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SURGERY > STOMACH > Flashcards

STOMACH Flashcards

1
Q

The LARGEST artery of the stomach

A

Left Gastric Artery - from CELIAC trunk

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2
Q

The most potent STIMULANTS of gastrin release

A

Peptides and Amino Acids

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3
Q

The most potent INHIBITOR of gastrin release

A

acid

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4
Q

Helicobacter pylori infection primarily mediates duodenal ulcer pathogenesis via

A

Antral alkalinization leading to inhibition of somatostatin release

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5
Q

Alarm symptoms that indicate the need for upper endoscopy

A 
age >55 w/ new onset dyspepsia
unintentional weight loss
persistent or recurrent vomiting
progressive dysphagia
recent onset odynophagia
unexplained IDA or GI bleeding
palpable abdominal mass or lymphadenopathy
family history of family GI cancer
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6
Q

Drugs that accelerate gastric emptying

A

Dopamine antagonist - Metoclopramide, Domperidone

Motilin - agonistErythromycin

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7
Q

The most accurate diagnostic test or Zollinger-Ellison syndrome (ZES) is

A

Secretin stimulation test

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8
Q

The MC complication of PUD

A

BLEEDING - melena, hematemesis, syncope

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9
Q

Other complications of PUD

A

PERFORATION - sudden severe abdominal pain, tenderness

OBSTRUCTION - early satiety, anorexia, abdominal pain, distention and vomiting

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10
Q

Tends to penetrate posteriorly into the PANCREAS leading to pancreatitis

A

Duodenal Ulcer

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11
Q

Tends to penetrate into the LEFT HEPATIC LOBE

A

Gastric Ulcer

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12
Q

DDx of Intractability or Nonhealing PUD

A 
cancer
persistent H.pylori infection
noncompliant patient
motility disorder
Zollinger-Ellison Syndrome
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13
Q

PPI Triple Therapy

A

PPI bid
Amoxicillin 1 g bid
Clarithromycin 500 mg bid

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14
Q

Quadruple Therapy - Gold standard for treatment of PUD

A

PPI bid
Bismuth, 2 tablets QID
Metronidazole, 250 mg tid
Tetracycline, 500 mg qid

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15
Q

Bismuth triple therapy

A

Bismuth, 2 tablets qid
Metronidazole, 250 mg tid
Tetracycline, 500 mg qid

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16
Q

MC symptoms of ZES

A

epigastric pain
GERD
diarrhea

17
Q

Uncontrolled secretion of gastrin by pancreatic or duodenal neuroendocrine tumor

A

Zollinger-Ellison Syndrome

18
Q

The preoperative imaging study of choice for gastrinoma

A

Somatostatin receptor scintigraphy (Octreotide scan)

19
Q

The overall risk of significant serious adverse gastrointestinal (GI) events in patients taking nonsteroidal anti-inflammatory drugs (NSAIDs) increases to 5 times in:

A 
patient age >60
prior GI event
high NSAID dose
concurrent steroid intake
concurrent anticoagulant intake
20
Q

Indications for surgery in PUD

A

bleeding
perforation
obstruction
intractability or nohnhealing

21
Q

Risk factors for gastric cancer

A 
family history
diet rich in nitrates (preserved, smoked and cured foods) and salt
diet low in vitamins A and C
type A blood
familial polyposis and adenoma
HNPCC
H.pylori infection
previous gastric surgery
atrophic gastritis
cigarette smoking
adenomatous gastric polyps
Menetrier disease
pernicious anemia
22
Q

MC mesenchymal tumor of GIT

A

Gastrointestinal Stromal Tumor (GIST)

from interstitial cells of Cajal

c-KIT (CD 117) and CD 34 - tumor markers
23
Q

The standard treatment for an isolated 3 cm gastrointestinal stromal tumor (GIST) in the body of the stomach

A

wedge resection

24
Q

Management for LOW grade gastric lymphoma

A

H. pylori eradication

persistent localized lesion: 2nd course of H.pylori eradication + low doses of external beam radiation (EBRT)

advanced lesion: initial H. pylori eradication + EBRT w/ chemotherapy then endoscopic surveillance

25
Q

Management for HIGH grade gastric lymphoma

A

chemoradiation

surgery - reserved for urgent situations or tumor complications like acute hemorrhage, obstruction not relieved by steroids or failure of response to chemoradiation

26
Q

Arise from ENTEROCHROMAFFIN CELLS and are characterize by the ability to secrete biologically active substances

A

Gastric Carcinoids

27
Q

Subtypes of Gastric Carcinoids

A 
TYPE I
	associated w/ type A chronic atrophic gastritis, w/ or w/o pernicious anemia
	MC variant
	occurs in px w/ hypergastrinemia
	women
	benign

TYPE II
carcinoid associated w/ ZES
MEN I

TYPE III
	sporadic form or neuroendocrine carcinoma
	NOT associated w/ hypergastrinemia
	MEN
	SOLITARY
	WORSE prognosis
	large tumors and more advances stage
28
Q

Carcinoid syndrome consists of

A 
secretory diarrhea
flushing
telangiectasia
valvular heart disease
pellagra
cramping
edema
bronchial constriction

debulking surgery + Octreotide (somatostatin analogue)

29
Q

Management of Carcinoid Tumors

A

TYPE I
endoscopic polypectomy
antrectomy for recurrence

TYPE II
treatment of gastrinoma
somatostatin analogue
possible local excision or antrectomy

TYPE III
en bloc resection w/ regional lymph nodes
possible chemotherapy or radiation

30
Q

Middle aged men with epigastric pain, weight loss, diarrhea and hypoproteinemia

A

Hypertrophic gastropathy (Menetrier disease)

associated w/ protein losing enteropathy and hypochloryhydria
large rugal folds spare the antrum
increased risk of cancer
31
Q

Elderly women w/ chronic GI blood loss, associated autoimmune CT disorder and chronic liver disease

A

Watermelon Stomach (Gastric Antral Vascular Ectasia)

dilated mucosal blood vessels in the stomach
resembles portal gastropathy (proximal stomach)

endoscopic therapy
antrectomy
32
Q

Men w/ UGIB which is usually intermittent

A

Dieulafoy lesion

congenital malformation
unusually large tortuous submucosal artery

endoscopic hemostasis, angiographic embolization oversew or resection
33
Q

Treatment for severe early dumping after gastrectomy that is persistent despite an antidumping diet and fiber

A

Octreotide

34
Q

MC complicating symptom post vagotomy

A

diarrhea

SURGERY (27 decks)

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