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general surgery jouna > stomach > Flashcards

stomach Flashcards

(65 cards)

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1
Q

what part of the stomach is the cardia

A

where esophagus enter

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2
Q

what part of the stomach is the fundus

A

the tip of the stomach it lies posterior to the 5th left rib in the midclavicular plane (source of gastric bubble).

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3
Q

what is the antrum in the stomach

A

opens up into pylorus and contain pyloric sphincter

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4
Q

what are the layers of the stomach wall

A

-Mucosa & submucosa&raquo_space; simple columnar epithelium.

-Muscular layer:
An innermost oblique muscle layer.
An inner circular layer.
An outer longitudinal layer.

-Serosa (intraperitoneal).

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5
Q

arterial supply of the lesser curvature

A

o Right gastric artery (branch from hepatic artery).
o Left gastric artery (branch from celiac trunk).

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6
Q

arterial supply of greater curvature

A

o Right gastroepiploic artery (branch from gastroduodenal artery).
o Left gastroepiploic artery (branch from splenic artery).

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7
Q

pylorus arterial supply

A

gastroduodenal artery.

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8
Q

Fundus and upper body of stomach arterial supply

A

short posterior gastric arteries
(branch from splenic artery).

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9
Q

posterior duadenal ulcer result from bleeding from what artery

A

Gastroduodenal artery runs behind 1st part of duodenum

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10
Q

lymphatic drainage mostly where in stomach

A

Celiac LNs

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11
Q

venoud drainage in stomach

A

Follows arterial names & drain into the portal venous system.

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12
Q

innervation of stomach

A

Parasympathetic (vagus nerve

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13
Q

Parasympathetic effect:

A

(1) Increase peristalsis.
(2) Increase laminal secretions.
(3) Opens up sphincters.

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14
Q

Sympathetic effects:

A

(1) Diminished activity of viscera.
(2) Close sphincters.
(3) Vasoconstrictor.

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15
Q

what is epigastric pain related to food, early satiety, postprandial belching, & nausea.

A

Dyspepsia

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16
Q

the are located in duodenum or pancreas which result in increased secretion of gastric acid

A

Zollinger-Ellison syndrome defined as a gastrinoma (gastrin secreting tumor)

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17
Q

what are Protective factors of gastric mucosa

A

(1) Mucus secretion.
(2) Bicarbonate secretion.
(3) Prostaglandins (inhibit - acid secretion)

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18
Q

Destructive factors of gastric mucosa

A

(1) NSAIDs
(2) H. Pylori (urease secretion).
(3) Uremia
(4) Bile reflux
(5) Alcohol, smoking, spicy foods

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19
Q

what is defined as deep erosions in the lining of the stomach or duodenum that result in inflammation of gastric or duodenal wall.

A

PUD

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20
Q

when do you suspect ZES

A

if there is multiple ulcers , gastrin levels are >1000pg/mL

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21
Q

What is the duodenum considered as in relation to the small intestines, and where does it begin and end?

A

The duodenum is considered the first and shortest (25 cm) part of the small intestines. It begins at the pylorus and ends at the duodenojejunal junction.

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22
Q

What is the histological characteristic of the duodenum, and what is the function of Brunner’s glands?

A

The duodenum is characterized by having villi and submucosal Brunner’s glands, which function in protecting the duodenal mucosa.

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23
Q

What are the parts of the duodenum and their respective lengths?

A

• 1st part: 2 inches
• 2nd part: 3 inches
• 3rd part: 4 inches
• 4th part: 1 inch

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24
Q

What is unique about the 1st part of the duodenum, and what is its anatomical position?

A

The duodenal cap (first 1 inch of the 1st part) is the only intraperitoneal part.

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25
In the 2nd part of the duodenum, what important structure enters, and what anatomical division does it signify?
The ampulla of Vater enters here; it marks the division between the foregut and midgut.
26
How does the 3rd part of the duodenum relate to the inferior vena cava (IVC) and aorta, and what vessels overrun it?
It crosses to the left, anterior to the IVC and aorta, and is overrun by the superior mesenteric vessels.
27
What is the anatomical pathway and landmark associated with the 4th part of the duodenum?
It ascends to join the jejunum where it takes a sharp turn due to the ligament of Treitz.
28
What is the arterial supply to the 1st and 2nd parts of the duodenum, and which artery do they branch from?
The anterior and posterior superior pancreaticoduodenal arteries, which are branches from the gastroduodenal artery.
29
What is the arterial supply to the 3rd and 4th parts of the duodenum, and which artery do they branch from?
The anterior and posterior inferior pancreaticoduodenal arteries, which are branches from the superior mesenteric artery.
30
What is the venous drainage of the duodenum, and into what system do these veins ultimately drain?
The duodenal veins follow the arteries and drain into the hepatic venous system.
31
Q: What are the main causes of peptic ulcer disease?
• Helicobacter pylori infection (gram-negative bacteria) • NSAIDs (inhibit prostaglandin production, impairing mucosal defenses) • Acid hyper-secretory states (e.g., Zollinger-Ellison syndrome) • Other risk factors: smoking, alcohol, emotional stress, dietary factors (coffee, spicy food)
32
What are the common clinical features of peptic ulcer disease?
• Epigastric pain (aching) • Nausea • Vomiting • Early satiety • Weight loss • May be complicated by upper GI bleeding (hematemesis)
33
What is the pathogenesis of duodenal ulcers?
Caused by an increase in offensive factors (more gastric acid secretion).
34
What is the pathogenesis of gastric ulcers?
Caused by a decrease in defensive factors.
35
What is the H. pylori infection rate in duodenal vs. gastric ulcers?
• Duodenal ulcers: 70–90% of cases • Gastric ulcers: 60–70% of cases
36
What are the common locations/types of duodenal ulcers?
• Posterior duodenal ulcer: Most common; gastroduodenal artery is most likely to bleed. • Anterior duodenal ulcer: More likely to perforate into the lesser sac.
37
Q: What are the types and locations of gastric ulcers?
• Type I (70%): Lesser curvature • Type II: Type I + duodenal ulcers • Type III: Prepyloric (within 2 cm of pylorus) • Type IV: Near esophagogastric junction • Posterior wall ulcers: May result in pancreatitis and bleeding (splenic artery)
38
What is the typical age distribution for duodenal vs. gastric ulcers?
• Duodenal ulcers: In younger patients (<40) • Gastric ulcers: In older patients (>40)
39
What is a specific clinical feature of duodenal ulcers?
Eating relieves pain, and nocturnal pain is more common.
40
What is a specific clinical feature of gastric ulcers?
Eating increases the pain; complications are higher, and recurrence rate is higher with medical therapy.
41
What is the malignant potential of duodenal ulcers?
Low
42
What is the malignant potential of gastric ulcers?
High (5–10% are malignant). Biopsy is required to rule out malignancy, with adenocarcinoma being the most common type.
43
What labs are done in acute abdomen cases related to peptic ulcer disease?
CBC, LFTs, amylase, lipase, RFTs, urinalysis, etc.
44
What imaging is done to rule out emergency causes?
Chest and abdomen X-ray to rule out air under the diaphragm.
45
What is the most accurate diagnostic method for peptic ulcers?
Upper endoscopy
46
What is done during upper endoscopy?
• Biopsies for H. pylori diagnosis and to rule out malignancy in gastric ulcers • Preferred when severe or active bleeding is present (electrocautery of bleeding ulcers) • Malignancy findings: Raised, nodular edges, non-radiating gastric folds
47
When is a barium meal used in diagnosis?
Sometimes used initially but is less reliable than endoscopy.
48
When is serum gastrin measurement indicated?
When considering Zollinger-Ellison syndrome as a diagnosis.
49
What is mandatory if a patient presents with upper GI bleeding and multiple ulcers?
Upper endoscopy must be done.
50
What is the gold standard test for H. pylori diagnosis?
Endoscopic biopsy using Giemsa stain or biopsy urease test.
51
What is the role of the stool antigen test in H. pylori diagnosis?
High sensitivity, easy to perform, and good for screening.
52
What is the advantage of the urea breath test in H. pylori detection?
• Highly sensitive and specific • Detects active infection • Helps assess post-treatment status
53
What is a limitation of the H. pylori serology test?
Low specificity; presence of antibodies does not confirm active infection.
54
What should be ensured before performing stool antigen or breath tests for H. pylori?
The patient should not be taking PPI, bismuth, or antibiotics to avoid false-negative results.
55
What are key lifestyle modifications for peptic ulcer disease management?
• Discontinue aspirin & NSAIDs • Avoid alcohol • Stop smoking • Reduce emotional stress • Avoid eating before bed
56
What is the first-line and most effective acid suppression therapy?
Proton pump inhibitors (PPIs) like omeprazole.
57
How do PPIs work in treating ulcers?
They block the H⁺/K⁺ ATPase pump in parietal cells, reducing acid secretion.
58
How do H2 receptor blockers work in ulcer management?
They block histamine-mediated acid secretion from parietal cells (e.g., cimetidine, ranitidine).
59
What is the role of antacids in peptic ulcer therapy?
Used for adjunctive therapy and symptomatic relief.
60
What drugs are used in triple therapy for H. pylori eradication?
• PPI • Amoxicillin • Clarithromycin (Metronidazole replaces amoxicillin if penicillin allergic)
61
How long is triple therapy for H. pylori given?
A: 14 days
62
What drugs are used in quadruple therapy for H. pylori?
• PPI • Bismuth • Metronidazole • Tetracycline
63
When is quadruple therapy preferred over triple therapy?
In patients with macrolide resistance risk factors.
64
How long is quadruple therapy for H. pylori given?
7 days
65
When can acid suppression agents be discontinued in PUD?
After 4–6 weeks in patients with uncomplicated ulcers who are asymptomatic.

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