Alimentary Track (2nd best) - 17% Flashcards
A. Esophagus -- B. Stomach -- C. Small Intestine -- D. Large Intestine -- E. Anorectal F. Endoscopy (27 cards)
LARP - posterior vagus becomes what? anterior vagus becomes what?
posterior - celiac plexus, criminal nerve of Grassi
anterior - liver and biliary tree, nerve of laterjet
treatment of achalasia? what if high surgical risk?
pneumatic dilation of LES, heller myotomy (5cm onto esophagus, 2cm onto stomach), POEM
- high surgical risk –> botox, nitrates and CCBs
treatment of DES (early distal contraction)
- control of GERD symptoms, CCBs
- botox
- POEM
treatment of nutcracker syndrome
- control of GERD, CCBs
- TCAs, botox
- POEM
GERD with BMI >35? esophageal motility disorder?
Roux en Y.
Toupet (posterior 270 wrap)
size of bougie for a wrap
56 or 60cm
barretts esophagus treatment
- always consider antireflux surgery
- nondysplastic - medical therapy, surveillance endoscopy every 3-5 years
- low grade dysplasia - medical therapy vs endoscopic eradicaton, surveillance every 6-12mo
- high grade dysplasia - endoscopic eradication therapy, surveillance every 3 mo
bleeding during hiatal hernia repair
replaced L hepatic
layers of the stomach
mucosa (lamina propria, muscularis propria)
submucosa
muscularis externa (oblique, circular, longitudinal)
serosa
Secretions
- parietal cells (stim, inhibit)
- G cells (stim, inhibit)
- ECL (stim, inhibit)
- D cells (stim, inhibit)
- Chief cells (stim)
parietal cells - HCL + IF - stimulated by Ach, gastrin, histamine. inhibited by SS, prostaglandins (PGE1), secretin, CCK.
G cells - gastrin - stimulate by AA, Ach, food (alkaline). inhibited by. inhibited by H+ in the duodeun
ECL- histamine - stimulated by Ach, gastrin. inhibited by SS, H2 blockers
D cells - SS - stimulated by acid. inhibited by vagus
Chief cells - pepsinogen (becomes pepsin by HCl). stimulated by Ach
PUD types
MAAM 1- lesser curve 2 - 2 ulcers 3 - "pre" 4 - "at the door" (cardia) 5 - anywhere (NSAIDS)
metabolic changes with gastric outlet obstruction
hypokalemic, hypochloremic, metabolic alkalosis
Dx and tx:
- alkaline reflux gastritis dx and tx
- dumping syndrome dx and tx
- afferent loop syndrome
- alkaline reflux gastritis - HIDA, PPI, cholestyramine, reglan –> RNY
- dumping syndrome - symptoms (hyperosmotic phase=hypoTN, diarrhea, dizziness. reactive phase=high insulin, low glucose), low carb and frequent meals
- afferent loop syndrome - CT, RNY
Obesity surgery for who?
BMI >35 +comorbidity (DM, HTN, OSA, HLD)
BMI >40
Roux limb length
Y limb length
pouch volume
roux - 130cm
y - 40cm from LOT
pouch - 30-40cc
hypoproteinemic, hypertrophic gastritis
risk factors, diagnosis, treatment
Menetrier’s Disease - parietal cell loss, large gastric folds, CMV + h.pylori in children, premalignant
- dx: chromium labeled albumin test reveal inc GI protein loss
- tx: antichlorhydric drugs or total gastrostomy
omeprazole MOA
blocks H/K atpase
Metoclopramide MOA, AE
Doperidone MOA, AE
Erythromycin MOA, AE
metoclopramide - d2 agonist, 5HT3 antagonist, 5TT4 agonist. AE: inc prolactin, dystonia tardive, AV block, SVT, bradycardia
doperidone - d2 agonist. AE: inc prolactin, QT prolongation
erythromycin - motilin agonist. AE: cholestatic hepatitis, hypersensitivity reaction
vessels ligated during bleeding duodenal ulcer
GDA and transverse pancreatic branch
most common sequela of vagotomy
diarrhea
blood supply to the esophagus
Cervical - inferior thyroid artery (off the thyrocervical trunk)
Thoracic - aorta
Abdominal - L gastric and inferior phrenic nerve
nerve to the cricopharyngeal mm
RLN
Pathophysiology of Achalasia
loss of Nitric oxide inhibitory neurons of the LES
Zenker Diverticulum tx:
Poor surgical candidate → endoscopic
>3cm: endoscopic division of the upper esophageal sphincter creating a common lumen between the diverticulum and the esophagus
<2cm: open myotomy through L neck incision with or without the diverticulectomy
