stomach 2

Question 1

What is the most common cause of upper GI bleeding?

Answer 1

Peptic ulcer disease (PUD).

Question 2

Which artery is most commonly involved in duodenal ulcer bleeding?

Answer 2

Gastroduodenal artery.

Question 3

What are signs of slow GI bleeding?

Answer 3

Iron deficiency anemia, coffee ground vomit, and melena.

Question 4

What are signs of rapid and severe GI bleeding?

Answer 4

Hematemesis or melena.

Question 5

What is the diagnostic and therapeutic test of choice for GI bleeding due to PUD?

Answer 5

Upper GI endoscopy.

Question 6

What are the initial management steps for acute slow GI bleeding?

Answer 6

ABCs, large bore IV access, fluids, blood transfusion if needed, NPO, NGT, IV PPIs, and antibiotics.

Question 7

When should endoscopy be done in a patient with controlled GI bleeding and stable condition?

Answer 7

Within 24 hours.

Question 8

What should be done if GI bleeding is uncontrolled or the patient is unstable?

Answer 8

Urgent endoscopy.

Question 9

What is the management for ulcers with high re-bleeding risk?

Answer 9

Surgical hemostasis with sutures or pyloroplasty.

Question 10

What are clinical features of gastric outlet obstruction?

Answer 10

Nausea, vomiting of undigested food, GERD symptoms, early satiety, epigastric fullness, weight loss.

Question 11

What physical exam finding suggests gastric outlet obstruction?

Answer 11

Succussion splash (+/– visible peristalsis). is a sloshing sound heard during abdominal examination when the patient is rocked side to side.

Question 12

What electrolyte imbalance is associated with gastric outlet obstruction?

Answer 12

Hypochloremic, hypokalemic metabolic alkalosis with hyponatremia. due to vomitting

Question 13

What is the diagnostic test involving saline in gastric outlet obstruction?

Answer 13

Saline load test – if aspirate >400 ml after 30 minutes, test is positive.

How it’s done:
1. A nasogastric (NG) tube is inserted and the stomach is emptied completely.
2. 750–1000 mL of normal saline is slowly instilled into the stomach through the NG tube.
3. After 30 minutes, the stomach contents are aspirated back.

Question 14

What is the initial management of gastric outlet obstruction?

Answer 14

Nasogastric suction, correct electrolytes and fluid deficits, nutritional support.

Question 15

What surgery is often needed in gastric outlet obstruction?

Answer 15

Pyloroplasty (in ~75% of cases)

is a surgical procedure to widen the opening of the pylorus, which is the lower part of the stomach that connects to the small intestine (duodenum).help food pass more easily from the stomach to the duodenum.

Question 16

What acid-base disorder can develop in gastric outlet obstruction?

Answer 16

Paradoxical aciduria due to metabolic alkalosis.

is a condition where the urine is acidic despite the body being in a state of metabolic alkalosis — which seems contradictory, hence the term paradoxical.

Question 17

Where do perforations commonly occur in peptic ulcer disease?

Answer 17

Anterior duodenal ulcers and gastric ulcers

Question 18

What are the classic clinical features of ulcer perforation?

Answer 18

Acute severe epigastric pain (may become diffuse), worsened by movement/respiration, signs of peritonitis, and hemodynamic instability.

Question 19

What is Valentino’s sign?

Answer 19

RLQ pain from perforated ulcer tracking down paracolic gutter, often misdiagnosed as appendicitis.

Question 20

What are the key physical exam findings in a patient with perforated ulcer?

Answer 20

Ill appearance, still posture, shallow breathing, absent bowel sounds, epigastric tenderness, involuntary guarding, broad-like rigidity, and very painful percussion.

Question 21

What is the best initial diagnostic test for suspected perforated ulcer?

Answer 21

Upright chest X-ray (CXR) showing free air under diaphragm.

Question 22

If upright CXR is not possible, what alternative view can be used to detect perforation?

Answer 22

A: Left lateral decubitus CXR

Question 23

What imaging is most sensitive for detecting free intra-abdominal air?

Answer 23

ct

Question 24

What are the emergency management steps for a perforated ulcer?

Answer 24

ABCs, IV fluids, blood collection, IV PPIs, antibiotics, and emergency laparotomy.

Question 25

Why is the omentum used in perforation surgery?

Answer 25

Because ulcer edges are friable; omentum is placed over the perforation to support closure.

Question 26

What type of incision is used for emergency laparotomy in ulcer perforation?

Answer 26

Upper midline incision.

Question 27

What is the goal of surgery in peptic ulcer disease?

Answer 27

Reduce gastric acid secretion and excise the ulcer.

Question 28

What are surgical indications for peptic ulcer disease?

Answer 28

Failure of 12-week treatment, cancer suspicion, or complications (bleeding, obstruction, perforation).

Question 29

What is the typical surgery for duodenal ulcers?

Answer 29

Highly selective vagotomy ± ulcer excision. procedure in which only the vagal nerve fibers supplying the acid-producing part of the stomach (parietal cell area) — the fundus and body — are cut.

Question 30

What types of gastric ulcers need truncal vagotomy?

Answer 30

Type II and III (due to acid hypersecretion).

Question 31

What is the surgical procedure for: • Type I gastric ulcer?

Answer 31

Ulcer excision + Billroth I (distal gastrectomy + gastroduodenostomy).

Question 32

What is the surgical procedure for: • Type II and III gastric ulcers?

Answer 32

Ulcer excision + truncal vagotomy + pyloroplasty.

Question 33

What is the surgical procedure for: • Type IV gastric ulcer?

Answer 33

Ulcer excision + Billroth II (distal gastrectomy + gastrojejunostomy).

Question 34

What are the main nutritional disturbances after ulcer surgery?

Answer 34

Vitamin B12 and iron deficiency.

Question 35

What is a marginal ulcer and where does it occur?

Answer 35

Ulcers that occur on stumps or anastomosis sites, usually related to incomplete vagotomy.

Question 36

What are the clinical features of a marginal ulcer?

Answer 36

The patient presents with peptic ulcer disease (PUD) symptoms again.

Question 37

What investigation confirms the diagnosis of a marginal ulcer?

Answer 37

Endoscopy

Question 38

What is the management of a marginal ulcer?

Answer 38

Trial of PPIs and consider re-operation if needed.

Question 39

What is post-vagotomy diarrhea and how common is it?

Answer 39

Diarrhea occurring in many patients after vagotomy; it typically improves over time.

Question 40

What causes dumping syndrome?

Answer 40

Unregulated rapid movement of gastric contents into the small intestine, often hyperosmolar, leading to symptoms.

Question 41

What are the two types of dumping syndrome based on timing?

Answer 41

• Early: Occurs 5–15 minutes post-prandially • Late: Occurs 2–4 hours post-prandially

Question 42

What are the GI symptoms of dumping syndrome?

Answer 42

Nausea, vomiting, diarrhea, flatus, and bloating.

Question 43

What are the vasomotor symptoms of dumping syndrome?

Answer 43

Tachycardia, palpitations, flushing, diaphoresis, dizziness.

Question 44

What is a late complication of dumping syndrome?

Answer 44

A: Hypoglycemia.

Question 45

How is dumping syndrome managed?

Answer 45

Dietary modification • Small, frequent meals • Low in carbohydrates, high in proteins • Avoid fluids with meals

Question 46

What is afferent (or efferent) loop syndrome?

Answer 46

Obstruction or dilation of the afferent limb in a Billroth II procedure due to kinking, angulation, volvulus, or adhesions.

Question 47

What are the clinical features of afferent loop syndrome?

Answer 47

• Post-prandial RUQ pain • Abdominal fullness • Bilious vomiting that relieves symptoms • Steatorrhea

Question 48

What investigations are used for afferent loop syndrome?

Answer 48

• Ultrasound: Shows dilated afferent loop • Barium meal: Contrast enters afferent loop

Question 49

What is the management for afferent loop syndrome?

Answer 49

Surgical revision (e.g., conversion to Billroth I or Roux-en-Y).

Question 50

What is biliary gastritis (reflux gastritis)?

Answer 50

A: Bile reflux into the stomach causing mucosal irritation and gastritis.

Question 51

What are the clinical features of biliary gastritis?

Answer 51

Bilious vomiting with gastritis symptoms.

Question 52

How is biliary gastritis diagnosed?

Answer 52

Endoscopy

Question 53

What is the management of biliary gastritis?

Answer 53

A: Revision surgery is indicated.

Question 54

Which blood type is associated with gastric cancer

Answer 54

Blood type A (Think: there is an “A” in gastric but no “O” or “B” = gAstric = type “A”)

Question 55

What are the symptoms of gastric cancer ?

Answer 55

The acronym “WEAPON”: Weight loss Emesis Anorexia Pain/epigastric discomfort Obstruction Nausea

Question 56

What is a Blumer’s shelf?

Answer 56

Solid peritoneal deposit anterior to the rectum, forming a “shelf,” palpated on rectal examination

Question 57

What is a Virchow’s node?

Answer 57

Metastatic gastric cancer to the nodes in the left supraclavicular fossa

Question 58

What is a surveillance laboratory finding?

Answer 58

CEA elevated in 30% of cases (if +, useful for postoperative surveillance)

Question 59

What is the histology? of gastric cancer

Answer 59

adenocarcinoma

Question 60

Which morphologic type is named after a “leather bottle”?

Answer 60

Linitis plastica—the entire stomach is involved and looks thickened (10% of cancers)

Question 61

Which patients with gastric cancer are NONoperative?

Answer 61

1. Distant metastasis (e.g., liver metastasis) 2. Peritoneal implants

Question 62

What is the genetic alteration seen in >50% of patients with gastric cancer?

Answer 62

P53

Question 63

What is the treatment? of gastric cancer

Answer 63

Surgical resection with wide (>5 cm checked by frozen section) margins and lymph node dissection

Question 64

What operation is performed for tumor in the: Antrum?

Answer 64

Distal subtotal gastrectomy

Question 65

What operation is performed for tumor in the: midbody and proximal

Answer 65

Total gastrectomy

Question 66

What is a total gastrectomy?

Answer 66

Stomach is removed and a Roux-en-Y limb is sewn to the esophagus

Question 67

When should splenectomy be performed?

Answer 67

When the tumor directly invades the spleen/splenic hilum or with splenic hilar adenopathy

Question 68

What is the differential diagnosis for gastric tumors?

Answer 68

Adenocarcinoma, leiomyoma, leiomyosarcoma, lymphoma, carcinoid, ectopic pancreatic tissue, gastrinoma, benign gastric ulcer, polyp