Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
SB82 Stomach
SB82 Stomach - loosely taken from Fiser's ABSITE review
| Question | Answer |
|---|---|
| What is the normal stomach transit time? | 3-4 hours |
| Peristalsis occurs only in what portion of the stomach? ________ | Distal |
| What arteries supply blood to the lesser curvature of the stomach? | Right and left gastrics |
| What arteries supply blood to the greater curvature of the stomach? | Right and left gastroepiploics, short gastrics |
| What artery supplies blood to the pylorus? _____________ | Gatroduodenal artery |
| Where does the fundus end? | At a horizontal line through the GE junction |
| What substance is secreted by the cardia glands? ___________ | Mucus |
| At what pH are oxyntic cells activated best? | 2.5 |
| What is the first enzyme active in proteolysis? ___________ | Pepsinogen |
| What cell type secretes the first enzymes active in proteolysis? ______________ | Chief cells |
| What enzyme is activated by histamine to initiate acid release? _____________ | Adenylate cyclase |
| What enzyme is activated by acetylcholine and gastrin to initiate acid release? __________ | Phospholipase |
| What substances inhibit parietal cells? | Somatostatin, PGE-1, secretin, CCK |
| What substance binds vitamin B12 and allows its resorption in the terminal ileum? ________ | Intrinsic factor |
| Why is an antrectomy helpful to resolve gastric ulcers? | It removes the portion of the stomach that contains G cells, which release gastrin (normally causes increased acid release) |
| Gastrin release is stimulated by what two substances? | Amino acids, acetylcholine |
| The antrum contains cells that release what two main GI hormones? | Gastrin from G cells, somatostatin from D cells |
| What are the main causes of rapid gastric emptying? | Previous surgery, ZES, ulcers |
| These large collections of fiber within the stomach are more prevalent in diabetics with poor gastric emptying ___________ | phytobezoars |
| Vascular malformation in the stomach ______________ | Dieulafoy’s ulcer |
| A stomach disorder characterized by mucous cell hyperplasia and increased rugal folds _________ | Menetrier’s disease |
| Gastric volvulus is associated with what type of hernia? ___________ | Type II (paraesophageal) |
| Where is the stomach tear located in Mallory Weiss tear? | Near the lesser curvature |
| Where does the nerve of Latarjet terminate? | Terminates as the “crow’s foot” near the incisura angularis |
| What is the difference between a truncal vagotomy and a highly-selective vagotomy? | Truncal vagotomy divides the vagal trunks at the level of the esophagus (decreased emptying of solids), and a HSV divides the nerves of Latarjet but preserve the “crow’s foot” (normal emptying of solids) |
| What procedure can you perform to improve emptying of solids after any vagotomy? _________ | Pyloroplasty |
| What is the most common problem following vagotomy? _____________ | Diarrhea (30-50%) |
| What is the pathophysiology of diarrhea after vagotomy? | Sustained MMCs force bile acids into the colon |
| What is the most important factor of continued or recurrent bleeding with upper GI bleed? | Presence of bleeding at the time of EGD |
| What is the most frequent type of peptic ulcer? ____________ | Duodenal |
| What is the most common location of duodenal ulcers? ____________ | First part of the duodenum |
| Anterior duodenal ulcers ______________ (perforate / bleed) | Perforate |
| Posterior duodenal ulcers ______________ (perforate / bleed) | Bleed |
| Symptoms of duodenal ulcer | Epigastric pain radiating to the back that abates with eating but returns 30 minutes later |
| A patient appears to have complicated ulcer disease difficult to control with medication. What disease process do you suspect? _________ | Gastrinoma |
| What is the best surgery to prevent recurrence of a duodenal ulcer refractory to medical management? | Truncal vagotomy and antrectomy with Billroth I or II |
| Surgical management of bleeding duodenal ulcer | 1st duodenostomy with GDA ligation |
| Eighty percent of patients with perforated duodenal ulcer will have this finding ___________ | Perforation |
| What can cause pain in the pericolic gutters after duodenal ulcer perforation? | Dependency of gastric drainage |
| Intractability of duodenal ulcers is defined as what? | No relief after 3 months of PPI therapy, or recurrence of ulcer within one year after medical therapy |
| Diagnostic test for Zollinger-Ellison syndrome ___________ | Secretin stimulation test results in HIGH gastrin level (usually gastrin is suppressed by secretin) |
| Enucleation can be performed for ZES pancreatic tumors of what size? | < 2 cm |
| What are the 4 types of gastric ulcers? | Type I – lesser curvature; Type II – lesser curvature and duodenum; Type III – prepyloric; Type IV – lesser curvature along the cardia; Type V – Ulcer associated with NSAIDs |
| Type A blood is associated with what type of gastric ulcer? | Type I (lesser curvature) |
| Stress gastritis occurs within what time frame? | 3-10 days after stressful event |
| What is the initial treatment for stress gastritis? ____________ | PPI |
| Refractory bleeding from stress gastritis may be controlled through __________ | Selective angiography with vasopressin injection |
| Location of Type A chronic gastritis ________ | Fundus |
| Type A chronic gastritis is associated with what diseases? | Pernicious anemia and autoimmune diseases |
| Location of Type B chronic gastritis ___________ | Antrum |
| Type B chronic gastritis is associated with what disease? ____________ | H. pylori infection |
| What portion of the stomach has 40% of gastric cancers? __________ | Antrum |
| A patient has adenomatous stomach polyps. What is his risk of gastric cancer? ___________ | 10-20% |
| Drop metastases from stomach cancer to the ovaries ____________ | Krukenberg tumor |
| What margins do you need for gastric cancer resection? __________ | 5 cm |
| Most common benign gastric neoplasm _________ | GIST tumor |
| Indications for surgical resection of GIST tumor | > 5 cm or > 5-10 mitoses per high-powered field |
| Margins for GIST tumor resection | 1 cm |
| Chemotherapy for GIST tumors __________ | Gleevec |
| What is the mechanism of action of the chemotherapeutic agent used in GIST tumor treatment? | Tyrosine kinase inhibitor |
| How do gastric leiomyosarcomas spread? __________ | Hematogenously |
| What is the most commonly involved organ in extranodal lymphoma? ____________ | Stomach |
| MALT (mucosa-associated lymphoma) usually resolves after what intervention? ____________ | H. pylori eradication |
| Roux-en-Y gastric bypasses may result in these six complications | Marginal ulcers, leak, necrosis, B12 deficiency, iron-deficiency anemia, gallstones |
| What is the most common cause of failure after gastric bypass? | High carbohydrate snacking |
| What percentage of patients develop marginal ulcers after gastric bypass? | 10% |
| Treatment for stenosis of anastomosis following gastric bypass ___________ | Serial dilation |
| What is the pathphysiology of dumping syndrome? | Rapid transit of carbohydrates into the small bowel, causing fluid shifts and sudden release of insulin |
| A patient complains of postprandial epigastric pain, nausea, and vomiting. EGD with biopsy shows gastritis and evidence of bile reflux. What is the likely diagnosis? | Alkaline reflux gastritis |
| What is the initial treatment of alkaline reflux gastritis? | PPI, cholestyramine, metoclopramide |
| Surgical treatment for refractory alkaline reflux gastritis | Conversion ot Billrot I or II to Roux-en-Y |
| Roux limbs should be what length to reduce the risk of roux stasis? | > 40 cm |
| Delayed gastric emptying after vagotomy __________ | Chronic gastric atony |
| Treatment for delayed gastric emptying after vagotomy | Near-total gastrectomy with Roux-en-Y |
| Treatment for duodenal stump blowout | Duodenostomy with drains |
| Treatment for efferent loop obstruction __________ | Balloon dilation |
Created by:
StudyBug82
Popular Surgery sets