Stomach, Duodenum, Esophagus Flashcards
Why is a drainage procedure necessary when performing vagotomy?
Because the vagus nerve helps innervate the pylorus. Gastric drainage is required (either pyloroplasty or gastroeterostomy via laparoscopy)
T/F: Fulminant diarrhea is a potential post-vagotomy syndrome
True
T/F: Bile emesis is usually spontaneous.
True. Probably due to bile gastritis due to intestinalization of gastric mucosa
What is the most common blood group in patients with duodenal ulcers, especially BLEEDING duodenal ulcers?
Type O
Why is it possible to develop iron deficiency as a result of gastrectomy?
An acid environment is needed to release ferric ion from food and make it available for absorption in the intestine
In ZES, gastrin release can be prompted with secretin or ________
calcium
Where is gastrin produced?
antrum, duodenum, small intestine (distal gastrectomies lead to a significant decrease in gastrin)
A barium study showing massive gastric folds in the proximal stomach is associated with (high/low) albumin.
= 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)
How are the etiologies of duodenal and gastric ulcers different?
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
What makes early gastric cancer “early”?
It involves only the mucosa and not the muscular wall of the stomach. Treat with gastrectomy (or endoscopic mucosal resection).
What is the treatment of antral gastric cancer?
Distal gastrectomy with lymph node dissection and possible postop chemo
What is the “incisura”?
Located at the distal end of the the lesser curvature, it separates where the body of the stomach ends and the antrum begins
What is a gastrointestinal stromal tumor?
Rare GI tumors = leiomyosarcomas. Overlying mucosa remains intact. Not responsive to radiation or chemotherapy. Characteristic “doughnut” sign on barium studies
What is the second most common malignancy of the stomach?
Lymphoma (it is the highest site of extranodal non Hodgkins)
What is the treatment of gastric lymphoma?
Chemo and radiation (except MALT lymphomas, associated with H Pylori and cleared up with PPIs and abx like amoxicillin + clarithomycin)
A characteristic “doughnut” sign on barium studies is suggestive of
GIST (gastrointestinal stromal tumor)
Acute gastric distention (as in surgery) can lead to a vasovagal syndrome, which results in
pallor, sweating, hypotension, bradycardia, abdominal pain. Treatment is NGT for 48 hours until gastric function returns to normal
T/F: Autoimmune metaplastic atrophic gastritis is associated with an increased risk of gastric carcinoma.
True
Why is a drainage procedure not necessary with highly selective vagotomy?
Innervation to pylorus remains intact