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COMAT: Surgery > Stomach > Flashcards

Stomach Flashcards

1
Q

what do the gastric parietal cells produce?

A

HCl

intrinsic factor

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2
Q

what do the chief cells produce?

A

pepsinogen

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3
Q

what do the mucous neck cells produce?

A

bicarbonate

mucus

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4
Q

what do the G cells produce?

A

gastrin

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5
Q

where are the G cells located?

A

antrum

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6
Q

what is pepsin?

A

proteolytic enzyme that hydrolyzes peptide bonds

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7
Q

what is intrinsic factor?

A

protein secreted by the parietal cells that combines with vitamin B12 and allows for absorption in the terminal ileum

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8
Q

what is GERD?

A

excessive reflux of gastric contents into the esophagus, ‘heartburn’

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9
Q

what are the causes of GERD?

A

decreased LES tone
decreased esophageal motility to clear refluxed fluid
gastric outlet obstruction
hiatal hernia

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10
Q

what are the signs/symptoms of GERD?

A

heartburn, regurgitation, respiratory problems/pneumonia from aspiration of refluxed gastric contents, substernal pain

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11
Q

what tests are included in the work up of GERD?

A

EGD
UGI contrast study with esophagogram
24hr acid analysis
manometry, EKG, CXR

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12
Q

what is the medical treatment of GERD?

A

small meals
PPIs or H2 blockers
elevation of head at night and no meals prior to sleeping

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13
Q

what is Barrett’s esophagus?

A

columnar metaplasia from the normal squamous epithelium as a result of chronic irritation from reflux

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14
Q

what is the major concern with Barrett’s esophagus?

A

developing cancer

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15
Q

what type of cancer develops in Barrett’s esophagus?

A

adenocarcinoma

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16
Q

what is the treatment of Barrett’s esophagus with dysplasia?

A

nonsurgical: endoscopic mucosal resection and photodynamic therapy; other options include radio frequency ablation, cryoablation

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17
Q

define laparoscopic nissen fundoplication

A

360deg fundoplication - 2cm long

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18
Q

define toupet

A

incomplete posterior wrap often used with severe decreased esophageal motility

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19
Q

how does the Nissen wrap work?

A

thought to work by improving the LES:

  • increasing LES tone
  • elongating LES about 3cm
  • returning LES into abdominal cavity
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20
Q

what are the postoperative complications of Lap Nissen?

A
  • gas bloat syndrome
  • stricture
  • dysphagia
  • spleen injury requiring splenectomy
  • esophageal perforation
  • pneumothorax
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21
Q

what is gas bloat syndrome?

A

inability to burp or vomit

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22
Q

what are the associated risk factors for gastric cancer?

A

diet - smoked meats, high nitrates, low fruits and vegetables, alcohol, tobacco
environment - high risk area, poor socioeconomic status, atrophic gastritis, male gender, blood type A. previous partial gastrectomy, pernicious anemia, polyps, H. pylori

23
Q

which blood type is associated with gastric cancer?

A

blood type A

24
Q

what are the symptoms of gastric cancer?

A

WEAPON

  • weight loss
  • emesis
  • anorexia
  • pain/epigastric discomfort
  • obstruction
  • nausea
25
Q

what is Blumer’s shelf?

A

solid peritoneal deposit anterior to the rectum, forming a ‘shelf’, palpated on rectal examination

26
Q

what is a Virchow’s node?

A

metastatic gastric cancer to the nodes in the left supraclavicular fossa

27
Q

what is a surveillance laboratory finding?

A

CEA elevated in 30% of cases

28
Q

what is the initial work up of gastric cancer?

A

EGD with biopsy, endoscopic U/S to evaluate the level of invasion, CT scan of abdomen/pelvis for metastasis, cxr, labs

29
Q

what is the histology of gastric cancer?

A

adenocarcinoma

30
Q

what is the differential diagnosis for gastric tumors?

A

adenocarcinoma, leiomyoma, leiomyosarcoma, lymphoma, carcinoid, ectopic pancreatic tissue, gastrinoma, benign gastric ulcer, polyp

31
Q

which morphologic type is named after a ‘leather bottle’?

A

linitis plastica

- the entire stomach is involved and looks thickened

32
Q

which patients with gastric cancer are nonoperative?

A 
distant metastasis (liver)
peritoneal implants
33
Q

what is the role of laparoscopy?

A

to rule out peritoneal implants and to evaluate for liver metastasis

34
Q

what is the genetic alteration seen in >50% of patients with gastric cancer?

A

P53

35
Q

what is the treatment for gastric cancer?

A

surgical resection with wide (>5cm checked by frozen section) margins and lymph node dissection

36
Q

what operation is performed for a gastric cancer tumor in the antrum?

A

distal subtotal gastrectomy

37
Q

what operation is performed for a gastric cancer tumor in the midbody?

A

total gastrectomy

38
Q

what operation is performed for a gastric cancer tumor in the proximal stomach?

A

total gastrectomy

39
Q

what is a subtotal gastrectomy

A

75% of the stomach removed

40
Q

what is a total gastrectomy

A

stomach is removed and a Roux-en-Y limo is sewn to the esophagus

41
Q

when should a splenectomy be performed?

A

when the tumor directly invades the spleen/splenic hilum or with splenic hilarious adenopathy

42
Q

what is the adjuvant treatment for gastric cancer?

A

stages II and III: postoperative chemotherapy and radiation

43
Q

what is GIST?

A

GastroIntestinal Stromal TUmor

44
Q

what was GIST previously known as?

A

leiomyosarcoma

45
Q

what is the cell of origin of GIST?

A

CAJAL, interstitial cells of cajal

46
Q

where is a GIST found?

A

GI tract - ‘esophagus to rectum’

- most commonly found in the stomach, small bowel, duodenum, rectum, colon, esophagus

47
Q

what are the symptoms of GIST?

A

GI bleed, occult GI bleed, abdominal pain, abdominal mass, nausea, distention

48
Q

how is GIST diagnosed?

A

CT scan, EGD, colonoscopy

49
Q

how are the distant metastases of GIST diagnosed?

A

PET scan

50
Q

what is the tumor marker for GIST?

A

C-KIT (CD117 antigen)

51
Q

what is the prognosis of GIST?

A

local spread, distant metastasis
poor long-term prognosis:
- size >5cm
- mitotic rate >5 per 50hpf

52
Q

what is the treatment of GIST?

A

resect with negative margins, +/- chemotherapy

53
Q

is there a need for lymph node dissection?

A

no

54
Q

what is the chemotherapy for metastatic or advanced disease?

A

imatinib - tyrosine kinase inhibitor

COMAT: Surgery (17 decks)

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