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Stomach Flashcards

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1
Q

Cells in the fundus & secretions

A

Chief: pepsinogen
Parietal: HCL, intrinsic factor
Enterochromaffin-like cells: Histamine

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2
Q

Cells in pylorus & secretions

A

D cells: somatostatin
G cells: gastrin

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3
Q

Cells in duodenum & secretions

A

I cells: CCK (increase gallbladder & pancreas actions)

K cells: gastric inhibitory peptide (stimulate insulin production)

M cells: motilin (increase intestinal motility). erythromycin - motilin agonist

S cells: secretin (increase pancreas bicarb, decrease gastrin & HCL)

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4
Q

Blood supply to stomach

A

1) Celiac trunk
1a) Left gastric artery
1b) Splenic artery
1c) Common hepatic

2) Left gastric
2a) Eosophageal branches

3) Splenic
3a) Short gastric (supply fundus)
3b) Left gastroepiploic

4) Common hepatic
4a) Hepatic -> right gastric
4b) Gastroduodenal -> Right
gastroepiploic

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5
Q

The ligament of ___ is a suspensory ___ of the ___ that connects the ___ to ___

A

Treitz
suspensory muscle connecting DJ flexure to connective tissue surrounding celiac axis & SMA

*bleeding proximal to this ligament = UBGIT

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6
Q

Haemoptysis vs Haematemesis

A

Haemoptysis
- bloody expectorant from respi system
- pt experience sensation in their throat, blood is frothy & bright red

Haematemesis
- Vomited blood
- Fresh red blood = moderate to severe bleeds
- Coffee-ground vomitus = altered blood due to gastric acid, limited bleeding
- Usually melena can be observed

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7
Q

Types of melena

A

Fresh: jet black, tarry stool, non-particulate, almost liquid

Stale: black-grey, dull, can be particulate (could be bleed that has stopped)

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8
Q

Ddx of black stools

A

Iron stools - from consumption of iron supplement

  • Greenish on rubbing between fingers, particulate
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9
Q

Haematemesis can be due to ___ or ___ bleeds

A

variceal
non-variceal

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10
Q

Causes for variceal bleed

A

Chronic liver disease -> portal hypertension -> portosystemic shunting -> dilated oesophageal veins

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11
Q

Causes of non-variceal bleed

A

Peptic ulcer disease
Stress ulcer
Mallory-Weiss tear
Dieulafoy (AVM of gastric fundus)
Malignancy (gastric/oesophageal CA)
Gastric antral vascular ectasia

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12
Q

What can cause peptic ulcer disease?

A

H.pylori

Drugs: NSAIDs, antiplts, steroids (delay healing), TCM

Smoking

Others: Zollinger Ellison syndrome, hypergastrinemia, stress, head trauma, burns, alcohol

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13
Q

What causes mallory-weiss tear?

A

Violent retching following alcoholic binge

Longitudinal fissures occur in the mucosa of herniated stomach at GEJ

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14
Q

Suspect ___ in pts with BGIT without history of NSAIDs or alcohol abuse

A

Dieulafoy (AV malformation)

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15
Q

questions to ask to classify when assessing UBGIT

A

1) haematemesis vs haemoptysis
2) variceal vs non-variceal
3) quantify amt of bleeding
4) comorbidities

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16
Q

Classifying non-variceal UBGITs

A

1) oesophagus - MW tear, esophagitis, cancer, boerhaave
2) stomach - PUD, gastritis, cancer, dieulafoy
3) duodenum - PUD, lymphoma, periampullary cancers, trauma
4) others

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17
Q

For fluid resus, two large bore __ ___ should be inserted at antecubital fossa

A

18G IV cannula

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18
Q

Bloods to order in haemodynamically unstable pts

A

GXM
FBC
Urea/Cr/E - renal function (isolated uremia = UBGIT)
LFT
PT/PTT/INR
Troponin - risk of MI with severe blood loss
ABG/Lactate

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19
Q

__ tube should be inserted when pt having haematemesis UNLESS suspect ___

A

NG - prevent aspiration, allow gastric lavage prior to OGD

unless suspecting variceal bleed - NG tube will worsen bleed

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20
Q

Targets for fluid resus is to maintain ___, ___, ___

A

Hb >7 / >9 (IHD)
MAP: >60mmHg (perfuse end organs)
Urine output: >0.5ml/kg/hr

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21
Q

What is massive blood transfusion?

A

Transfusion of pt entire blood volume within 24 hrs

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22
Q

Complications of massive blood transfusion

A

Lethal triad: Acidosis, hypothermia, coaulopathy

Acute haemolytic transfusion reaction
Acute febrile non-haemolytic transfusion risk: from pt Abs attacking donor WBC/HLA antigens

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23
Q

Two veins in portosystemic anastomosis that leads to variceal bleeds

Study These Flashcards
A

systemic: Oesophageal branch of azygos
portal: Left gastric veins

24
Q

Risk factors for variceal bleeding

Study These Flashcards
A

Risk for development of varices: Hepatic venous pressure gradient >10mmHg

Risk of bleed: varices size, decompensated cirrhosis, endoscopic stigmata of recent haemorrhage

25
Emergency management of severe variceal bleed is by ____ with a ___ tube that consists of ___
balloon tamponade Sengstaken-Blakemore tube gastric & oesophageal balloons + gastric/eosophageal aspiration openings
26
Predictors of variceal haemorrhage
1) Site: GEJ 2) Size: Grade 1-3 3) Child's score 4) Endoscopic stigmata of recent haemorrhage: red wale marks, cherry red spots, haematocystic spots, erythema 5) Previous haemorrhages
27
Locations of peptic ulcers
Duodenum (75%) Stomach - antrum (20%), lesser/greater curve Oesophagus Multiple sites = suspect ZES
28
Gastric ulcer pain pattern vs duodenal ulcer pain pattern
Gastric: pain occurs after eating, pts tend to avoid food and lose weight Duodenal: pain when hungry, relieved by food
29
Protective mechanisms against ulcer formation
Bicarbonate, mucus secretion Mucosal blood flow to remove protons Epithelial regenerative capacity Prostaglandins to maintain blood flow
30
What are prostaglandins in the stomach impt for? How are they affected by NSAIDs?
NSAIDs impair prostaglandin synthesis PG: increase bicarb & mucus secretion, promote blood flow, inhibit gastric acid secretion
31
H. pylori effect on stomach
Inhibits antral D cells, decrease somatostatin -> increased gastrin -> increased HCL -> gastric metaplasia in duodenum Decreased bicarb in duodenum + increased inflammation = duodenal ulcer
32
Symptoms of dyspepsia
Ulcer-like dyspepsia: burning, gnawing, intermittent epigastric pain Dysmotility-like dyspepsia: non-painful, bloating, belching, early satiety, N/V Unspecified dyspepsia
33
Clinical manifestation of perforated ulcer
Abdominal rigidity, involuntary guarding, generalised pain that worsens on movement Fever, hypotension, tachycardia, sepsis
34
Impt to order ___ when suspecting perforated ulcer
Erect chest X ray - detect free air under diaphragm
35
Diagnostic method for H.pylori
Endoscopic biopsy for CLO (campylobacter-like organism) test: biopsy tissue placed in medium containing urea & phenol red. If H.pylori present to cleave urea, becomes ammonia and pH increase, phenol red change from yellow to red
36
4 main complications for peptic ulcer disease
1) bleed 2) burst 3) block 4) burrow - ulcer penetrates into adjacent abdominal organs, leads to other diseases (eg. pancreatitis)
37
Risk factors for gastric cancer
H.pylori/EBV infection Environmental - smoking, diet (preserved food) Genetic - family history, FAP/HNPCC, familial diffuse gastric cancer PMH - Barrett's, gastric polyps/ulcers, gastric resection, chronic atrophic gastritis
38
Classification of gastric tumours
Boormann's Type 1: polypoid (tumour mostly intraluminal) Type 2: excavating (ulcerated) Type 3: ulcerative (tumour mostly in the wall) Type 4: diffuse thickening/linitis plastica (entire thickness of stomach involved)
39
Most common location of stomach for gastric cancer occurrence
Lesser curvature of the antropyloric region
40
Most gastric cancers are ___. Subtypes are ___
adenocarcinomas a) intestinal type - usually elderly men - papillary, tubular, mucinous - atrophic gastritis -> severe intestinal metaplasia -> dysplasia - less aggro - haematogenous spread b) diffuse type - younger, females - invasive, linitis plastica pattern (signet ring cells) - late presentation, worse prognosis - transmural, lymphatic spread
41
Examples of non-adenocarcinomas of the stomach
gastric neuroendocrine tumours (carcinoids) -> from enterchromaffin like cells lymphoma (MALT) gastrointestinal stromal tumour (GIST) leiomyoma/leiomyosarcoma
42
Cx of gastric cancer
Bleeding Gastric outlet obstruction Intestinal obstruction (carcinomatosis peritonei) Malnutrition Perforation
43
GOO presents as ____ in blood investigations
hypochloremic, hypokalaemic, metabolic alkalosis with paradoxical aciduria
44
Lymphatic spread of GIT cancers result in enlarged __ node at ___
Virchow's Left supraclavicular region
45
Modes of spread of gastric cancer
1) Local - pancreas, transverse colon, duodenum 2) Lymphatic - Virchow's node, perigastric lymph node, para-aortic nodes 3) Haematogenous - lung, hepatosplenomegaly 4) Trans-coelomic - peritoneal seeding, Sister Mary Joseph nodule, Krukenburg tumour (ovary)
46
___ is used to determine ___ of tumour invasion in gastric cancer, which is an important prognostic factor
Endoscopic ultrasound depth of tumour invasion *superior to CT in detecting depth
47
Types of gastrectomies
Total - everything gone including cardia & pylorus Distal - cardia preserved Pylorus preserving - upper 1/3, pylorus, antrum preserved Proximal - pylorus preserved
48
Gastric reconstruction options
1) Billroth I (gastroduodenostomy) 2) Billroth II (gastrojejunostomy) 3) Roux-en-Y esophagojejunostomy 4) Double tract
49
Signs of anastomotic leak post gastrectomy
TACHYCARDIA (early sign) early leak - sepsis, contaminated drain discharge
50
Late cx of gastrectomy
1) early satiety 2) Gastroesophageal reflux -> esophagitis 3) Dumping syndrome
51
What is dumping syndrome?
Post gastrectomy, rapid gastric emptying Hyperosmolar jejunal chyme -> draws water into lumen -> decreased blood volume (hypotension, tachycardia) + abdominal bloating (diarrhea) Rapid glucose absorption -> reactive hyperinsulinemia -> hypoglycaemia
52
Nutritional supplement requirements post gastrectomy
B12 (no more IF to bind) Iron (no more conversion from Fe3 to Fe2 by gastric acid) Vitamin D (fat malabsorption)
53
Loop syndrome occurs when?
Billroth II (gastrojejunostomy) Kinking, narrowing, adhesions of the jejunum causing mechanical obstruction
54
Extranodal lymphoma most commonly occurs in ___
stomach 1. marginal zone B cell lymphoma of mucosal associated lymphoid tissue (MALT) 2. diffuse large B cell lymphoma
55
Gastrointestinal stromal tumours are a type of ___. They are positive for ___ marker, and arises from ___.
soft tissue sarcoma of GI tract CD117 interstitial cell of Cajal
56
Risk factors for obesity
Genetics Environment: diet, culture
57
What are common complications of obesity?
T2DM, HTN, HLD, cardiovascular disease GERD, cholelithiasis, asthma, depression, degenerative joint disease

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