgkins)

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15
Q

What is the treatment of gastric lymphoma?

A

Chemo and radiation (except MALT lymphomas, associated with H Pylori and cleared up with PPIs and abx like amoxicillin + clarithomycin)

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16
Q

A characteristic “doughnut” sign on barium studies is suggestive of

A

GIST (gastrointestinal stromal tumor)

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17
Q

Acute gastric distention (as in surgery) can lead to a vasovagal syndrome, which results in

A

pallor, sweating, hypotension, bradycardia, abdominal pain. Treatment is NGT for 48 hours until gastric function returns to normal

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18
Q

T/F: Autoimmune metaplastic atrophic gastritis is associated with an increased risk of gastric carcinoma.

A

True

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19
Q

Why is a drainage procedure not necessary with highly selective vagotomy?

A

Innervation to pylorus remains intact

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20
Q

What is the most common sarcoma of the gastrointestinal tract and where is it most commonly found?

A

GIST; stomach

21
Q

A Zenker’s diverticulum outpouches in Killian’s triangle, which is

A

area between cricopharyngeal muscles and the inferior constrictor of the pharynx

22
Q

Failure of relaxation of the cricopharyngeal muscles is thought to contribute to the development of

A

Zenker’s diverticulum

23
Q

What is Plummer Vinson syndrome?

A

1) esophageal web
2) iron deficiency
3) atrophic oral mucosa
4) spoon-shaped brittle nails (koilonychia)

24
Q

What is a sliding hiatal hernia?

A

The cardia is displaced into the posterior mediastinum

25
Q

What is the classic paraesophageal “rolling” hernia? What type hernia is this?

A

The GEJ remains below the diaphragm, but stomach and other viscera migrate up along with esophagus. Type 4 hernia.

26
Q

This is a thin, circumferential scar in the lower esophagus, more common in men >65, comes from repeated trauma to the mucosa with chronic inflammation and fibrosis, usually associated with hiatal hernia:

A

Schantzki’s ring

27
Q

In which part of the mediastinum is the esophagus–anterior, medial, posterior?

A

Posterior

28
Q

How do infections from the subhepatic space extend to the infracolic space?

A

through the paracolic gutter

29
Q

Which part of hte pancreas is posterior to the superior mesenteric vessels?

A

The head (the uncinate)

30
Q

Infection in the subhepatic space is due to an infection where?

A

stomach, gallbladder, duodenum, liver

31
Q

Acid ingestion leads to involvement more of hte (esophagus/stomach) and (liquefactive/coagulative) necrosis.

A

Acid, stomach, coagulative

Alkali, esophagus, liquefactive

32
Q

What connects the lesser and greater omentum?

A

foramen of winslow/epiploic foramen

33
Q

What is Fothergill’s sign?

A

To determine if a mass is abdominal or INTRA-abdominal, have patient attempt sitting up (will tense rectus muscles, making intra-abdominal masses difficult to palpate)

34
Q

These cancers are associated with a mutation of the c-kit oncogene:

A

GIST

35
Q

When are partial fundoplications done in the context of GERD?

A

If esophageal motility is poor

36
Q

Endoscopic findings revealing multiple ulcers and petechiae in the stomach following trauma indicate:

A

erosive gastritis

37
Q

What is the most common cause of UGI bleeding?

A

peptic ulcer disease

38
Q

Patient with ulcer in jejunum, think:

A

ZES

39
Q

A patient whose weight is ____ pounds over their ideal body weight, or whose BMI is at least ____, is morbidly obese.

A

if >35 or if >100 pounds overweight

40
Q

T/F: A patient receiving myotomy for achalasia should also get partial fundoplication.

A

True, to prevent reflux

41
Q

A corkscrew esophagus is highly suggestive of

A

DES

42
Q

T/F: Patients with severe dysplasia in Barrett’s should get prophylactic esophagectomy

A

True (risk of progression to malignancy is 40-50%)

43
Q

What is “leather bottle stomach”?

A

A stomach full of diffuse gastric adenocarcinoma (signet ring cells, vs the discrete intestinal type of gastric adenocarcinoma) and difficult to insufflate

44
Q

Causes of hemobilia (x3):

A

1) instrumentation of the biliary tract
2) malignancy
3) trauma

45
Q

Patients with HIV and odynophagia:

A

esophageal candidiasis

46
Q

What is the treatment of bezoars, whether phyto (plant material) or tricho (hair)?

A

Ingestion of meat tenderizer and then endoscopy to take out any remaining fragments

47
Q

What are the two most common vascular rings?

A

Double aortic arch and right aortic arch with left ligamentum arteriosum

48
Q

Most aortoenteric fistulas occur between the aorta and the __________

A

duodenum

49
Q

What is the treatment for a bleeding duodenal ulcer that is causing hemodynamic instabilty in a patient despite transfusions?

A

oversew, vagotomy, pyloroplasty