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
What is the most common sarcoma of the gastrointestinal tract and where is it most commonly found?
GIST; stomach
A Zenker’s diverticulum outpouches in Killian’s triangle, which is
area between cricopharyngeal muscles and the inferior constrictor of the pharynx
Failure of relaxation of the cricopharyngeal muscles is thought to contribute to the development of
Zenker’s diverticulum
What is Plummer Vinson syndrome?
1) esophageal web
2) iron deficiency
3) atrophic oral mucosa
4) spoon-shaped brittle nails (koilonychia)
What is a sliding hiatal hernia?
The cardia is displaced into the posterior mediastinum
What is the classic paraesophageal “rolling” hernia? What type hernia is this?
The GEJ remains below the diaphragm, but stomach and other viscera migrate up along with esophagus. Type 4 hernia.
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:
Schantzki’s ring
In which part of the mediastinum is the esophagus–anterior, medial, posterior?
Posterior
How do infections from the subhepatic space extend to the infracolic space?
through the paracolic gutter
Which part of hte pancreas is posterior to the superior mesenteric vessels?
The head (the uncinate)
Infection in the subhepatic space is due to an infection where?
stomach, gallbladder, duodenum, liver
Acid ingestion leads to involvement more of hte (esophagus/stomach) and (liquefactive/coagulative) necrosis.
Acid, stomach, coagulative
Alkali, esophagus, liquefactive
What connects the lesser and greater omentum?
foramen of winslow/epiploic foramen
What is Fothergill’s sign?
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)
These cancers are associated with a mutation of the c-kit oncogene:
GIST
When are partial fundoplications done in the context of GERD?
If esophageal motility is poor
Endoscopic findings revealing multiple ulcers and petechiae in the stomach following trauma indicate:
erosive gastritis
What is the most common cause of UGI bleeding?
peptic ulcer disease
Patient with ulcer in jejunum, think:
ZES
A patient whose weight is ____ pounds over their ideal body weight, or whose BMI is at least ____, is morbidly obese.
if >35 or if >100 pounds overweight
T/F: A patient receiving myotomy for achalasia should also get partial fundoplication.
True, to prevent reflux
A corkscrew esophagus is highly suggestive of
DES
T/F: Patients with severe dysplasia in Barrett’s should get prophylactic esophagectomy
True (risk of progression to malignancy is 40-50%)
What is “leather bottle stomach”?
A stomach full of diffuse gastric adenocarcinoma (signet ring cells, vs the discrete intestinal type of gastric adenocarcinoma) and difficult to insufflate
Causes of hemobilia (x3):
1) instrumentation of the biliary tract
2) malignancy
3) trauma
Patients with HIV and odynophagia:
esophageal candidiasis
What is the treatment of bezoars, whether phyto (plant material) or tricho (hair)?
Ingestion of meat tenderizer and then endoscopy to take out any remaining fragments
What are the two most common vascular rings?
Double aortic arch and right aortic arch with left ligamentum arteriosum
Most aortoenteric fistulas occur between the aorta and the __________
duodenum
What is the treatment for a bleeding duodenal ulcer that is causing hemodynamic instabilty in a patient despite transfusions?
oversew, vagotomy, pyloroplasty
