other foregut issues Flashcards
(40 cards)
Condition after distal gastrectomy wtih Roux en Y reconstruction characterized by delayed gastric emptying in the absence of mechanical obstruction:
Roux syndrome - presents with abdominal pain, N/V, weight loss; diagnosed by gastric emptying study which may show reverse motility in roux limb (moving food toward stomach)
First line treatment of roux syndrome:
promotility agents
second line: surgery to reduce size of gastric pouch
for severe complications perform total gastrectomy and resection of roux limb
Which portions of the stomach have parietal cells (H+) and chief cells (pepsinogen)?
fundus and body
Which portion of the stomach has G cells (gastrin) and D cells (somatostatin)?
antrum
Criteria for metabolic syndrome:
- fasting glucose >100
- waist circumference >40cm in men and >35 cm in women
- triglerides >150
- HDL < 40 for men and <50 for women
Symptoms of dumping syndrome:
diaphoresis, weakness, lightheadedness, tachycardia
Early dumping syndrome (within 30 minutes) cause:
hyperosmotic load delivered to duodenum causes large fluid shift
Late dumping syndrome (2-3 hours after meal) cause:
large fluid bolus hitting duodenum causes insulin surge of release causing hypoglycemia
Treatment options for gastroparesis:
gastric pacemaker pyloroplasty endoscopic stent placement feeding tube botox injections metoclopromide erythromycin
Risk factors for stress gastritis:
prolonged ventilation
coagulopathy
Malignancy is more common in which types of peptic ulcers?
those refractory to medical therapy and those found in the stomach.
Surgical management of gastric adenocarcinoma:
excision with 6cm margins and lymphadenectomy; known to have a wide lateral spread form the primary tumor
What is afferent loop syndrome and what is the treatment?
afferent loop becomes partially or completely obstructed from excessive length of the afferent loop; surgery to convert a Billroth 2 to a Roux en Y is the tx
Ulcer caused by repetitive movement of the GE junction through the hiatus in a hiatal hernia
Cameron ulcer
First steps in management of gastric volvulus:
NGT decompression and IV resuscitation
Features of an abnormal gastric emptying study:
> 60% radiotracer present in the stomach at 2 hours or 10% present at 4 hours
True or false. staging laparoscopy should be performed before neoadjuvant therapy for gastric cancer
True
Triad of symptoms that raises concern for gastric volvulus:
Borchardt triad: severe epigastric pain, inability to vomit, inability to pass NGT
What are the four major arteries that supply blood to the stomach:
right gastric artery
left gastric artery
right gastropepiploic
left gastroepiploic
Which artery should be preserved in a subtotal gastrectomy?
left gastroepiploic artery
Most effective surgical procedure for reversing diabetes
duodenal switch
Antrum contains what type of cells
gastrin producing G cells and somatostatin producing D cells
What is Peterson’s space?
space between Roux limb and transverse colon mesenteries
Presentation and treatment of post vagotomy diarrhea:
presents with watery diarrhea and urgency with no correlation to meals; treat by increasing fiber, decreasing carbs & lactose, eliminating caffeine, and adding cholestyramine
