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ORAL BOARDS > UPPER GI > Flashcards

UPPER GI Flashcards

1
Q

Physical findings of locally advanced/metastatic disease in gastric CA

A

Palpable abdominal mass in large primary tumor
Liver or ovarian mets (Krukenberg’s tumor)
Palpable left supraclavicular node (Virchow’s node)
Periumbilical nodule (Sister Mary Joseph)
Pelvic deposits (rectal Blummer’s sehelf)
Jaundice
Ascites

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2
Q

Diagnostic modality of choice when gastric CA/malignancy suspected

A

Upper GI endoscopy

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3
Q

Siewert 1 lesion

A

1-5 cm above GE junction

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4
Q

Siewert 2 lesion

A

true GE junction (1 cm proximal and 2 cm distal)

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5
Q

Siewert 3 lesion

A

gastric cardia (2-5 cm distal to EGJ)

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6
Q

most sensitive noninvasive imaging mdodality for dx of hepatic mets in gastric CA

A

PET CT

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7
Q

Intestinal gastric CA is often seen arising in what settings?

A

chronic atrophic gastritis, often 2/2 H. pylori and autoimmune gastritits

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8
Q

When to perform EUS in gastric CA

A

Early-stage disease suspected or if ealy vs locally advanced disease needs to be determined

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9
Q

Endoscopic resection in gastric CA - when is it essential?

A

Accurate staging of early stage CA T1a or T1b. Best diagnosed by ER. Can also be used curatively for T1a lesions <2 cm without LVI

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10
Q

If metastatic gastric CA documented/suspected, what should you also test for?

A

HER2 and PDL1

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11
Q

At what T stage of gastric CA is perioperative chemotherapy or preop chemoXRT preferred

A

cT2 or higher OR any N

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12
Q

Tx option in locoregional gastric CA disease in medically fit patients but surgically unresectable

A

chemoxrt or systemic therapy

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13
Q

Unresectable criteria for gastric CA

A 
Locoregionally advanced (infiltration of root of mesentery or para-aortic lymph node highly suspicious on imaging or confirmed by biopsy OR invasion/encasement of major vascular structures excluding splenic vessels
Distant mets or peritoneal seeding incl. positive peritoneal cytology
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14
Q

D1 dissection

A

Gastrectomy + resectio nof both greater and lesser omenta (which includes LN along right and left cardia, lesser and greater curvature, suprapyloric along right gastric A and infrapyloric area)

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15
Q

Goal # of lymph nodes examined ain gastric resection

A

16+

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16
Q

D2 dissection

A

D1 + all nodes along L gastric A, common hepatic a, celiac a and splenic a

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17
Q

When should you consider palcing feeding tube in gastric CA

A

patients undergoing total gastrectomy (Especially if postop chemoXRT appears a likely recommendation)

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18
Q

Gene assoc with hereditary diffuse gastric CA

A

CDH1

19
Q

In CDH1 mutation carriers when is prophylactic total gastrectomy recommended?

A

Between ages 18-40 yo - need baseline endoscope beforehand!

20
Q

When to consider postop chemoXRT in gastric CA

A

Those who received less than a D2 lymph node dissection

21
Q

Resection margin in gastric CA

A

At least 5 cm

22
Q

Appropriate surgery for Siewert type III tumors

A

Extended total gastrectomy with segment of esophagus to provide adequate margin

23
Q

Appropriate surgical procedure for Siewert type I lesions

A

Transhiatal/transthoracic esophagectomy with proximal gastrectomy and gastric pull up with cervical/thoracic esophagogastrostomy

24
Q

Tumors in the distal stomach. - appropriate surgical treatment?

A

Subtotal gastrectomy with Billroth II or Roux en Y reconstruction

25
Q

Pitfalls during routine gastrectomy - gastrohepatic ligament might contain?

A

Accessory left hepatic artery (15-20%) which sometimes represents only arterial flow to the left lobe of the liver

26
Q

Ischemic looking duodenal stump during gastrectomy, next step?

A

Oversew with lembert sutures to prevent leak

27
Q

When gastric tumor extends susbtantial distance up esophagus and dow nstomach and don’t have proper oncologic resection margins, what should you perform?

A

total esophagogastrectomy with colon or jejunum interposition

  • left colonic segment based on ascending branch of L colic vessels (maybe middle colic)
  • can use jejunum if really in a pinch or colon is absent/no good
28
Q

When to begin jejunostomy feeds in post-gastrectomy pt

A

Day 2

29
Q

In cases of total gastrectomy, what type of supplementation needed?

A

Multivitamin, B12 and iron

30
Q

T1a vs T1b gastric tumor

A

T1a - lamina propria or muscularis mucosa

T1b - submucosa

31
Q

T2 gastric tumor

A

Muscularis propria

32
Q

T4a vs T4b gastric tumor

A 
Invades serosa (visceral peritoneum)
T4b - invades adjacent structures/organs
33
Q

N1 gastric tumor

A

Mets in 1-2 LN

34
Q

N2 gastric CA

A

3-6 regional LN

35
Q

Stage I gastric CA

A

T1-2, N0 M0

36
Q

Stage III gastric CA

A

T3-T4a + N (if no nodes, then IIb)

37
Q

Immunohistochemical expression of what is consistent with GIST?

A

KIT (CD117 antigen)

38
Q

First line therapy for metastatic GIST

A

Imatinib

39
Q

MC sites for metastatic GIST

A

Liver and peritoneum

40
Q

3 major factors predicting mets following resection of the primary are

A

tumor site of origin, size and mitotic rate

41
Q

3 main indications for cytoreductive surgery in metastatic or recurrent GIST

A

)emergencies such as hemorrhage, bowel perforation or obstruction

2) resectable disease stable or responsive to imatinib
3) focal progression defined as developemnt of secondary drug resistance to imatinib in one or few sites while other sites of mets remain stable

42
Q

Gross margins recommended in GIST resection

A

1 cm

43
Q

Lowest risk GIST

A

< or = 2 cm and <5 mitoses/HPF

ORAL BOARDS (1 decks)

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