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SB82 Stomach

SB82 Stomach - loosely taken from Fiser's ABSITE review

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
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