Stomach

Question 1

thickened gastric fold ddx

Answer 1

H pylori, ZE, eosinohilic gastritis, menetrier disease, crohn disease, gastric varices, lymphma, submucosal lymphoma

Question 2

eosinophilic gastritis

Answer 2

thickened folds in stomach/small bowel, history of allergy

Question 3

menetrier disease

Answer 3

protein-losing enteropathy; proximal stomach

replacement of parietal cells by hyperplastic epithelial cells&raquo_space; achlorhydria

?? association with gastric carcinoma

Question 4

crohn disease stomach

Answer 4

distal half of stomach; apthous ulcers

Question 5

fundic gland polyposis syndrome

Answer 5

variant of familial adenomatous polyposis (FAP) that involves stomach

polyps are hyperplastic

Question 6

hyperplastic polyp

Answer 6

inflammatory polyp; cystic dilation of gastric gland in response to inflammation

Question 7

adenomatous polyp, size/ treatment

Answer 7

neoplastic polyp with malignant potential; > 2cm, can have risk of malignant transformation

treat: endoscopic biopsy/polypectomy

Question 8

harmartomatous polyp

Answer 8

associated with peutz jegher, juvenile polyposis, cronkhite canada syndrome

Question 9

benign gastric masses

Answer 9

lipoma, GIST, ectopic pancreatic rest

Question 10

gastric lipoma

Answer 10

fatty attenuation on CT

indistinguishable from GIST on fluoro

Question 11

gastric GIST

Answer 11

most common submucosal gastric tumor

arise from interstitial cells of Cajal (pacemaker cells drive peristalsis); more likely to be malignant as they increase in size

Question 12

differential for submucosal gastric mass

Answer 12

mesenchymal tumor (GIST, fibroma, lipoma, neurofibroma), carcinoid, ectopic pancreatic rest

Question 13

ectopic pancreatic rest

Answer 13

heterotopic pancreas in gastric submucosa

umbilicated submucosal nodule with umbilication representing a focus of normal epithelium

Question 14

malignant gastric masses

Answer 14

gastric cancer, GIST (malignant), lymphoma, mets

Question 15

gastric cancer risk factors

Answer 15

ingestion of polycyclic hydrocarbons/nitrosamines, atrophic gastritis, pernicious anemia, post-subtotal gastrectomy

Question 16

krukenberg tumor

Answer 16

met spread of gastric carcinoma to ovary

Question 17

gastric cancer spread

Answer 17

lymphatic spread along lesser curvature&raquo_space; gastrohepatic liagement and greater curvature

Question 18

benign gastric ulcers

Answer 18

radiatic gastric folds: smooth/symmetric
ulcer extends beyond contour of lumen
Hampton line: nonulcerated acid-resistant mucosa

Question 19

gastric carcinoma ulcers

Answer 19

asymmetric ulcer crater with nodular tissue; does not project beyond location of gastric wall

abrupt transition between normal gastric wall/surrounding tissue

carman meniscus sign: splaying open of large flat malignant ulcer when compression applied

Question 20

RYGB

Answer 20

small gastric pouch created

roux limb created by transecting jejunum and anastamosing to gastric pouch

excluded stomach/pancreaticoviliary limb (afferent limb) connected via jejunojejunostomy

Question 21

placement of roux limb

Answer 21

antecolic favored (in front of transverse colon)

retrocolic requires defect through transverse mesocolon; risk of transmesocolic hernia

Question 22

how does RYGB work for weight loss

Answer 22

early satiety (small stomach) and malabsorption (bypass to jejunum)

Question 23

complications of roux en y surgery

Answer 23

postoperative leak, gastrogastric fistula, SBO, internal hernia, stomal stenosis, marginal ulcers

Question 24

roux en y postoperative leak

Answer 24

diagnosed 10 days after surgery
diagnosed with upper GI study

leaks from distal esophagus, gastric pouch, blind ending jejunal limb

Question 25

gastrogastric fistula

Answer 25

communication between gastric pouch and excluded stomach; may lead to inadequate weight loss/gain

Question 26

SBO from roux en y

Answer 26

acute post op: edema/hematoma at gastrojejunostomy/jejunojejunostomy

late post op: internal hernia (common with lap surgery) or adhesions

Question 27

internal hernias from roux en y

Answer 27

present within 2 years of bypass

transmesocolic; peterson’s space; mesenteric defect created by the jejunojejunostomy

Question 28

transmesocolic hernia

Answer 28

defect in mesentery of the transverse colon; associated with retrocolic Roux limb

Question 29

petersons space hernia

Answer 29

mesentery of roux limb and transverse mesocolin

Question 30

signs of internal hernia on imaging

Answer 30

swirling mesentery; mushroom mesentary shape; presence of bowel loops posterior to SMA