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Swartz > Stomach > Flashcards

Stomach Flashcards

1
Q

Surgery for peptic ulcer ds

A

HIGHLY SELECTIVE VAGOTOMY

TRUNCAL VAGOTOMY WITH DRAINAGE PROCEDURES

DRAINAGE PROCEDURES
2 types
I.GASTROJEJUNOSTOMY
Done in case of gastric outlet obstruction

II.PYLOROPLASTY
Done in case of:
*Who require pylorodudenostomy to deal with ulcer complication like bleeding
*Limited/focal scarring inpyloric region
*Technical difficulty in gastrojejunostomy

  1. heinke mikuliez :cut the pylorus transversely and suture it longitudinally to prevent sphincter action
  2. finney :side to side gastrojejunostomy, pylorus is incised.
  3. jaboulay:side to side gastrojejunostomy, pylorus not incised

VAGOTOMY AND ANTERECTOMY WITH
Billroth I:gastroduodenostomy
BillrothII:gastrojejunostomy
Roux en y gasreojejunostomy:

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2
Q

Billroth I

A

is anoperationin which thepylorusis removed and the proximalstomachisanastomoseddirectly to theduodenum

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3
Q

Billroth II

A

Removing antrum and doing Gastrojejunostomy

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4
Q

Truncal vagotomy

A

Truncal vagotomy (TV) includes division of the main trunk of the vagus (including its celiac/hepatic branch) and denervation of the pylorus; therefore, a pyloric drainage procedure (pyloromyotomy or pyloroplasty or gastrojejunostomy), is needed. This procedure also denervates the liver, biliary tree, pancreas, and small and large bowel

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5
Q

Highly selective vagotomy

A

Highly selective vagotomy includes denervation of only the fundus and body (parietal cell-containing areas) of the stomach (also called parietal cell vagotomy). It preserves the nerve supply of the antrum and pylorus; a pyloric drainage procedure is not needed. It does not denervate the liver, biliary tree, pancreas, or small and large bowel. This procedure is also called proximal gastric vagotomy.

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6
Q

Gastrinoma triangle

A

Formed by

Sup:confluence of cystic duct with CBD

Inf:jxn of 2 and 3 part of duodenum

Medially: jxn of neck and body of pancreas

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7
Q

Preoperative imaging of choice in gastrinoma

A

Gastrinoma cells contain type II somatostatin receptors that bind the indium-labeled somatostatin analogue (octreotide) with high affinity, making imaging with a gamma camera possible

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8
Q

Herditary gastrinomas associated with

A

MEN I

The inherited or familial form of gastrinoma is associated with multiple endocrine neoplasia type I (MEN I), which consists of parathyroid, pituitary, and pancreatic (or duodenal) tumors. Gastrinoma is the most common pancreatic tumor in patients with MEN I. Patients with MEN I usually have multiple gastrinoma tumors.

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9
Q

Dieulafoys lesion

A

Dieulafoy’s lesion is a congenital arteriovenous malformation characterized by an unusually large tortuous submucosal artery.

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10
Q

Watermelon stomach

A

Gastric Antral Vascular Ectasia

The parallel red stripes atop the mucosal folds of the distal stomach

dilated mucosal blood vessels that often contain thrombi, in the lamina propria

The histologic appearance can resemble portal hypertensive gastropathy, but the latter usually affects the proximal stomach, whereas watermelon stomach predominantly affects the distal stomach

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11
Q

syndromes characterized by epithelial hyperplasia and giant gastric folds

A

ZES and Ménétrier’s disease

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12
Q

Menetriers ds

A

Epithelial hyperplasia

Giant rugal folds

Protein losing enteropathy due to diffuse hyperplasia of mucus secreting cells

Hypochlorhydria due to devreased parietal cells

Rx: EGFR inh: cetuximab

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13
Q

Eitology of gastroparesis

A

Idiopathic

Endocrine or metabolic
Diabetes mellitus
Thyroid disease
Renal insufficiency

After gastric surgery
After resection
After vagotomy

Central nervous system disorders
Brain stem lesions
Parkinson’s disease

Peripheral neuromuscular disorders Myotonia dystrophica
Duchenne muscular dystrophy

Connective tissue disorders
Scleroderma
Polymyositis/dermatomyositis

Infiltrative disorders
Lymphoma
Amyloidosis

Diffuse gastrointestinal motility disorder Chronic intestinal pseudo-obstruction

Medication-induced

Electrolyte imbalance
Potassium, calcium, magnesium

Miscellaneous conditions 
Infections (especially viral) 
Paraneoplastic syndrome
 Ischemic conditions
 Gastric ulcer
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14
Q

Types of carcinoid tumors

A

TYPE I
Due to acid suppression leading to hypergastrenimia

Cause: pernicious anemia, chronic atrophic gastritis

TYPEII
Cause: MENI
Also ass with hypergastrenemia

TYPEIII
Sporadic
Not ass with hypergastrenemia

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15
Q

GIST arise from

A

Interstitial cells of cajal

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16
Q

Stomach Carcinoid arise from

A

Enterochromaffin like cells

17
Q

Medical rx of GIST

A

Imatinib

Tyrosine kinase inhibitor(against c-kit product the mutation of which os seen in GIST)

18
Q

Mc primary site of GI lymphoma

A

Stomach

19
Q

Most common symptoms of gastrinoma

A

The most common symptoms of ZES are epigastric pain, GERD, and diarrhea. More than 90% of patients with gastrinoma have peptic ulcer. Most ulcers are in the typical location (proximal duodenum), but atypical ulcer location (distal duodenum, jejunum, or multiple ulcers) should prompt an evaluation for gastrinoma

20
Q

Gasyrinoma should be considered in the D/d of

A

recurrent or refractory peptic ulcer, secretory diarrhea, gastric rugal hypertrophy, esophagitis with stricture, bleeding or perforated ulcer, familial ulcer, peptic ulcer with hypercalcemia, and gastric carcinoid

21
Q

Dd of intractable/nonhealing gastric ulcer

A

Cancer
Gastric
Pancreatic
Duodenal

Persistent Helicobacter pylori infection Tests may be false-negative
Consider empiric treatment

Noncompliant patient
Failure to take prescribed medication Surreptitious use of NSAIDs

Motility disorder

Zollinger-Ellison syndrome

22
Q

Roux en y gastrojejonostostmy

A

Creating a small pouch of small portion of stomach and attaching it directly to small intestine bypassing large part of stomach and duodenum

23
Q

Billroth I

Billroth II

A

I : gastroduodenostomy

II : gastrojejunostomy

24
Q

What are the indications of peptic ulcer sx

A

bleeding
perforation
obstruction
intractability or nonhealing

Swartz (4 decks)

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