Gastrointestinal Surgery: Part 1 Flashcards
(182 cards)
1
Q
3 main constrictions of Esophagus
A
- Pharyngoesophageal junction (C6)
- Left main bronchus and arch of aorta
- Esophagus pierces diaphragm
2
Q
Distance from upper incisor from the 3 constrictions
A
Pharyngoesophageal junction: 15 cm
Left main bronchus and arch of aorta: 25 cm
Esophagus pierces diaphragm: 40 cm
3
Q
Relevance of constriction at level of Pharyngoesophageal junction
A
- Narrowest portion of GIT
- Foreign bodies can get stuck
- Iatrogenic perforations
4
Q
Features if FB is stuck in Esophagus
A
Lateral view: Side of coin seen
Frontal view: Face of coin seen
Symptoms: Difficulty swallowing
5
Q
Features if FB is stuck in Trachea
A
Lateral view: Face of coin seen
Frontal view: Side of coin seen
Symptoms: Stridor and choking
6
Q
Management of FB
A
- Beyond C6: Patient observation
- Impacted at C6: Endoscopic removal
- Button battery: Endoscopic removal (D/t corrosive nature -> Perforation)
7
Q
Causes of Corrosive injury
A
- Alkali: Liquefactive necrosis -> Penetrates deeper (More dangerous)
- Acids: Pylorospasm -> Gastric damage
8
Q
Grading of Corrosive injuries
A
Zargar classification:
Endoscopic finding. Grading
1. Normal. 0
2. Superficial edema/erythema. 1
3. Mucosal/Submucosal ulceration. 2
4. Transmural ulceration with necrosis. 3
5. Perforation. 4
9
Q
Management of Corrosive injuries
A
- IV fluids and NPO
- NG tube should not be inserted blindly -> Can cause perforation
- No role of prophylactic antibiotics
- No role of steroids
- Definitive management: Mx of stricture
10
Q
Types of Tracheoesophageal fistula (TEF)
A
Type A: Isolated EA
Type B: Proximal TEF with distal EA
Type C: Proximal EA with distal TEF
Type D: Proximal and distal TEF
Type E (or H): TEF without EA (Patent esophagus)
Type F: Esophageal stenosis
11
Q
C/F of TEF
A
- Respiratory distress
- Excessive drooling of saliva
- Coiling of oro-gastric tube
- Rule out: VACTERL anomalies
12
Q
VACTERAL anomalies
A
Vertebral
Anorectal
Cardiac
Tracheoesophageal
Renal
Limb defects
13
Q
Investigations of TEF
A
- Contrast study: Confirmatory Iohexol > Dinosil
- Combined tracheoesophagoscopy: IOC for H type
14
Q
Management of TEF
A
- Waterson’s criteria
- Surgery
15
Q
What is Waterson’s criteria?
A
Birth weight. Pneumonia. Management
1. >=2.5 kg. - Surgery
2. 1.5-2.5 kg. +/- Nutrition supplementation for weight gain -> Sx
3. <1.5 kg. +/- Feeding gastrotomy for nutrition -> Delayed Sx
16
Q
Surgeries done for TEF
A
Type A:
1. 2 ends are close: Anastomose
2. 2 ends are far: Gastronomy -> Anastamosed when ends are close
Type B,C,D,E: Cameron haight surgery
Posterolateral thoracotomy -> Cut fistula -> Repair trachea and esophagus
17
Q
Factors which maintain Lower Esophageal sphincter patency
A
- Length of Intra abdominal esophagus (Most imp):
> 3-5 cm: Normal
> <2 cm: Predisposition to GERD - Pinching effect of right diaphragmatic crura
- Orientation of gastroesophageal Angle of His
- Arrangement of mucosal folds
18
Q
Pre-disposing factors of GERD
A
Inc transient LES relaxation: Earliest physiological indicator
Inc obesity and dec H. Pylori infection rate: Inc GERD
19
Q
C/F of GERD
A
- Retrosternal burning sensation (Heart burn)
- Water brash
- Pharyngitis/Laryngitis
- Chronic cough
- Wheezing
- Dental caries
20
Q
Investigations of GERD
A
- Endoscopy: IOC
- 24 hr pH monitoring: Gold standard
21
Q
Management of GERD
A
- Lifestyle changes:
> Reduce weight
> Small frequent meals
> Last meal 2 hours before bed - Medical Mx: PPI & Prokinetics
- Surgical Mx: Fundoplication
22
Q
Indications of Fundoplication
A
- Not responding to medical Mx
- Complications of GERD +
- GERD a/w large hiatal hernia
- Patient wants to stop medical Mx
23
Q
Principles of Fundoplication
A
- To restore adequate Intra-abdominal length
- To tighten diaphragmatic crura
- To wrap fungus around esophagus
- To preserve vagus nerves
- To re establish angle of His
24
Q
Types of Fundoplication
A
- Complete wrap (Nissen’s 360 deg)
- Partial wrap:
> Dor (180 deg ant)
> Toupet (180-270 deg post)
> Belsey (270 deg ant)
25
Complication of Complete wrap
Gas bloat syndrome
Partial wrap prevent it
26
What is Collis gastroplasty?
Create new esophagus
Inc length by >=3 cm
27
Newer modalities for treating GERD
1. Polymer injection: High recurrence
2. Endoscopic RFA: Good long term results
3. Magnetic sphincter augmentation (LINX)
4. Transoral incision less endoscopic Fundoplication (TEMPO trial)
28
What is Barrett’s esophagus?
Complication of long standing GERD
Specialised intestinal metaplasia (Squamous -> Columnar)
Red velvety mucosa
29
Investigations of Barrett’s esophagus
1. Endoscopic biopsy: Diagnosis
2. HPE: Goblet cells (Pathognomonic)
3. Chromoendoscopy:
> For microscopic involvement
> Methylene blue for Barrett’s/AdenoCa
> Lugol’s iodine for SCC
30
Types of Barrett’s esophagus
1. Long segment: >3 cm
2. Short segment: <3 cm
3. Cardia metaplasia: Microscopic
31
Risk of malignancy in Barrett’s esophagus
High grade dysplasia > Low grade dysplasia > Barrett’s esophagus
32
What is Prague C&M criteria?
M: Max extent = 14 cm
C: Circumferential extent = 6 cm
Correctly identify the gastroesophageal junction
Recognise hiatus and hernia
More C&M score -> Inc risk of Adenocarcinoma
33
Seattle protocol for biopsy in No dysplasia case
Repeat OGD 3-5 yearly (Except with >3 cm: 2-3 yearly)
34
Seattle protocol for biopsy in Low grade dysplasia case
Endoscopic ablation (RFA) of dysplastic mucosa
|
V
OGD after 6 months: Till 2 consecutive non dysplastic biopsies
35
Seattle protocol for biopsy in High grade dysplasia case
MDT discussion
+/- Esophagectomy/RFA
36
Specimen taken for biopsy in Barrett’s esophagus
4 quadrant biopsies every 2 cm + Targeted biopsies of macroscopic lesions
37
Treatment of Barrett’s esophagus
1. RFA: Cost effective + Dec S/E
2. EMR (Endoscopic mucosal resection):
> Removes whole mucosa
> Higher rate of strictures
38
M/C Esophageal cancer in Asia; overall
SCC
39
M/C Esophageal cancer in Western world
Adenocarcinoma
40
Location of SCC in esophagus
Middle 1/3rd
41
Location of Adenocarcinoma in esophagus
Lower 1/3rd
42
Risk factors of SCC
1. Smoking, alcohol
2. Preservative rich food
3. Smoked food
4. Tylosis
5. Achalasia cardia
6. Vit E and selenium deficiency
7. Zenker’s diverticulum
8. Corrosive injury
9. Plummer Vinson syndrome
43
Risk factors of Adenocarcinoma
1. Smoking, alcohol
2. GERD
3. CREST syndrome
4. Barrett’s syndrome
44
C/F of Esophageal cancer
1. Progressive dysphagia (Solids more than liquids)
2. Weight loss
3. Hoarseness: Sign of advanced ds (Left Recurrent laryngeal nerve involvement)
4. Chronic cough
45
Investigations of Esophageal cancer
1. Endoscopic biopsy: IOC
2. PET-CT: IOC for staging (F18-FDG)
3. Endoscopic USG: IOC for T staging
4. Barium swallow: Rat tail appearance (Apple core deformity)
46
What is Siewerts classification?
Used for GE junction tumors
Type I: 5 cm -1 cm above the anatomical cardia
Type II: 1 cm above & 2 cm below the anatomical cardia
Type III: 2 cm - 5 cm below anatomical cardia
Type I&II: Esophageal Ca
Type III: Gastric Ca
47
Treatment of Esophageal cancer
1. Esophagectomy
2. Esophageal replacements
48
Esophagectomy
Margins:
1. Proximal: 10 cm
2. Distal: 5 cm
Min LN removed: 15
49
Esophageal replacements
1. Gastric tube (Best): Based on right gastroepiploic artery and right gastric artery
2. Jejunum/colon: If stomach is affected
3. SEMS (Self expanding metallic stents):
> Used in malignant TEF
> M/C complication: Migration
50
Main prognostic factor for Esophageal cancer
T stage (Depth of invasion)
51
M/C benign tumor of Esophagus
Esophageal leiomyoma
52
Site of Esophageal leiomyoma
Mid to distal esophagus
53
Barium swallow in Esophageal leiomyoma
Punched out appearance
54
Management of Esophageal leiomyoma
1. Enucleation
2. STER: Submucosal Tunneling Endoscopic Resection
55
Features of Zenker’s diverticulum
AKA Cricopharyngeal achalasia
1. Killian’s dehiscence
2. Pulsion diverticulum: D/t inc pressure
3. False diverticulum: Only mucosa comes out
4. Position: Posterior midline (Starts) -> Left of midline (Final)
56
C/F of Zenker’s diverticulum
1. Regurgitation (Earliest)
2. Halitosis
3. Aspiration pneumonitis (M/C complication)
57
Management of Zenker’s diverticulum
1. Diverticulectomy + Cricopharyngeal myotomy
2. If not fit for Sx: Dohlmann’s procedure
58
What is Dohlmann’s procedure?
Endoscopic diverticulopexy + Cricopharyngeal myotomy
Linear stapler/Laser used
Inc recurrence
59
Features of Mid-Esophageal/Parabronchial diverticula
1. True diverticulum
2. Traction diverticulum
3. Cause: TB/Histoplasmosis
4. Large/Symptomatic -> Diverticulectomy
60
Types of Hiatal hernia
Type I/Sliding hiatal hernia
Type II/Rolling/Paraesophageal hiatal hernia
Type III: Sliding + Rolling
Type IV: Paraesophageal (Content: Not stomach)
61
M/C Diaphragmatic hernia
Type I/Sliding hiatal hernia
62
C/F of Type I hiatal hernia
GERD/Asymptomatic
Not life threatening
63
IOC for Type I hiatal hernia
CT with oral contrast
64
Management of Type I hiatal hernia
Surgery only in large/symptomatic hernia
65
What is Type II/Rolling hiatal hernia
Portion of stomach herniates into thoracic cavity -> Volvulus and necrosis (Life threatening)
GE junction: Normal
Mx: Surgery
66
Cause of Iatrogenic perforation
Post endoscopy (Therapeutic, Cancer related, etc)
67
Site of Iatrogenic perforation (Esophageal)
Upper 1/3rd (Narrowest constriction)
68
IOC for Iatrogenic perforation
CECT
69
Treatment of Iatrogenic perforation
Small perforation + Stable patient + No sepsis: Conservative (NPO, IV fluids, IV antibiotics, analgesics)
Large perforation + Sepsis +: Surgical repair
70
Cause of Spontaneous perforation
AKA Boerhaave syndrome
Forceful vomiting against a closed glottis
Seen in alcoholics
71
Site of Spontaneous perforation
Lower 1/3rd (Left posterolateral wall)
72
C/F of Spontaneous perforation
1. Meckler’s triad: S/c emphysema + Retching + Chest pain
2. Hamman’s crunch: Crunching sound on heart auscultation
3. High mortality
73
D/D of Spontaneous perforation
Mallory Weiss tear
74
What is Mallory Weiss tear?
Split in mucosa/submucosa
Upper GI hemorrhage
75
Investigations for Spontaneous perforation
Stable patients: CECT
Unstable patients: Contrast study
X ray: Pneumomediastinum
1. Naclerio V sign
2. Continuous hemidiaphragm
3. Ginkgo leaf sign
4. Pleural effusion
76
Management of Spontaneous perforation
1. Conservative Mx: Stable patients
> Seal perforation
> Adequate drainage
> Nutritional support
2. Endoscopic sealing with clips/SEMS
3. T-tube placement and open repair
77
C/F of Shatzki ring
Intermittent dysphagia
78
What is Shatzki ring?
B ring (Mucosal submucosal)
Ring in portion of hiatal hernia
79
Management of Shatzki ring
If symptomatic -> Dilatation
80
What is Feline esophagus?
Lines markings on imaging
81
Investigation for Feline esophagus
Endoscopy: Stacked up appearance
82
Feline esophagus seen in
1. GERD (M/C), lower 1/3rd
2. Eosinophilic esophagitis, upper 1/3rd
83
What is Eosinophilic esophagitis?
Chronic immune/antigen mediated disease
D/t food antigens -> Cytokines release -> Eosinophilia
84
Investigation of Eosinophilic esophagitis
Endoscopy: Rings, furrows, crepe paper mucosa
Biopsy +: >=15 eosinophils/hpf
85
Treatment of Eosinophilic esophagitis
Steroids, PPI
Goal: <5 eosinophils/hpf
86
Features of Esophageal candidiasis
A/w oral thrush
Seen in immunocompromised patients
Endoscopy: Shaggy appearance
Barium swallow: Worm like ulcers
87
CMV is seen in
Post transplant patients/GVHD
88
Ulcers of CMV in esophagus
Serpiginous/Geographical
89
Features of Esophageal herpes
A/w herpes labialis
Ulcers: Small with raised margins
90
M/C Esophageal motility disorder
Achalasia cardia
91
Cause of Achalasia cardia
Failure of LES to relax
D/t loss of ganglion cells in Myenteric and Auerbach plexus
92
Types of Achalasia cardia
1. Primary Achalasia
2. Secondary Achalasia
3. Vigorous Achalasia
4. Pseudoachalasia
5. Triple A syndrome (Allgrove syndrome)
93
What is Primary Achalasia?
Loss of ganglion cells
94
Secondary Achalasia is secondary to
Chagas’ disease (Trypanosoma cruzii)
95
Which Achalasia is seen in malignancy?
Pseudoachalasia
96
What is Allgrove syndrome?
AKA Triple A syndrome
1. Alacrimia
2. Achalasia
3. ACTH resistant adrenal insufficiency
97
Triad of Achalasia cardia
Dysphagia, regurgitation and weight loss
98
Dysphagia in Achalasia cardia
Initially: Liquids > Solids
Later: Solids > Liquids
99
Other C/F of Achalasia cardia
1. Heart burn
2. Nocturnal coughing
3. Post prandial choking
100
Complication of Achalasia cardia
Aspiration pneumonitis
101
Investigations of Achalasia cardia
1. Barium swallow
2. Endoscopy
To rule out cancer
102
Classification of Achalasia cardia
Chicago classification:
Type I: Classical, DCI <100 mmHg
Type II:
1. Achalasia with Esophageal compression
2. Pan Esophageal pressurization in >20% swallows
Type III: Spastic, DCI >450 mmHg
103
Peristalsis in Achalasia cardia
No normal peristalsis (100% failed) in all types
104
Median IRP in all types of Achalasia cardia
Elevated (>15 mmHg)
105
What is Eckardt score?
1. Weight loss
2. Retrosternal pain
3. Dysphagia
4. Regurgitation
106
Treatment of Achalasia cardia
1. Botox
2. Heller’s myotomy
3. Pneumatic dilatation
4. Per-oral endoscopic myotomy (POEM)
107
Disadvantages of Botox
1. Highest recurrence
2. Repeated injections: Scarring
3. Restricted to elderly patients with co-morbidities
108
What is Heller’s myotomy?
Laparoscopic myotomy: 6 cm proximal to 2-3 cm distal
Better outcome in type I & II
M/C complication: GERD
109
Indications of Pneumatic dilatation
Elderly, female undulated esophagus, type II Achalasia
110
POEM is best for
Type III and other spastic conditions
111
Procedure of POEM
Submucosal tunneling -> Muscles out -> Mucosa sutured
112
Complication of POEM
Inc rate of esophagitis
113
Features of Distal Esophageal Spasm
1. 5 times less common than Achalasia
2. Simultaneous, repetitive, high amplitude contractions
114
C/F of DES
1. Chest pain (Angina like)
2. Dysphagia
115
Investigations for DES
1. ECG
2. Manometry
3. Barium study: Corkscrew/Rosary bead appearance
116
Features of CHPS
Pyloric hypertrophy -> Gastric outlet obstruction
Usually affects 1st born male child
117
C/F of CHPS
2-3 weeks
Normal at birth ——————> Projectile, non bilious vomiting
118
Findings of CHPS on examination
1. Palpable olive shaped epigastric mass
2. Visible peristalsis (Left -> Right)
Feeding: Best time to examine
119
D/D of CHPS
Duodenal atresia
120
Difference b/w CHPS and Duodenal atresia
CHPS. Duodenal atresia
At birth Normal. Bilious vomiting
Complaints Non bilious projectile Bilious vomiting
Vomiting after few weeks
Seen M/C in. 1st born male child. Down syndrome
IOC. USG. X ray
Mx. Ramstedt. Duodenoduodenostomy
Pyloromyotomy
121
Investigations for CHPS
1. USG: IOC -> Pyloric channel -> Thickness >4 mm; Length >16 mm
2. Contrast study:
> Mushroom sign
> Double track sign
3. Labs: Hypochloremic hypokalemic metabolic alkalosis with paradoxical aciduria
122
Treatment of CHPS
Correction of metabolic abnormality:
1. Best fluid: 0.45% NS + Dextrose + KCl (If urine output: N)
2. RL
Ramsteadt’s pyloromyotomy
123
What is Ramstedt’s pyloromyotomy?
Surgical Mx of CHPS
Pylorus cut -> Mucosa should bulge out
Resume feeding:
1. Uneventful Sx: Within 4-6 hours
2. Mucosal injury +: After 24-48 hours
124
M/C Peptic ulcer
Duodenal ulcers (90% a/w H. Pylori and inc in acid production)
125
M/C complication of Peptic ulcers
Bleeding
126
M/C cause of upper GI hemorrhage
Peptic ulcer
127
Types of Duodenal ulcers
Anterior and posterior ulcers
128
M/C complication of Post ulcers
Bleeding (D/t erosion of gastroduodenal artery)
129
M/C complication of Anterior ulcer
Perforation -> Perforation peritonitis
130
Management of Post ulcers
Fails
Endoscopic (2 attempts) ———-> Open surgery (Underrunning of vessel)
131
C/F of Anterior ulcers
1. Pain
2. Inc HR, Dec BP
3. Rebound tenderness
4. Board like rigidity
132
Investigation for Ant ulcers
X ray: Gas under diaphragm (Hollow viscus perforation)
133
Treatment for Anterior ulcers
NPO
IV fluids
IV antibiotics
Painkillers
Emergency exploratory laparotomy + Omental patch repair
134
Types of Gastric ulcers
Johnson criteria:
Type 1: Along lesser curvature; M/C
Type 2: Prepyloric + duodenal; A/w acid hypersecretion
Type 3: Only prepyloric; A/w acid hypersecretion
Type 4: Body of stomach; Bleed most commonly: D/t left gastric artery branches
135
Management of Gastric ulcers
1. Biopsy must be done to rule out malignancy
2. Antrectomy
3. Pauchet’s procedure (Type 4 ulcers)
136
Toxins released by H. Pylori
CAG-A and VAC-A genes
137
What helps H.Pylori to survive in acidic environments?
Urease
138
H. Pylori is a/w
1. Peptic ulcers
2. Type B gastritis
3. Gastric cancer
4. MALTomas
139
H. Pylori is slightly protective against
1. Adenocarcinoma esophagus
2. Barrett’s esophagus
140
Types of Gastric reconstruction surgeries
1. Bilroth I
2. Bilroth 2 (Poly A reconstruction)
3. Roux-en-Y gastrojejunostomy (M/C)
141
Procedures where Bilroth 1 is used
1. Gastric resection
2. Gastroduodenal anastomosis
142
Procedures where Bilroth 2 is used
1. Gastric resection
2. Close duodenal stump
3. End-to-side gastrojejunal anastomosis
143
Procedures where Roux-en-Y gastrojejunostomy is done
1. Gastric resection
2. Close duodenal stump
3. End-to-side gastrojejunostomy
4. End-to-side jejunojejunostomy
144
Types of Vagotomy
1. Truncal
2. Highly selective
145
What is Truncal vagotomy?
Maximal acid reduction
Least ulcer recurrence
Max vagotomy related complication
146
What is Highly selective vagotomy?
Least acid reduction
Max ulcer recurrence
147
Complications of Vagotomy and Reconstruction
1. Nutritional deficiencies
> M/C: Iron deficiency
> Other deficiencies: Vitamin B12, Vitamin D3
2. Internal hernia
3. Dumping syndrome
148
Types of Internal hernia
1. Petersen’s hernia
2. Stemmer’s hernia
149
What is Petersen’s hernia?
Bowel loop herniates behind roux limb
Seen in Antecolic reconstruction
150
What is Stemmer’s hernia?
Bowel loops herniate through transverse mesocolon
Seen in Retrocolic reconstruction
151
Diff b/w both types of Dumping syndrome
Early. Late
1.Occurs d/t rapid influx of fluid in the Rebound hypoglycaemia d/t excessive insulin release
Bowel d/t hyperosmolar contents in bowel
2. Epigastric fullness, nausea & vomiting. Hypoglycemia (Tachycardia, sweating, headache)
3. Worsens with more food. Improves with more food
4. Starts in 15-20 mins after food. Starts in 30-40 mins after food
152
Prevention of Dumping syndrome
1. Small frequent meals
2. Avoid liquid with meals
3. Avoid sugar rich liquids
4. Avoid simple sugars
5. Take high protein/fat diet
6. Resistant cases: Try octreotide
153
Risk factors of Gastric cancer
1. Smoking
2. Alcohol
3. Smoked fish/food
4. Preservative rich food
5. H. Pylori
6. Gastric resection
7. Polyps
154
Lauren’s classification of Gastric cancer
Intestinal. Diffuse
1. Environmental. Familial
2. Gastric atrophy, intestinal metaplasia. Blood type A
3. Inc incidence with age. Younger age
4. Gland formation. Poorly differentiated
Signet ring cells
5. APC gene mutations. Mutated E-Cadherin gene (Dec E-Cadherin)
155
Japanese classification of Gastric cancers
For early gastric cancers: Above muscle layer
Type I: Best prognosis
156
Borrmann’s classification of Gastric cancer
For advanced gastric cancers: Invading muscle layer
Type IV (Linitis plastica): Worst prognosis
157
What is Troisier sign/Virchow LN?
Left Supraclavicular LN (Sign of advanced Ca in any malignancy)
158
What is Irish nodule?
Left Axillary lymphadenopathy
159
What is Blumer’s shelf?
Mets into pelvis/pouch of Douglas (Sign of advanced Ca in any GI malignancy)
160
What is Sister Mary Joseph nodule?
Periumbilical mets
M/C: Gastric > Ovarian Ca
161
What is Krukenberg tumor?
B/L Ovarian mets
Seen in gastric or lobular breast Ca
Diffuse gastric Ca: Signet ring cells
Spread: Retrograde lymphatics
162
What is Leser-Trelat sign?
Multiple seborrheic keratosis (Internal malignancy)
163
What are Tripe palms?
Hyperkeratotic palms (Internal malignancy)
164
Investigations of Gastric cancer
1. Endoscopic biopsy: IOC
2. PET-CT: IOC for overall staging
3. EUS: IOC for T staging (Main prognostic factor)
165
Surgical management of Gastric cancer
Primary tumour:
1. Margins: Proximal margin -> 5 cm, Distal margin -> Pylorus
2. Resection: Distal/Subtotal (Antral tumour)/Total
Lymph nodes:
1. D1 gastrectomy: 1-6 stations removed
2. D2 gastrectomy: 1-11 stations removed
166
M/C site of metastasis in Gastric cancer
Liver
167
Origin of GIST
Intestinal pacemaker cells of Kajal
168
M/C site of GIST
Stomach
169
Triad of Sporadic GIST
Carney’s triad:
1. Gastric GIST: A/w SDH-B mutation (Primary imatinib resistance)
2. Pulmonary chondromas
3. Paragangliomas
170
Syndrome in Familial GIST
1. Gastric GIST
2. Paraganglioma
171
IOC for GIST
CECT
172
C/F of GIST
1. Upper GI hemorrhage
2. Lump
3. Perforation
173
Treatment of GIST
1. Surgical resection: 2 cm margin
2. Malignant/Metastasis: Sx + Imatinib
3. Imatinib resistant: Sunitinib/Sorafenib
174
M/C extra nodal site for Gastric lymphoma
Stomach
175
M/C type of Gastric lymphoma
Diffuse large B-cell lymphoma
176
C/F of Gastric lymphoma
Lump, upper GI bleed
177
What is MALToma?
A/w H. Pylori
Low grade: Responds to H. Pylori eradication
High grade: Treat like lymphoma
178
Triad seen in Gastric volvulus
Borchardt’s triad:
1. Unproductive retching
2. Inability to pass Ryle’s tube
3. Epigastric pain
179
Types of Gastric volvulus
1. Organoaxial (M/C): A/w diaphragmatic defect; vascular compromise +
2. Mesenteroaxial: Chronic symptoms; Diaphragmatic defects less common
180
IOC for Gastric volvulus
CECT
181
Management of Gastric volvulus
Derotate stomach
Fix underlying cause
181
What is Trichobezoar?
Hairball in the stomach
Secondary to trichophagy (Eating one’s own hair)
Mx: Surgical removal -> Psychiatry reference
