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STOMACH Flashcards

(47 cards)

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1
Q

Blood supply stomach

A

Left gastric - mallory weiss and type 4 ulcer
Right gastric - common hepatic artery

Lt gastroepiploic & short gastric - splenic a
Rt gastroepiploic - gastroduodenal a

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2
Q

Drug a/w IHPS

A

Erythromycin

In early life

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3
Q

Syndromes a/w IHPS

A

Trisomy 18
Apert syndrome
Cornelia de Lange syndx..

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4
Q

Cl/f IHPS

A

Symptoms after 2-3 wk of birth

Projectile NON BILIOUS vomitting
Visible peristalsis Lt to Rt
Olive shaped lump in epigastrium

Metabolic abnormalities:

Hypokal
Hypochlor
Hyponat
Metabolic alkalosis
Paradoxical aciduria

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5
Q

Radiology IHPS

A

Usg - Antral Nipple Sign

X ray - single bubble sign

Contrast - string sign
Double track sign
Mushroom sign

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6
Q

management IHPS

A

Rehydrn
N/2 NS + KCl + Dextrose

Sx - Ramstedt Pyloromyotomy

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7
Q

Mc site for peptic ulcer
Mc vessel implicated in bleed

A

Duodenum - D1

Gastroduodenal a in posterior duodenal ulcer

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8
Q

Which ulcer perforates and causes what

Which ulcer bleeds

A

ANTERIOR duodenal ulcer perforates - chemical peritonitis

POSTERIOR - bleeds into Gastroduodenal a
(Visualised by KOCHERIZATION)

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9
Q

Which repair in perforation peritonitis

A

GRAHAM’s PATCH repair using Omental patch

Giant perforn >2.5 - 3cm
TRIPLE TUBE TECHNIQUE

Duodenostomy tube
Ryles tube
Jejunostomy tube

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10
Q

VALENTINO syndrome

A

Collection in RIGHT retroperitoneum

Mimics acute appendicitis

RENAL VEIL SIGN - collection of air around rt kidney

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11
Q

Maneuver for fundal ulcers

A

U maneuver

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12
Q

Named classification for gastric ulcers

A

JOHNSON’S CLASSIFICATION

Type I (mc) - along lesser curvature
II - prepyloric & duodenal
III - prepyloric
IV - body of stomach (bleeds mc)
(Lt gastric a)

V -diffuse / NSAID ulcer

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13
Q

Mc complication of duodenal & gastric ulcer

A

Duodenal - bleeding

Gastric - perforation

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14
Q

Mx gastric ulcer perforation

A

Type I - Distal Gastrectomy

II & III - Distal gastrectomy + vagotomy/PPI

IV - PAUCHET procedure
CSENDES procedure

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15
Q

H.pylori can cause..

A

Peptic ulcer
Type B gastritis
Gastric Cancer
MALToma

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16
Q

Billroth I

A

Distal gastrectomy with end to end gastroduodenal anastomosis

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17
Q

Billroth II or Polya reconstruction

A

Subtotal gastrectomy with end to side GASTROJEJUNOSTOMY and closure of duodenal stump

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18
Q

Roun en Y gastrojejunostomy

A

Subtotal gastrectomy

Closure of duodenal stump

Jejunum cut 50 cm from DJ flexure

Distal jejunum with all bowel lifted up and end to side GASTROJEJUNOSTOMY
(ROUX LIMB)

Proximal 50cm jejunum with all liver and pancreatic secretions anastomosed with end to side JEJUNOJEJUNOSTOMY
(BILIO-PANCREATIC LIMB)

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19
Q

Hernias a/w Roux en Y GJostomy

Study These Flashcards
A

Antecolic - bowel herniation behind roux limb k/a PETERSONS hernia

Retrocolic - bowel herniation THROUGH TRANSVERSE MESOCOLO - STEMMERS hernia

20
Q

Cause of & Drainage procedure for Impaired gastric emptying after vagotomy

Study These Flashcards
A

Cutting of motor branch to pylorus coming from anterior trunk of vagus

HEINKE MIKULICZ PYLOROPLASTY
where longitudinal incision given and sutured transversely

21
Q

Types of VAGOTOMY

Study These Flashcards
A
  1. Truncal vagotomy + Antrectomy
  2. Truncal vagotomy + Gastrojejunostomy
  3. Highly selective Vagotomy
22
Q

Highly Selective Vagotomy

Study These Flashcards
A

Distal 6-8 cm esophagus skeletonized

Crows foot branches cut

Denervation stopped 7cm proximal to pylorus therefore sparing distal pylorus and antrum and avoiding stasis

23
Q

Complications VAGOTOMY

Study These Flashcards
A

H’ge

Anastomotic leak

Duodenal stump blowout of POD4
L/t peritonitis

Peptic ulcers at anastomotic site

Post vagotomy diarrhoea
(Not responding to Octreotide)

Bilious vomitting

Gall stone formation

Impaired gastric emptying

Nutritional def

DUMPING syndrome

24
Q

Nutritional def VAGOTOMY

Study These Flashcards
A

Mc - Iron def

B12 def

Calcium def

25
DUMPING SYNDROME
EARLY - Rapid transit of content from stomach to bowel causes bloating, vomitting, pain and nausea 10-20 mins post food Worsens with more food LATE - Rebound HYPOGLYCAEMIA d/t Insulin release causing tachy, sweating, palpitations, headache After 30-40 min post food Improves w more food
26
Ca stomach RF
H. pylori Gastritis True ADENOMATOUS polyp Alcohol Smoking Preservative rich food Smoked food Fish Blood gp A Gastrectomy and reconstruction (4x) Menetriers disease
27
Menetriers disease
TFG alpha causes PROTEIN LOSING ENTEROPATHY Hypertrophy of gastric mucosal folds
28
Mc gastric polyp
METASTATIC POLYP D/t H.pylori and doesnt inc ca risk
29
Laurens classification
INTESTINAL envtl Males Inc w age Gastric atrophy + intestinal metaplasia Gland formation Hemat spreak APC mutation Microsatellite instability P53, p16 mutn DIFFUSE Familial Women Young age Blood gp A Poorly differentiated SIGNET RING CELLS Lymphatic / Transmural spread Dec E cadherin CDH mutation P53, p16 mutn
30
JAPANESE classification
For EARLY gastric Ca (no muscle invasion) Type I - Polypoidal (best prognosis) IIa - elevated IIb - flat IIc - depressed III - excavated
31
BORMANN classification
For ADVANCED gastric ca (invades muscle) Type I - polypoidal II - ulcerated w raised borders III - Ulcerated & infiltrates gastric wall IV - diffusely infiltrating (LINITIS PLASTICA) (WORST prognosis) V - unable to classify
32
MOLECULAR classification
Subtype I - Microsatellite instability- (best) Subtype II - EBV type Subtype III - Chromosomal instability Subtype IV - Genomically stable - (worst)
33
Cl/F gastric ca
Lump Outlet obstruction (mcc) Anorexia Anemia Neodyspepsia Silent presentation Wt loss Atypical presentations (8)
34
Atypical features of ca gastric
1. Sister mary joseph nodule (SIGNET RING CELLS) 2. Krukenberg tumor 3. IRISH NODULE - lt. Axillary LN 4. BLUMER SHELF - pelvis / POD 5. Virchow node 6. Trosseau syndrome - migratory throm.. 7. LESER TRELAT - Multiple seborrheic keratosis 8. TRIPE PALMS - Hyperkeratotic palms
35
Types of gastrectomy
Distal gastrectomy (30%) - tumor at pylorus / antrum Subtotal / Partial (60-70%) - at body Total - at fundus or siewert type II
36
Stomach LN stations
LEVEL I (1-6) Rt paracardial Lt paracardial Lesser curvature Greater curvature Suprapyloric Infrapyloric LEVEL II (7-11) Lt gastric Common hepatic Celiac Splenic hilum Splenic artery Hepatoduodenal ligament Retro pancreatic
37
Chemo and neoadj. Chemo indications ca stomach
Chemo - advanced Muscle invasion LN positive Neoadj- bulky tumor T3,T4
38
Mc site for local recurrence post sx
Gastric bed (give RT)
39
Rx for PDL1 mutn
Pembrolizumab Nivolumab
40
S1 chemotherapy
ORAL chemo for metastatic ca Tegafur Otercail Gimeracil
41
CARNEY’s triad CARNEY STRATAKIS syndrome
CARNEY triad in SPORADIC GIST: Gastric GIST - imatinib resistant Multifocal and aggressive Paragangliomas Pulmonary chondromas CARNEY STRATAKIS synd.. in FAMILIAL GIST Gastric GIST Paragangliomas
42
GIST mx
Sx with 2cm margin Gastric - wedge resection Intestinal - R&A Remove adhering structures
43
Rx for Malignant GIST
Imatinib Sorafenib Sunitinib
44
Named classification for GIST
FLETCHERS classification for malignancy risk: Very low Low Intermediate High
45
Pathological types of GIST IHC of GIST
Spindle type Epithelioid type Cd117 + (mc) Cd34 + DOG1 + (most specific) Wild type GIST: Cd117 -ve PDGF alpha -ve
46
BORCHARDT’s triad
Seen in Gastric volvulus Upper abdo pain Retching Inability to insert RYLES tube
47
Sign in contrast study of volvulus
CASCADE SIGN

SURGERY (6 decks)

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