Lange - Upper GI

Question 0

Patient with combination of acute abdomen with upright CXR showing free air under diaphragm – next step in diagnosis?

Answer 0

Take to OR for exploration (no other test needed)

Question 1

Highly selective vagotomy? Difference from other vagotomies?

Effect on complication rate? Recurrence rate?

Answer 1

Nerve supply to the pylorus left intact – no drainage procedure is necessary

Lower complication rate but higher recurrence rate

Question 2

Treatment for perforation?

Answer 2

If benign clinical presentation or improving, consider antibiotics with nasogastric decompression (nonsurgical)

Question 3

Necessary procedure following truncal vagotomy?

Answer 3

pyloroplasty (Drainage procedure)

Question 4

Typical complications after vagotomy?

Answer 4

1. Diarrhea
2. Delayed gastric emptying
3. Dumping syndrome
4. Intussusception
5. Afferent Loop syndrome

Question 5

Dumping syndrome? Types?

Answer 5

Early dumping – occurs within 30 minutes, caused by rapid gastric emptying of hyperosmolar load to small bowel

Late dumping – 1-3 hours after eating with vasomotor symptoms (related to excess release of insulin in response to postprandial glucose rise)

Question 6

When to surgically treat prolapse of gastric mucosa into duodenum?

Answer 6

Obstructive symptoms (vomiting)

Question 7

Most common blood type in patients with duodenal ulcer disease?

Answer 7

Group O

Question 8

Post gastrectomy – nutrient absorption that is most affected?

Answer 8

Iron – acid needed to release ferric iron from food

Question 9

Billroth I?

Answer 9

Partial gastrectomy with gastroduodenal anastomosis

Question 10

Treatment of gastric ulcer vs duodenal ulcer?

Answer 10

1. Biopsy for malignancy
2. Biliroth I (partial gastrectomy with gastroduodenal anastomosis)
3. Vagotomy – gastric ulcers not associated with acid hypersecretion

Question 11

Can provoke increase in gastrin levels in patient with ZES by giving?

Answer 11

Calcium or secretin

Question 12

Complication of chronic duodenal ulcer?

Answer 12

Pyloric obstruction due to scarring and stenosis of duodenum

Question 13

Gastrin produced where?

Stimulates?

Answer 13

Antrum and small intestine.

Stimulates parietal cells to secrete acid; stimulates chief cells to secrete pepsinogen

Question 14

Treatment for:

1. Early gastric cancer
2. Antral gastric cancer
3. GIST

Answer 14

1. Gastric resection or endoscopic resection

2. Distal subtotal gastrectomy with the lymph node dissection and chemoradiation

Question 15

GISTs do not respond to?

Answer 15

Radiation or chemotherapy

Question 16

Location of:

1. Eosinophilic gastroenteritis?
2. Menetrier’ disease?

Answer 16

gastric antrum

proximal stomach

Question 17

Incisura?

Answer 17

Where body of the stomach ends and antrum begins

Question 18

Treatment of choice for gastric lymphoma?

Answer 18

Chemotherapy and radiation (surgery)

Question 19

Characteristics sign of a GIST on barium studies?

Answer 19

Donut sign

Question 20

Type of polyp that is unlikely to become carcinoma? Other type of polyp? Location?

Answer 20

Hyperplastic

Adenomatous – Antrum

Question 21

Gastric volvulus associated with?

Answer 21

Paraesophageal hiatal hernia

Question 22

Symptoms of an acute gastric distention? Best treatment?

Answer 22

Vasovagal reaction ; Nasogastric decompression

Question 23

Autoimmune metaplastic atrophic gastritis associated with?

Answer 23

hypochlorhydria parietal cell antibodies and high gastrin

Question 24

Patient gets truncal vagotomy – also needs? Types?

Answer 24

Drainage procedure Pyloroplasty, gastrojejunostomy, antrectomy

Question 25

Difference in management of older patient with peptic ulcer bleeding? Why?

Answer 25

``` Surgery indicated earlier stage – #vessels atherosclerotic and less likely to stop bleeding spontaneously #diminished perfusion less well-tolerated ``` Oversew gastroduodenal artery, vagotomy, drainage

Question 26

Patient presents with RUQ pain. Sonogram cannot distinguish?

Answer 26

Acute cholecystitis

Question 27

Treatment for GIST?

Answer 27

Resection of mass or Gleevec

Question 28

Pernicious anemia associated with?

Answer 28

Anchlorhydra and gastric carcinoma

Question 29

Between what muscles does a Zenker. Diverticulum emerge?

Answer 29

Cricopharyngeus and inferior constrictor muscle | Killian's triangle

Question 30

Surgical treatment for symptomatic pharyngeal esophageal diverticulum? Etiology ?

Answer 30

Myomectomy (if asymptomatic, no treatment) Failure of cricopharyngeus muscle to relax

Question 31

Epiphrenic diverticulum associated with? Symptoms? Treatment?

Answer 31

Hiatal hernia, esophageal spasm, achalasia Typically asymptomatic; no treatment unless symptomatic

Question 32

Plummer-Vinson syndrome?

Answer 32

Esophageal web + atrophic oral mucosa + brittle nails + Fe deficiency anemia