Stomach / Small Intestine Flashcards
What are the greatest risk factors for stress ulcer formation?
Coagulopathy and prolonged ventilation
What are symptoms of B3 deficiency?
AKA Niacin deficiency
Dermatitis
Diarrhea
Dementia
What level of gastric lymph node dissection is now recommended?
D2: left gastric, CHA, celiac trunk, splenic hilum and splenic artery
D2 is found to have superior recurrence-free survival with minimal increase in morbidity
What makes up a D1 dissection?
Perigastric nodes around lesser and greater curvature
What is the triad associated with Zollinger Ellison syndrome?
Gastric acid hypersecretion
PUD
Gastrinomas
What cell type produces intrinsic factor?
Parietal cells
What are the symptoms of B12 deficiency?
Aka cobalamin
Numbness
Tingling in peripheral extremities
Cognitive issues
Weakness
Glossitis
What is the Johnson classification of gastric ulcers?
I: Lesser curve
II: Gastric body + duodenum
III: Pre pyloric
IV: High on lesser curve (cardia)
V: N-Said associated
II and III associated with increased acid secretion
I and IV associated with decreased mucosal protection
What medications comprise triple therapy?
PPI, Clarithromycin, Amoxicillin
If allergic to PCN, can substitute Metronidazole
What is the role of staging laparoscopy in gastric cancer? (4 indications)
- > Stage T1b (invasion in submucosa)
- Prior to starting any preoperative chemo
- Presence of GE jxn tumors
- Lymphadenopathy > 1 cm
What lab tests values will you see in gastroparesis
Hypokalemic, hypochloremic, metabolic alkalosis (2/2 vomiting) and elevated gastrin due to abdominal distension
What branch of the vagus nerve is associated with recurrent ulcer disease?
Criminal Nerve of Grassi (posterior branch of the vagus nerve)
What is the preferred screening for gastric adenocarcinoma?
CT CAP q 6-12 months for 2 years then annually for up to 5 years
What is the staging of GIST tumors?
C Kit +; metastasize hemotagenously most often to the liver
Stage IA < 5 cm w/no LN spread
Stage IB 5-10 cm with no LN spread
Stage II: <5 cm no LN, high mitotic count
or >10 cm w/low mitotic count
Stage IIIA: 5-10 cm , no LN, high mitotic count
Stage IIIB: >10 cm w/high mitotic count
Stage IV: +LN or mets
Considered malignant if >5cm or >5 mitoses/ hpf
Tx: Imantinib, resect w/1 cm margins, NO nodal dissection
What are contraindications of transcystic CBD exploration (4)?
- Stones in CHD
- Cystic duct < 3 mm
- Stones >6-8 mm
- > 8 stones in CBD
What type of operation should be performed for an appendeceal mass?
If less than 15 mm –> Appendectomy
if >20 mm then hemicolectomy
What are the following genes associated with?
BRCA1, SPINK 1, CFTR, PRSS1, APC, SMAD4
BRCA1: Breast, ovarian, fanconi anemia, pancreatic cancer
SPINK 1: pancreatitis but with low penetrance
CFTR: cystic fibrosis
PRSS1: hereditary pancreatitis
APC: FAP and colon cancer
SMAD4: Juvenille polyposis syndrome
What causes isolated gastric varices?
Splenic vein thrombosis 2/2 pancreatitis
What is the most common post op complication after loop ileostomy reversal?
SBO followed by SSI
What is the adjuvant treatment for GIST tumors?
Tumors with high risk features (>10 cm, 10-15 mitoses/hpf) require adjuvant therapy with Imatinib for 3 years
Which two tests have high specifiticy for NET?
- 5-HIAA and chromogranin
- 5-HT only reaches the systemic circulation in patients with liver metastasis
Does MALT of the small intestine require additional treatment?
No, primary resection is sufficient for localized disease
Which type of malignancy is most commonly found in the proximal small bowel? The distal small bowel?
Adenocarcinoma most often found in duo and jejunum and small bowel lymphoma most often found in the distal small bowel
Which type of Billroth II is more associated with blind loop syndrome?
- Antecolic, which is why retrocolic is preferred
For a Meckel’s Diverticulum how big can the base be and still staple?
Two cm or less can staple; 2+ needs segmental resection
Which GI malignancy associated with FAP has the highest mortality?
Duodenum
Patients with Crohn’s disease are at higher risk of which small bowel malignancy?
Adenocarcinoma
How are Desmoid tumors usually described?
- Spindle cells and abundant fibrous storma
- Radiation therapy can be used for treatment
What are contraindications to PD catheter placement?
- Abdomina wall infection, type 2 ultrafiltration failure, lack of peritoneal membra
What is the cutoff size for appendicitis?
6mm
