Gastric

Question 1

What’s treatment for dumping syndrome?

Answer 1

diet modification (slower eating, delay fluid until 30 minutes after meals, avoid simple carbs)
Acarbose, octreotide
Convert Billroth I to Billroth II or RnY

Question 2

What are the nodal levels for gastrectomy?

Answer 2

N1 - Peri-gastric/pyloric
N2 - Celiac axis:
7: L gastric a
8: common hep a
9: celiac axis
10: Splenic hilum
11: Splenic artery
N3
12: hepatoduodenal lig
13: rertropan/periduodenal
14: root of mesentery
N4
15: Middle colic
16: paraaortic

Question 3

What’s elevated DeMeester score?

Answer 3

> 14.72

Question 4

What are the types of gastric carcinoid?

Answer 4

Type I: associated w chronic atrophic gastritis, <1 cm, multiple/polypoid, slow growth and rare mets, tx w endoscopic polypectomy if < 6
Type II: Associated w Zollinger Ellison and MENI, slow growth, more likely to metastasize, localize and resect
Type III: Sporadic, >1 cm at diagnosis, not associated w hypergastrinemia, frequent metastasis, radical resection w regional LAD

Question 5

What are the treatment regimen for PUD?

Answer 5

Triple therapy:
Clarithromycin, amoxicillin, PPI, BID x 2 weeks
Quad therapy:
Bismuth, Flagyl, Tetracycline, Omeprazole x 2 weeks

Question 6

What are the types of peptic ulcers?

Answer 6

Type I: body (most common)
Type II: Body + Duodenum
Type III: Pre-pyloric
Type IV: Lesser curve near GE junction
Type V: Diffuse

Question 7

What are the causes of the types of peptic ulcers?

Answer 7

Type I+IV: Impaired mucosal protection
Type II+III: Acid hypersecretion
Type V: NSAID

Question 8

What are the Forrest Class for bleeding duodenal ulcer? What’s their risk for rebleed?

Answer 8

IA: arterial bleed (90%)
IB: Oozing bleed
IIA: Visible vessel (50%)
IIB: Adherent clot (25-30%)
IIC: Dark base/hematin covered lesion
III: No active bleed (3-5%)

Question 9

What is nerve of Latarjet?

Answer 9

nerve supply of antrum and pylorus