Stomach

Question 1

Type 1 Hiatal Hernia

Answer 1

Sliding >90%

Question 2

Type 2 Hiatal hernia

Answer 2

Purely paraesophageal - GE junction is in the NORMAL location

Question 3

Type 3 hiatal hernia

Answer 3

Combined sliding and paraesophageal

Question 4

Type IV hiatal hernia

Answer 4

Entire stomach in chest + another organ (usually colon) - needs repair

Question 5

Type I gastric ulcer - location and cause

Answer 5

Lesser curve - decreased mucosal protection

Question 6

Type II gastric ulcer - location and cause

Answer 6

Lesser curve and duodenum - increased acid production

Question 7

Type III gastric ulcer - location and cause

Answer 7

Type THREE = PRE pyloric - increased acid production

Question 8

Type IV gastric ulcer - location and cause

Answer 8

Proximal lesser curve - decreased mucosal protection

Question 9

Type V gastric ulcer - location and cause

Answer 9

Diffuse - NSAIDS

Question 10

Siewart Classification - Class I

Answer 10

1-5 cm above GE junction

Question 11

Siewart Classification - Type II

Answer 11

Within 1cm above and 2cm below the GE junction

Question 12

Siewart Classification Type 3

Answer 12

2-5cm below the GE junction

Question 13

Type of volvulus that cases rotation along axis of stomach from GE junction to pylorus

Answer 13

Organoaxial

Question 14

Type of volvulus that causes rotation along short axis of stomach bisecting the lesser and greater curvature

Answer 14

Mesoaxial

Question 15

Deemester score of greater than _____ indicates reflux

Answer 15

14.72

Question 16

Bochdalek Hernia

Answer 16

Diaphragmatic posterior lateral

Question 17

Morgagni Hernia

Answer 17

Congenital Anterior Diaphragmatic Hernia

Question 18

H. pylori triple therapy

Answer 18

1. Amoxicillin (or Flagyl), 2. Clarithromycin, 3. PPI

Question 19

Treatment for bleeding that cannot be controlled endoscopically?

Answer 19

Midline laparotomy, anterior gastrotomy, oversew the bleeding area, biopsy, close

Question 20

Treatment for duodenal bleeding that cannot be controlled endoscopically?

Answer 20

Longitudinal anterior duodenotomy, control bleeding with sutures placed superior and inferior to ulcer (taking care to avoid CBD), approximate ulcer crater, close duodenotomy transversely - 0 Vicryl UR 6

Question 21

Hereditary diffuse gastric cancer is caused by a germline mutation in?

Answer 21

CDH1

Question 22

Women with CDH1 are at increased risk of?

Answer 22

Breast CA

Question 23

FAP is caused by a mutation on which gene?

Answer 23

APC 5q21

Question 24

T1b gastric cancer invades into?

Answer 24

The submucosa

Question 25

T1a gastric cancer invades into?

Answer 25

Lamina propria or muscularis mucosa

Question 26

Who gets neoadjuvant chemo in gastric cancer?

Answer 26

T2 (invades muscularis propria) or higher or any N

Question 27

How many lymph nodes are needed in gastric cancer resection?

Answer 27

15 nodes

Question 28

D1 dissection

Answer 28

Stations 1-6

Question 29

D2 dissection

Answer 29

Stations 7-11

Question 30

Adjuvant therapy in gastric cancer

Answer 30

5FU based therapy - T3 (invades into subserosa), T4 (invades through serosa or adjacent structures) or node + disease after R0 (negative microscopic margin) resection

Question 31

Gastric mass with expansion of marginal zone compartment with sheets of lymphoid cells

Answer 31

Maltoma- Treatment of H. pylori

Question 32

Which hormone is inhibited by acidification of the duodenum?

Answer 32

Gastrin

Question 33

What is the treatment of GIST?

Answer 33

All should be resected with wedge, R0 resection if greater than or equal to 2cm

Question 34

Stomach mesenchymal neoplasm expressing CD117 and KIT

Answer 34

GIST

Question 35

What is a D2 dissection?

Answer 35

Removal of perigastric lymph nodes + nodes around the left gastric, common hepatic, celiac and splenic arteries

Question 36

What surgery is performed for mid-distal gastric cancers?

Answer 36

Partial gastrectomy with 5cm proximal margin and 2cm distal margin on the duodenum

Question 37

Surgical option for refractory gastroparesis?

Answer 37

Pyloroplasty

Question 38

Gastric emptying study is abnormal if?

Answer 38

>60% of tracer present after 2 hrs, or >10% remains after 4 hrs

Question 39

Which type of polyps have no malignant potential?

Answer 39

Fundic polyps

Question 40

Spiral shaped, gram negative, motile bacteria that reside in the mucosa of the stomach

Answer 40

H. pylori

Question 41

Treatment of bile reflux after partial gastrectomy?

Answer 41

1. Lifestyle management, weight loss, cholestyramine 2. Conversion to Roux-en-Y

Question 42

What is the most common type of Sarcoma found in the GI tract?

Answer 42

GIST - originating from the interstitial cells of Cajal

Question 43

Absolute contraindications to PD catheter placement

Answer 43

Question 44

Which type of vagotomy patients have higher incidence of dumping syndrome?

Answer 44

Truncal vagotomy

Question 45

Highly selective vagotomy

Answer 45

Removes innervation only to the lesser curvature (pylorus preserving)

Question 46

Truncal vagotomy

Answer 46

Removes innervation to both vagus nerves (pylorus loses function) - requires drainage

Question 47

Placement of vagus nerve at GE junction

Answer 47

Left anterior, right posterior (LARP)

Question 48

Stage IV gastric lymphoma (bleeding or obstruction management)

Answer 48

Chemotherapy, palliative gastrectomy

Question 49

Which technique can help to reduce gastric band slippage?

Answer 49

Pars-flaccida technique