Stomach / Small Intestine

Question 1

What are the greatest risk factors for stress ulcer formation?

Answer 1

Coagulopathy and prolonged ventilation

Question 2

What are symptoms of B3 deficiency?

Answer 2

AKA Niacin deficiency
Dermatitis
Diarrhea
Dementia

Question 3

What level of gastric lymph node dissection is now recommended?

Answer 3

D2: left gastric, CHA, celiac trunk, splenic hilum and splenic artery

D2 is found to have superior recurrence-free survival with minimal increase in morbidity

Question 4

What makes up a D1 dissection?

Answer 4

Perigastric nodes around lesser and greater curvature

Question 5

What is the triad associated with Zollinger Ellison syndrome?

Answer 5

Gastric acid hypersecretion
PUD
Gastrinomas

Question 6

What cell type produces intrinsic factor?

Answer 6

Parietal cells

Question 7

What are the symptoms of B12 deficiency?

Answer 7

Aka cobalamin
Numbness
Tingling in peripheral extremities
Cognitive issues
Weakness
Glossitis

Question 8

What is the Johnson classification of gastric ulcers?

Answer 8

I: Lesser curve
II: Gastric body + duodenum
III: Pre pyloric
IV: High on lesser curve (cardia)
V: N-Said associated

II and III associated with increased acid secretion

I and IV associated with decreased mucosal protection

Question 9

What medications comprise triple therapy?

Answer 9

PPI, Clarithromycin, Amoxicillin

If allergic to PCN, can substitute Metronidazole

Question 10

What is the role of staging laparoscopy in gastric cancer? (4 indications)

Answer 10

1. > Stage T1b (invasion in submucosa)
2. Prior to starting any preoperative chemo
3. Presence of GE jxn tumors
4. Lymphadenopathy > 1 cm

Question 11

What lab tests values will you see in gastroparesis

Answer 11

Hypokalemic, hypochloremic, metabolic alkalosis (2/2 vomiting) and elevated gastrin due to abdominal distension

Question 12

What branch of the vagus nerve is associated with recurrent ulcer disease?

Answer 12

Criminal Nerve of Grassi (posterior branch of the vagus nerve)

Question 13

What is the preferred screening for gastric adenocarcinoma?

Answer 13

CT CAP q 6-12 months for 2 years then annually for up to 5 years

Question 14

What is the staging of GIST tumors?

Answer 14

C Kit +; metastasize hemotagenously most often to the liver

Stage IA < 5 cm w/no LN spread
Stage IB 5-10 cm with no LN spread
Stage II: <5 cm no LN, high mitotic count
or >10 cm w/low mitotic count
Stage IIIA: 5-10 cm , no LN, high mitotic count
Stage IIIB: >10 cm w/high mitotic count
Stage IV: +LN or mets

Considered malignant if >5cm or >5 mitoses/ hpf

Tx: Imantinib, resect w/1 cm margins, NO nodal dissection

Question 15

What are contraindications of transcystic CBD exploration (4)?

Answer 15

1. Stones in CHD
2. Cystic duct < 3 mm
3. Stones >6-8 mm
4. > 8 stones in CBD

Question 16

What type of operation should be performed for an appendeceal mass?

Answer 16

If less than 15 mm –> Appendectomy
if >20 mm then hemicolectomy

Question 17

What are the following genes associated with?
BRCA1, SPINK 1, CFTR, PRSS1, APC, SMAD4

Answer 17

BRCA1: Breast, ovarian, fanconi anemia, pancreatic cancer
SPINK 1: pancreatitis but with low penetrance
CFTR: cystic fibrosis
PRSS1: hereditary pancreatitis
APC: FAP and colon cancer
SMAD4: Juvenille polyposis syndrome

Question 18

What causes isolated gastric varices?

Answer 18

Splenic vein thrombosis 2/2 pancreatitis

Question 19

What is the most common post op complication after loop ileostomy reversal?

Answer 19

SBO followed by SSI

Question 20

What is the adjuvant treatment for GIST tumors?

Answer 20

Tumors with high risk features (>10 cm, 10-15 mitoses/hpf) require adjuvant therapy with Imatinib for 3 years

Question 21

Which two tests have high specifiticy for NET?

Answer 21

• 5-HIAA and chromogranin
  
  • 5-HT only reaches the systemic circulation in patients with liver metastasis

Question 22

Does MALT of the small intestine require additional treatment?

Answer 22

No, primary resection is sufficient for localized disease

Question 23

Which type of malignancy is most commonly found in the proximal small bowel? The distal small bowel?

Answer 23

Adenocarcinoma most often found in duo and jejunum and small bowel lymphoma most often found in the distal small bowel

Question 24

Which type of Billroth II is more associated with blind loop syndrome?

Answer 24

• Antecolic, which is why retrocolic is preferred

Question 25

For a Meckel’s Diverticulum how big can the base be and still staple?

Answer 25

Two cm or less can staple; 2+ needs segmental resection

Question 26

Which GI malignancy associated with FAP has the highest mortality?

Answer 26

Duodenum

Question 27

Patients with Crohn’s disease are at higher risk of which small bowel malignancy?

Answer 27

Adenocarcinoma

Question 28

How are Desmoid tumors usually described?

Answer 28

• Spindle cells and abundant fibrous storma
  
  • Radiation therapy can be used for treatment

Question 29

What are contraindications to PD catheter placement?

Answer 29

• Abdomina wall infection, type 2 ultrafiltration failure, lack of peritoneal membra

Question 30

What is the cutoff size for appendicitis?

Answer 30

6mm