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Flashcards in Stomach Deck (22)
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1
Q

Vagotomy for PUD – what at the two main divisions?

A

Left –> Anterior –> hepatic and nerve of Latarej (pylorus)

Right –> Posterior –> high branching, Criminal nerve which innervates the cardia,

2
Q

Three types of vagotomy

A

Truncal
Selective
Highly selective

3
Q

Tx bile reflux inBII

A

lifestyle, cholestyramine, metoclopramide, conversion to Roux en Y with at least 40 Roux limb length

4
Q

h/o bariatric surgery with new obstructing mass (and no h/o trichophagia) is a ohaytophytobezoar. Tx?

A

Tx is chemical dissolution

5
Q

Absolute contra to PD placement (6)

A
loss of peritoneal fxn
impaired ability to use the catheter
Severe protein malnutrition
Active abdominal wall infection, 
active Crohns, UC, ischemic colitis
Frequent diverticulitis
6
Q

MALT lymphoma is strongly associated with ___ therefore the treatment is ___

A

H pylori

Antibiotics

7
Q

Late Dumping syndrome

A
  • Occurs 2-3 hours after a meal
  • large food bolus enters the small bowel, causing a large insulin release on hypoglycemia
  • HYPOGLYCEMIA Leads to inc in catecholes, diaphoresis, tremulousness, weakness, lightheadedness
8
Q

Lap Roux en Y decreases?

A

DM, HTN, and HLD

9
Q

4 cm subethilelial mass on stomach , bx with low grade stromal tumoe exp CD 117 and muttion in the KIT gene. Dx and next step in mgmt?

A

GIST> 2 cm size. (stromal tumor of the stomach)

wedge RESECTION
with negative margins

10
Q

PPI ppx appropriate for:

A
  1. TBI
    SCI
    and Burns
    Mech vent >48 hours predisposes to stress ulcers
    Coagulopathy INR>1.5 or pats <50 inc risk
    High dose steroids
11
Q

Pt with Choledocho s/p Roux En Y surgery ? how to proceed?

A

Lap assisted ERCP

12
Q

BII with megaloblastic anemia

A

chronic afferent loop syndrome

13
Q

Why did the vertical banded gastostmy become unpopular?

A

poor weight loss

ice cream diet

14
Q

Problem with jejunoileal by[ass, it caused caused severe malabsorption and __

A

ESLD

15
Q

58 M with GERD with 6 mos PPI and EGD with Barrett no dysplasia. next step in mgmt?

A

Fundoplication

16
Q

t#n1 gastric adeno. Most appropriate technique for staging laparoscopy?

A

send washings for cytology from the left and right paracolic gutters and pelvis and bx of any suspicious nodules

17
Q

which weight lossw surgery is the most affective in curing diabetes?

A

Biliopncreqatic diversion with duodenal switch

18
Q

S/P antrectomy with truncal vagotomy with new dysphagia? which of the following is correct re: post op dysphagia

A

peri-esophageal fibrosis and lower esophageal denervation in the main underlying pathology

19
Q

60 M evaluated for epigastric pain EGD with bx showing lymphocytic infiltration of lamina propia with lymphoepithelial lesions positive for CD 20. whats the best treatment?

A

Antibiotics – MALT with marginal B zone lymphoma - usually caused by H pylori

20
Q

53 M with only able to eat liquids, upper GI with gastric dilation and pyloric narrowing. EGD negative for Cancer. What is the first line tx?

A

EGD with balloon dilation

21
Q

s/p biliopancreatic diversion POD 14 with tachycardia andperigastric air fluid collection. Dx and next best step in mgmt?

A

I R

22
Q

POst op 1 month from duodenal switch for obesity, tachy and febrile. CT with oral contrast shows intraabdominal contrast pooling, MC leak site for BP diversion after duodenal switch

A

gastric sleeve