Stomach Virgilio/Mcgraw

Question 1

Procedures and Complications

Answer 1

See Pic

Question 2

Truncal vagotomy and selective vagotomy always need drainage procedure (e.g., pyloroplasty)

Answer 2

Whereas highly selective vagotomy does not

Question 3

Complications post bariatric Surgery

Answer 3

1

Question 4

Complications post bariatric Surgery

Answer 4

2

Question 5

gastric ulcers have features suggestive of malignancy and How many Bx taken

Answer 5

elevated irregular folds
association with a polypoid or fungated mass
and abnormal adjacent mucosal folds

Several biopsies, typically six or more Taken

Question 6

If Gastric Ulcer and Bx Benign

Answer 6

If benign ulcers are diagnosed
then EGD is repeated in 6 weeks to ensure resolution
All ulcers should be followed and biopsied until complete resolution occurs.

Question 7

Giant gastric ulcer Defined As

Answer 7

3 Cm or Greater

Question 8

What Gastric Tumor Size can be missed in CT

Answer 8

Small gastric tumors and metastases smaller than 5 mm can be missed on CT scans.

Question 9

Gastric Cancer Types

Answer 9

..

Question 10

HER2 Receptor and FGF2 Receptor Commonly seen in which type

Answer 10

HER2 Receptor > Intestinal Type
FGF2 > Diffuse

Question 11

Other useful histologic markers for GIST

Answer 11

include PDGFRα, CD34, and smooth-muscle actin

Question 12

patient with GIST started Imatinib then resistance

Answer 12

about half of all patients will develop resistance to the drug within 2 years of its initiation.

For these patients, other TKIs (i.e., sunitinib) remain effective second-line therapy.

Question 13

When to consider surgery for metastatic GIST

Answer 13

trial of imatinib of at least 6 but no more than 24 months should be given prior to resection of recurrent or metastatic GISTs.

response to TKI in this setting is predictive of outcomes after surgery and longer-term survival, allowing appropriate patient selection.

Question 14

GIST with SDH, NF1, or BRAF, > these tumors are generally resistant to TKIs because they

Answer 14

they lack the gain-of-function mutation of cKIT or PDGRFα.

Question 15

MALT Lymphoma Work Up

Answer 15

-Endoscopy + Biopsy
-Immunohistochemical and H pylori Stain
-Negative H-Pylori stain Should be confirmed with Fecal antigen test or Urea Breath Test
-Positive H.Pylori Should Do PCR t(11.18) translocation
-presence of the t(11;18) translocation > shortened progression-free survival, higher rates of disseminated disease, and the persistence of MALT lymphoma following H. pylori eradication.
-CT Staging

Question 16

When to consider Sx in MALT

Answer 16

reserved for the :
-control of residual local disease following H. pylori eradication
and radiation/chemotherapy
or in patients who develop a complication

Question 17

Lugano Staging

Answer 17

See

Question 18

patients who also have the t(11;18) translocation

Answer 18

radiation therapy should accompany H. pylori eradication

Question 19

patients with H. pylori–negative stage I or II1 disease

Answer 19

radiation therapy is recommended

Question 20

For advanced disease (II2, IIE, IV)

Answer 20

rituximab combined with multiagent chemotherapy is a first-line treatment

Question 21

If the patient remains H. pylori–positive (i.e., resistant to eradication) with persistent MALT lymphoma

Answer 21

second course of antibiotic therapy with or without concurrent radiation therapy would be appropriate.

Question 22

Rituximab (in combination with H. pylori eradication therapy) can be given to patients with

Answer 22

stage I/stage II disease who are H. pylori–positive and t(11;18) positive if radiation therapy is contraindicated