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SB82 Stomach - loosely taken from Fiser's ABSITE review
|What is the normal stomach transit time?
|Peristalsis occurs only in what portion of the stomach? ________
|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? _____________
|Where does the fundus end?
|At a horizontal line through the GE junction
|What substance is secreted by the cardia glands? ___________
|At what pH are oxyntic cells activated best?
|What is the first enzyme active in proteolysis? ___________
|What cell type secretes the first enzymes active in proteolysis? ______________
|What enzyme is activated by histamine to initiate acid release? _____________
|What enzyme is activated by acetylcholine and gastrin to initiate acid release? __________
|What substances inhibit parietal cells?
|Somatostatin, PGE-1, secretin, CCK
|What substance binds vitamin B12 and allows its resorption in the terminal ileum? ________
|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 ___________
|Vascular malformation in the stomach ______________
|A stomach disorder characterized by mucous cell hyperplasia and increased rugal folds _________
|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? _________
|What is the most common problem following vagotomy? _____________
|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? ____________
|What is the most common location of duodenal ulcers? ____________
|First part of the duodenum
|Anterior duodenal ulcers ______________ (perforate / bleed)
|Posterior duodenal ulcers ______________ (perforate / 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? _________
|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 ___________
|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? ____________
|Refractory bleeding from stress gastritis may be controlled through __________
|Selective angiography with vasopressin injection
|Location of Type A chronic gastritis ________
|Type A chronic gastritis is associated with what diseases?
|Pernicious anemia and autoimmune diseases
|Location of Type B chronic gastritis ___________
|Type B chronic gastritis is associated with what disease? ____________
|H. pylori infection
|What portion of the stomach has 40% of gastric cancers? __________
|A patient has adenomatous stomach polyps. What is his risk of gastric cancer? ___________
|Drop metastases from stomach cancer to the ovaries ____________
|What margins do you need for gastric cancer resection? __________
|Most common benign gastric neoplasm _________
|Indications for surgical resection of GIST tumor
|> 5 cm or > 5-10 mitoses per high-powered field
|Margins for GIST tumor resection
|Chemotherapy for GIST tumors __________
|What is the mechanism of action of the chemotherapeutic agent used in GIST tumor treatment?
|Tyrosine kinase inhibitor
|How do gastric leiomyosarcomas spread? __________
|What is the most commonly involved organ in extranodal lymphoma? ____________
|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?
|Treatment for stenosis of anastomosis following gastric bypass ___________
|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 __________