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Pathology > Stomach > Flashcards

Stomach Flashcards

1
Q

the cardia is near what “tube”

A

esophagus

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2
Q

[part of the stomach]

HCl secretion

A

cardia

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3
Q

[part of the stomach]

role in capacitance by undergoing receptive relaxation

A

fundus

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4
Q

[part of the stomach]

the site of the autonomic pacemaker responsible for initiating gastric motor activity

A

fundus

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5
Q

[part of the stomach]

The incisura is the junction of ____

A

junction of the body and antrum

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6
Q

What are the arteries supplying the lesser curvature of the stomach

A

Right Gastric

Left gastruc

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7
Q

What are the arteries supplying the greater curvature of the stomach

A

Right gastroepiploic

Left gastroepiploic

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8
Q

What are the arteries supplying the fundus of the stomach

A

Short gastric

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9
Q

The short gastric artery is a direct branch of the

A

splenic artery

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10
Q

What are the branches of the celiac trunk

A

Common hepatic
Left Gastric
Splenic

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11
Q

Artery in the stomach that is a branch of the celiac trunk?

A

left gastric

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12
Q

What stomach veins drain to the portal circulation?

A

right gastric vein

Left gastric vein/coronary vein

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13
Q

What stomach arteries drain to the splenic vein?

A

Short gastric vein

Left gastroepiploic vein

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14
Q

What stomach arteries drain to the superior mesenteric vein?

A

right gastroepiploic

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15
Q

[Lymphatic Drainage]

Drains the proximal lesser curvature

A

superior gastric LN

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16
Q

[Lymphatic Drainage]

the distal lesser curvature

A

suprapyloric LN

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17
Q

[Lymphatic Drainage]

proximal greater curvature

A

pancreaticosplenic LN

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18
Q

[Lymphatic Drainage]

distal greater curvature

A

infrapyloric LN

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19
Q

[innervation]

the left vagal trunk is located ___ (anterior/posterior) to the stomach

A

anterior

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20
Q

[innervation]

what is a branch of the left vagal trunk?

A

hepatic branch

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21
Q

[innervation]

What nerve that is a branch of the vagus nerve lies posterior to the stomach?

A

right vagal trunk

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22
Q

[innervation]

what innervates the posterior fundus?

A

Criminal nerve of Grassi from the Right vagal trunk

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23
Q

[innervation]

what are the branches of the right vagal trunk?

A

celiac branch

criminal nerve of grassi

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24
Q

[Stomach Histology: type of cell]

produce protective mucus layer that contains bicarbonate and glycoprotein

A

Surface Mucous Cells

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25
Q

[Stomach Histology: type of cell]

less alkaline mucus layer that contains glycoprotein

A

mucous neck cells

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26
Q

[Stomach Histology: type of cell]

produces pepsinogen

A

mucous neck cell, chief cells

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27
Q

[Stomach Histology: type of cell]

produces HCl

A

parietal (oxyntic) cells

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28
Q

[Stomach Histology: type of cell]

produces intrinsic factor

A

parietal (oxyntic) cells

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29
Q

[Stomach Histology: type of cell]

chief cells produce these enzymes

A

pepsinogen
gastric lipase
leptin

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30
Q

[Stomach Histology: type of cell]

produces of serotonin

A

enterochromaffin cells

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31
Q

[Stomach Histology: type of cell]

produces histamine

A

enterrochromaffin-like cells

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32
Q

[Stomach Histology: type of cell]

produces somatostatin

A

D cells

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33
Q

[Stomach Histology: type of cell]

produces gastrin

A

G cells

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34
Q

___ is the sharp depression in the lesser curvature of the stomach at the junction of the body

A

angularis incusura

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35
Q

[Control of acid secretion]

Compounds that induce acid secretion

A

Acetylcholine, Histamine, Gastrin

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36
Q

[Control of acid secretion]

Compounds that induce acid secretion

A

somatostatin

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37
Q

these compounds increase cAMP resulting to increased activation of protein kinases

A

Histamine, adenylate cyclase, somatostatin

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38
Q

Acetylcholine uses phospholipase ___

A

phospholipase C

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39
Q

Gastrin uses this receptor

A

CCK8 receptor

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40
Q

H+ is secreted to the channel via this antiporter

A

HK ATPase

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41
Q

[diagnostic tests for the stomach]

the most serious complication of EGD

A

esophageal perforation

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42
Q

[diagnostic tests for the stomach]

helpful in the diagnosis of gastric perforation (pneumoperitoneum) or delayed gastric emptying (large air-fluid level)

A

Plain abdominal x-ray

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43
Q

[diagnostic tests for the stomach]

better than EGD in detecting diverticula, fistula, tortousity or stricture location, and size of hiatal hernial

A

double contrast UGIS

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44
Q

[diagnostic tests for the stomach]

important in staging work-up

A

CT and MRI

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45
Q

[diagnostic tests for the stomach]

gold standard for H. pylori diagnosis

A

antral mucosal biopsy

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46
Q

[diagnostic tests for the stomach]

the standard test to confirm eradication of H. pylori post-treatment

A

urea breath test

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47
Q

[diagnostic tests for the stomach]

sensitive and specific for active H. pylori infection; can also be used to confirm cure

A

H. pylori fecal antigen test

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48
Q

[peptic ulcer disease: type]

mucosa only affected;

A

A

erosion

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49
Q

[peptic ulcer disease: type]

mucosa + muscularis mucosa + submucosa + muscularis propria

A

B

Acute Ulcer

50
Q

[peptic ulcer disease: type]

mucosa + muscularis mucosa + submucosa + muscularis propria + serosa

A

C

chronic ulcer

51
Q

[GU vs DU]

near the incisura, food worsens pain, less likely to awaken patient, risk of malignancy is common

A

GU

52
Q

[GU vs DU]

near the first portion of the duodenum (within 3 cm of pylorus); common in younger age group

food relieves pain; awakens the patient from sleep

A

DU

53
Q

[GU vs DU]

due to decreased cryoprotection

Gastric acid output is normal or decreased

A

GU

54
Q

[GU vs DU]

due to increased production of gastric acid

decreased bicarbonate secretion

A

DU

55
Q

[GU vs DU]

treatment of GU

A

gastrectomy

56
Q

[GU vs DU]

treatment of DU

A

vagotomy (to decrease production of acid)

57
Q

[PUD diagnosis]

Indications of EGD

A
  1. Age >45 years old with symptoms

2. Patients with alarm symptoms: weight loss, bleeding, recurrent vomiting, anemia, dysphagia

58
Q

[PUD]

most common complication of PUD

A

bleeding

59
Q

[PUD]

indications for surgery

A
  1. persistent bleeding/ rebleeding
  2. significant hemorrhage (>4 units/24 hours)
  3. Elderly with comorbidities
  4. ulcers at posterior duodenal bulb and ulcers in the gastric curvature
  5. active pulsatile bleeding, visible vessels
60
Q

[forrest classification for endoscopic findings]

Active, pulsatile bleeding

A

Grade Ia

61
Q

[forrest classification for endoscopic findings]

active, nonpulsatile bleeding

A

Grade Ib

62
Q

[forrest classification for endoscopic findings]

nonbleeding, visible vessels

A

Grade IIa

63
Q

[forrest classification for endoscopic findings]

adherent clot

A

Grade IIb

64
Q

[forrest classification for endoscopic findings]

no signs of recent bleeding

A

Grade III

65
Q

[forrest classification for endoscopic findings]

black dot

A

Grade IIc

66
Q

Diagnostic workup for stomach perforation

A

upright CXR

detects pneumoperitoneum

67
Q

[diagnose]

nonbilous vomiting, profound hypokalemic hypochloremic metabolic alkalosis

epigastric pain, and weight loss

A

gastric outlet obstruction

68
Q

[Medical treatment of PUD]

bismuth triple therapy is composed of

A
  1. Bismuth, 2 tables QID
  2. Metronidazole, 250mg TID
  3. Tetracycline, 500mg QID
69
Q

[Medical treatment of PUD]

what is the gold standard for H. pylori eradication?

A

quadruple therapy

  1. PPI BID
  2. Bismuth, 2 tables QID
  3. Metronidazole, 250mg TID
  4. Tetracycline, 500mg QID
70
Q

[Medical treatment of PUD]

PPI triple therapy is composed of

A
  1. PPI BID
  2. Amoxicillin 1 gram BID
  3. Clarithromycin 500mg BID
71
Q

[Medical treatment of PUD]

when will you repeat the EGD/biopsy post medical treatment of H.pylori

A

at 6-8 weeks

72
Q

[Gastric Ulcer Types]

Antral lesser curvature

A

Type I

Most common

73
Q

[Gastric Ulcer Types]

Antral lesser curvature + duodenal ulcer

A

Type II

74
Q

[Gastric Ulcer Types]

prepyloric ulcer

A

Type II

75
Q

[Gastric Ulcer Types]

high in the lesser curvature

A

Type IV

76
Q

[Gastric Ulcer Types]

NSAID induced

A

Type V

One less
Two two
Three pre
Four by the door
Five NSAID
77
Q

[PUD Surgery]

Gastroduodenostomy is also called ___

A

Bilroth I

78
Q

[PUD Surgery]

Antecolic gastrojejunustomy is also called ___

A

Bilroth II

79
Q

____ syndrome

caused by destruction of the pyloric sphincter leading to abrupt delivery of hyperosmolar load to the small intestines

A

dumping syndrome

80
Q

[Type of dumping syndrome]

peripheral and splancnic vasodilatation

sweating, light-headedness, tachycardia relieved by saline or recumbency

A

early dumping

15 to 30 minutes post prandial

81
Q

[Type of dumping syndrome]

die to hyperinsulinemia with reactive hypoglycemia; relieved by glucose

A

Late dumping

2-3 hours post prandial

82
Q

What is the surgical method used for dumping syndrome?

A

conversion to Roux-en-Y anastomosis

83
Q

[diagnosis]

constant epigastric pain, nausea, bilious emeses

Endoscopy: inflamed, beefy red, friable gastric mucosa

A

bile or alkaline reflux gastritis

associated with bilroth II

84
Q

___ syndrome

due to functional obstruction due to disruption of normal propagation of pacesetter potentials in the roux limb from the proximal duodenum

A

Roux stasis Syndrome

85
Q

[Loop syndromes]

due to bowl kink, volvulus or internal herniation,

severe abdominal pain, nonbilous emesis

steatorrhea, B12 folate iron deficiency

A

Afferent loop syndrome

86
Q

[Loop syndromes]

abdominal pain, bilous emesis months to years after ROux en Y

A

Efferent loop syndrome

87
Q

What is the confirmatory test for the diagnosis of Zollinger-Ellison Syndrome

A

Secretin Stimulation Test

88
Q

[diagnosis]

epigastric pain, GERD, diarrhea

elevated serum gastrin and Basal Acid output

A

Zollinger-Ellison Syndrome

89
Q

The gastrin level after a secretin stimulation test which suggests zollinger-Ellison syndrome

A

gastrin > 200pg/mL

90
Q

Diet low in these vitamins is associated with gastric adenocarcinoma

A

Vitamin A and C

91
Q

most common malignant neoplasm in the stomach

A

adenocarcinoma

92
Q

Carcinoma is diagnosed when the tumor invades this ____

A

lamina propria or muscularis mucosae

93
Q

[Lauren Classification - Stomach CA]

well-delineated, slow growth, distal stomach, ulcerative

A

intestinal type

94
Q

[Lauren Classification - Stomach CA]

small cells, poorly differentiatied,

younger age,

seen in the cardia of the stomach, linitis plastica

A

Diffuse type

95
Q

virchow node refers to what LN which is associated with gastric CA

A

left supraclavicular lymphadenopathy

96
Q

[gastric CA PE]

cul-de-sac tumor palpable on rectal exam is also called

A

blumer shelf

97
Q

[Gastric adenoma diagnostics]

useful for post operative surveillance

A

CEA

98
Q

[Gastric adenoma diagnostics]

diagnostic gold standard

A

upper endoscopy + biopsy

99
Q

[Gastric adenoma diagnostics]

used to asses direct local invation

A

Abdominal pelvic CT with IV and oral contrast

100
Q

[Gastric adenoma diagnostics]

more accurate in assessing gastric wall invasion and determine the presence or absence of LN metastasis

A

endoscopic UTZ

101
Q

[Gastric adenoma diagnostics]

can detect occult metastasis; can rule out peritoneal implants and liver metastasis

A

staging laparoscopy with peritoneal fluid cytology

102
Q

[Standard surgical treatment]

for tumors of the gastric antrum

A

Radical subtotal gastrectomy

103
Q

[Standard surgical treatment]

for all lesions in the midbody or fundus (proximal), linitis plastica, cancers associated with menetrier disease, gastric remnant CA, mutiple diffuse type

A

radical total gastrectomy

104
Q

[Primary Gastric Lymphoma]

always arise from the mucosa, from the MALT

A

low grade MALT lymphoma

105
Q

[Primary Gastric Lymphoma]

associated with inactivation of p53, cmyc

A

high grade lymphoma

106
Q

Advanced lesions of low-grade gastric lymphoma are treated using

A
  1. Initial H. pylori eradication
  2. EBRT with chemotherapy
  3. Endoscopic surveillance
107
Q

___ arise from the interstitial cells of Cajal

A

GIST

prognosti factors: tumor size, mitotic count

108
Q

tumor marker of GIST

A

cKIT (CD 117) and CD 34)

109
Q

Surgical Treatment of GIST

A

Wedge resection with negative margins

110
Q

Drug of choice for unresectable, metastatic GIST

A

Imatinib (gleevec)

111
Q

these arise from gastric enterochromaffin-like cells

A

gastric carcinoids

112
Q

[type of gastric carcinoids]

associated with type A chronic gastritis, autoimmine, hypergastrinemia

A

Type I

Endoscopic polypectomy

113
Q

[type of gastric carcinoids]

associated with zollinger-ellison

A

Type II

treat gastrinoma with somatostatin analogues

114
Q

[type of gastric carcinoids]

sporadic, solitary, worse prognosis, worse in med

A

Type III

en-block resection with regional LN

115
Q

[diagnose]

____ associated with protein losing enteropathy and hypochlorydia; spares the antrum

A

menetrier disease

116
Q

[diagnose]

middle aged man, with epigastric pain, weight loss, diarrhea, hypoproteinemia

biopsy: diffuse hyperplasia of surface mucus-secreting cells and decrease parietal cells

A

menetrier disease

117
Q

___ is also called watermelon stomach

A

Gastric Antral Vascular Ectasia

118
Q

[diagnose]

dilated mucosal blood vessels in the distal stomach; associated with autoimmune connective tissue disorder

A

Gastric antral vascular ectasia

treat with neodymum ytrrium-aluminum garnet

antreactomy

119
Q

[diagnose]

congenital AV malformation, large tortous suubmucosal artery

Pulsating blood from a normal appearing gastric mucosa

A

Dieulafoy lesion

120
Q

[diagnose]

regurgitation of feeding
projectile non-bilous emesis
peristaltic gastric waves visible
hypokalemic hyperchloremic metabolic acidosis

A

pyloric stenosis

Fredet-Ramstedt pyloromyotomy

121
Q

olive-shaped mass in RU epigastrium

A

pyloric stenosis

Pathology (36 decks)

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