Stomach, Small Bowel

Question 1

MALT is a precursor to ______;

Rx with ________

Answer 1

gastric lymphoma; it regresses with H. Pylori rx

Question 2

clo test detect…

Answer 2

urease from H. pylori

Question 3

Type I gastric ulcer assoc w/ ____;

other types assoc w/ _______

Answer 3

Type A blood; others- type O blood

Question 4

Type I gastric ulcer _________ (here); Type II ______; Type III ______; Type IV _______; Type V _____

Answer 4

I: lesser curve; II: 2 ulcers (lesser curve and duodenal); III: prepyloric; IV: high lesser curve; V: anywhere assoc w NSAID use

Question 5

Gastric adeno CA: assoc w/ adenoma > than ___; type ___ blood; ____ (med); ____ (disease); ____ (disease)

Answer 5

adenoma >2cm; type A blood; nitrosamines, chronic atrophic gastritis; pernicious anemia

Question 6

Size margins for gastric adenocarcinoma

Answer 6

6cm; has intramural spread

Question 7

Gastric lymphoma: Rx of choice?

Answer 7

chemo and RT rx of choice, surgery for complications

Question 8

Bowel rest and NGT cures ___% of partial SBO; ___% of complete SBO

Answer 8

65% of partial; 20% of complete

Question 9

Terminal ileum resection consequences:

Decreased x 3 things…..

Answer 9

decr bile salt absorption -> less colonic h20 absorption -> diarrhea; decr B12/intrinsic factor absorption; decr binding of oxalate-> more oxalate absorbed in colon-> more oxalate stones

Question 10

Pts w/ Crohn’s dz with numerous strictures:

avoid _____, preform ______

Answer 10

avoid resection (and short gut); preform stricturoplasties

Question 11

Carcinoid:

_____ is converted to _____; measured in _____

Answer 11

tryptophan -> serotonin -> 5-HIAA

Question 12

Tryptophan diversion in Carcinoid can cause……

Answer 12

pellegra (3 D’s: dermatitis, dementia, diarrhea)

Question 13

Serotonin is secreted by these cells with this stain?

________ and ___________

Answer 13

enterochromaffin cells; argentafin staining

Question 14

___% of patients with ___ get carcinoid syndrome:

what is it?? ___, ____, ___, ___

Answer 14

9% of patients with METS; flushing, asthma, diarrhea, R sided heart valve dz

Question 15

what helps carcinoid syndrome?

Answer 15

octreotide helps

Question 16

1/3 of patients with SB carcinoid have………..;

1/4 have…………..

Answer 16

1/3 have multiple primary sites, 1/4 have metachronous adenocarcinoma

Question 17

chemo for carcinoid: ____, ____, ____

Answer 17

streptozocin, doxorubicin, 5 FU palliate

Question 18

Fistula: less likely to heal with………………….

___, ___, ___, ___, ___, ___, _____

Answer 18

FRIENDS: Foreign body, Radiation, IBD, Epitheliazation, Neoplasm, Distal obstruction, Sepsis/infection

Question 19

TPN with fistulas…..

incr closure rate? (y/n) ; incr survival? (y/n)

Answer 19

proven to incr closure rate of fistulas, but nor shown to incr survival

Question 20

SBO with air in biliary tree….. cause?

Answer 20

SBO due to gallstones (from cholecysto-enteric fistula). “gallstone ileus”

Question 21

tx for choecysto-enteric fistula causing SBO……

Answer 21

remove stone to relieve sbo but leave gallbladder and fistula to decr mortality