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