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Flashcards in Stomach Deck (121)
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1

the cardia is near what "tube"

esophagus

2

[part of the stomach]

HCl secretion

cardia

3

[part of the stomach]

role in capacitance by undergoing receptive relaxation

fundus

4

[part of the stomach]

the site of the autonomic pacemaker responsible for initiating gastric motor activity

fundus

5

[part of the stomach]

The incisura is the junction of ____

junction of the body and antrum

6

What are the arteries supplying the lesser curvature of the stomach

Right Gastric
Left gastruc

7

What are the arteries supplying the greater curvature of the stomach

Right gastroepiploic
Left gastroepiploic

8

What are the arteries supplying the fundus of the stomach

Short gastric

9

The short gastric artery is a direct branch of the

splenic artery

10

What are the branches of the celiac trunk

Common hepatic
Left Gastric
Splenic

11

Artery in the stomach that is a branch of the celiac trunk?

left gastric

12

What stomach veins drain to the portal circulation?

right gastric vein
Left gastric vein/coronary vein

13

What stomach arteries drain to the splenic vein?

Short gastric vein
Left gastroepiploic vein

14

What stomach arteries drain to the superior mesenteric vein?

right gastroepiploic

15

[Lymphatic Drainage]

Drains the proximal lesser curvature

superior gastric LN

16

[Lymphatic Drainage]

the distal lesser curvature

suprapyloric LN

17

[Lymphatic Drainage]

proximal greater curvature

pancreaticosplenic LN

18

[Lymphatic Drainage]

distal greater curvature

infrapyloric LN

19

[innervation]

the left vagal trunk is located ___ (anterior/posterior) to the stomach

anterior

20

[innervation]

what is a branch of the left vagal trunk?

hepatic branch

21

[innervation]

What nerve that is a branch of the vagus nerve lies posterior to the stomach?

right vagal trunk

22

[innervation]

what innervates the posterior fundus?

Criminal nerve of Grassi from the Right vagal trunk

23

[innervation]

what are the branches of the right vagal trunk?

celiac branch
criminal nerve of grassi

24

[Stomach Histology: type of cell]

produce protective mucus layer that contains bicarbonate and glycoprotein

Surface Mucous Cells

25

[Stomach Histology: type of cell]

less alkaline mucus layer that contains glycoprotein

mucous neck cells

26

[Stomach Histology: type of cell]

produces pepsinogen

mucous neck cell, chief cells

27

[Stomach Histology: type of cell]

produces HCl

parietal (oxyntic) cells

28

[Stomach Histology: type of cell]

produces intrinsic factor

parietal (oxyntic) cells

29

[Stomach Histology: type of cell]

chief cells produce these enzymes

pepsinogen
gastric lipase
leptin

30

[Stomach Histology: type of cell]

produces of serotonin

enterochromaffin cells

31

[Stomach Histology: type of cell]

produces histamine

enterrochromaffin-like cells

32

[Stomach Histology: type of cell]

produces somatostatin

D cells

33

[Stomach Histology: type of cell]

produces gastrin

G cells

34

___ is the sharp depression in the lesser curvature of the stomach at the junction of the body

angularis incusura

35

[Control of acid secretion]

Compounds that induce acid secretion

Acetylcholine, Histamine, Gastrin

36

[Control of acid secretion]

Compounds that induce acid secretion

somatostatin

37

these compounds increase cAMP resulting to increased activation of protein kinases

Histamine, adenylate cyclase, somatostatin

38

Acetylcholine uses phospholipase ___

phospholipase C

39

Gastrin uses this receptor

CCK8 receptor

40

H+ is secreted to the channel via this antiporter

HK ATPase

41

[diagnostic tests for the stomach]

the most serious complication of EGD

esophageal perforation

42

[diagnostic tests for the stomach]

helpful in the diagnosis of gastric perforation (pneumoperitoneum) or delayed gastric emptying (large air-fluid level)

Plain abdominal x-ray

43

[diagnostic tests for the stomach]

better than EGD in detecting diverticula, fistula, tortousity or stricture location, and size of hiatal hernial

double contrast UGIS

44

[diagnostic tests for the stomach]

important in staging work-up

CT and MRI

45

[diagnostic tests for the stomach]

gold standard for H. pylori diagnosis

antral mucosal biopsy

46

[diagnostic tests for the stomach]

the standard test to confirm eradication of H. pylori post-treatment

urea breath test

47

[diagnostic tests for the stomach]

sensitive and specific for active H. pylori infection; can also be used to confirm cure

H. pylori fecal antigen test

48

[peptic ulcer disease: type]

mucosa only affected;

A

erosion

49

[peptic ulcer disease: type]

mucosa + muscularis mucosa + submucosa + muscularis propria

B

Acute Ulcer

50

[peptic ulcer disease: type]

mucosa + muscularis mucosa + submucosa + muscularis propria + serosa

C

chronic ulcer

51

[GU vs DU]

near the incisura, food worsens pain, less likely to awaken patient, risk of malignancy is common

GU

52

[GU vs DU]

near the first portion of the duodenum (within 3 cm of pylorus); common in younger age group

food relieves pain; awakens the patient from sleep

DU

53

[GU vs DU]

due to decreased cryoprotection

Gastric acid output is normal or decreased

GU

54

[GU vs DU]

due to increased production of gastric acid

decreased bicarbonate secretion

DU

55

[GU vs DU]

treatment of GU

gastrectomy

56

[GU vs DU]

treatment of DU

vagotomy (to decrease production of acid)

57

[PUD diagnosis]

Indications of EGD

1. Age >45 years old with symptoms

2. Patients with alarm symptoms: weight loss, bleeding, recurrent vomiting, anemia, dysphagia

58

[PUD]

most common complication of PUD

bleeding

59

[PUD]

indications for surgery

1. persistent bleeding/ rebleeding
2. significant hemorrhage (>4 units/24 hours)
3. Elderly with comorbidities
4. ulcers at posterior duodenal bulb and ulcers in the gastric curvature
5. active pulsatile bleeding, visible vessels

60

[forrest classification for endoscopic findings]

Active, pulsatile bleeding

Grade Ia

61

[forrest classification for endoscopic findings]

active, nonpulsatile bleeding

Grade Ib

62

[forrest classification for endoscopic findings]

nonbleeding, visible vessels

Grade IIa

63

[forrest classification for endoscopic findings]

adherent clot

Grade IIb

64

[forrest classification for endoscopic findings]

no signs of recent bleeding

Grade III

65

[forrest classification for endoscopic findings]

black dot

Grade IIc

66

Diagnostic workup for stomach perforation

upright CXR

detects pneumoperitoneum

67

[diagnose]

nonbilous vomiting, profound hypokalemic hypochloremic metabolic alkalosis

epigastric pain, and weight loss

gastric outlet obstruction

68

[Medical treatment of PUD]

bismuth triple therapy is composed of

1. Bismuth, 2 tables QID
2. Metronidazole, 250mg TID
3. Tetracycline, 500mg QID

69

[Medical treatment of PUD]

what is the gold standard for H. pylori eradication?

quadruple therapy
1. PPI BID
2. Bismuth, 2 tables QID
3. Metronidazole, 250mg TID
4. Tetracycline, 500mg QID

70

[Medical treatment of PUD]

PPI triple therapy is composed of

1. PPI BID
2. Amoxicillin 1 gram BID
3. Clarithromycin 500mg BID

71

[Medical treatment of PUD]

when will you repeat the EGD/biopsy post medical treatment of H.pylori

at 6-8 weeks

72

[Gastric Ulcer Types]

Antral lesser curvature

Type I

Most common

73

[Gastric Ulcer Types]

Antral lesser curvature + duodenal ulcer

Type II

74

[Gastric Ulcer Types]

prepyloric ulcer

Type II

75

[Gastric Ulcer Types]

high in the lesser curvature

Type IV

76

[Gastric Ulcer Types]

NSAID induced

Type V


One less
Two two
Three pre
Four by the door
Five NSAID

77

[PUD Surgery]

Gastroduodenostomy is also called ___

Bilroth I

78

[PUD Surgery]

Antecolic gastrojejunustomy is also called ___

Bilroth II

79

____ syndrome

caused by destruction of the pyloric sphincter leading to abrupt delivery of hyperosmolar load to the small intestines

dumping syndrome

80

[Type of dumping syndrome]

peripheral and splancnic vasodilatation

sweating, light-headedness, tachycardia relieved by saline or recumbency

early dumping

15 to 30 minutes post prandial

81

[Type of dumping syndrome]

die to hyperinsulinemia with reactive hypoglycemia; relieved by glucose

Late dumping

2-3 hours post prandial

82

What is the surgical method used for dumping syndrome?

conversion to Roux-en-Y anastomosis

83

[diagnosis]

constant epigastric pain, nausea, bilious emeses

Endoscopy: inflamed, beefy red, friable gastric mucosa

bile or alkaline reflux gastritis

associated with bilroth II

84

___ syndrome

due to functional obstruction due to disruption of normal propagation of pacesetter potentials in the roux limb from the proximal duodenum

Roux stasis Syndrome

85

[Loop syndromes]

due to bowl kink, volvulus or internal herniation,

severe abdominal pain, nonbilous emesis

steatorrhea, B12 folate iron deficiency

Afferent loop syndrome

86

[Loop syndromes]

abdominal pain, bilous emesis months to years after ROux en Y

Efferent loop syndrome

87

What is the confirmatory test for the diagnosis of Zollinger-Ellison Syndrome

Secretin Stimulation Test

88

[diagnosis]

epigastric pain, GERD, diarrhea

elevated serum gastrin and Basal Acid output

Zollinger-Ellison Syndrome

89

The gastrin level after a secretin stimulation test which suggests zollinger-Ellison syndrome

gastrin > 200pg/mL

90

Diet low in these vitamins is associated with gastric adenocarcinoma

Vitamin A and C

91

most common malignant neoplasm in the stomach

adenocarcinoma

92

Carcinoma is diagnosed when the tumor invades this ____

lamina propria or muscularis mucosae

93

[Lauren Classification - Stomach CA]

well-delineated, slow growth, distal stomach, ulcerative

intestinal type

94

[Lauren Classification - Stomach CA]

small cells, poorly differentiatied,

younger age,

seen in the cardia of the stomach, linitis plastica

Diffuse type

95

virchow node refers to what LN which is associated with gastric CA

left supraclavicular lymphadenopathy

96

[gastric CA PE]

cul-de-sac tumor palpable on rectal exam is also called

blumer shelf

97

[Gastric adenoma diagnostics]

useful for post operative surveillance

CEA

98

[Gastric adenoma diagnostics]

diagnostic gold standard

upper endoscopy + biopsy

99

[Gastric adenoma diagnostics]

used to asses direct local invation

Abdominal pelvic CT with IV and oral contrast

100

[Gastric adenoma diagnostics]

more accurate in assessing gastric wall invasion and determine the presence or absence of LN metastasis

endoscopic UTZ

101

[Gastric adenoma diagnostics]

can detect occult metastasis; can rule out peritoneal implants and liver metastasis

staging laparoscopy with peritoneal fluid cytology

102

[Standard surgical treatment]

for tumors of the gastric antrum

Radical subtotal gastrectomy

103

[Standard surgical treatment]

for all lesions in the midbody or fundus (proximal), linitis plastica, cancers associated with menetrier disease, gastric remnant CA, mutiple diffuse type

radical total gastrectomy

104

[Primary Gastric Lymphoma]

always arise from the mucosa, from the MALT

low grade MALT lymphoma

105

[Primary Gastric Lymphoma]

associated with inactivation of p53, cmyc

high grade lymphoma

106

Advanced lesions of low-grade gastric lymphoma are treated using

1. Initial H. pylori eradication
2. EBRT with chemotherapy
3. Endoscopic surveillance

107

___ arise from the interstitial cells of Cajal

GIST

prognosti factors: tumor size, mitotic count

108

tumor marker of GIST

cKIT (CD 117) and CD 34)

109

Surgical Treatment of GIST

Wedge resection with negative margins

110

Drug of choice for unresectable, metastatic GIST

Imatinib (gleevec)

111

these arise from gastric enterochromaffin-like cells

gastric carcinoids

112

[type of gastric carcinoids]

associated with type A chronic gastritis, autoimmine, hypergastrinemia

Type I

Endoscopic polypectomy

113

[type of gastric carcinoids]

associated with zollinger-ellison

Type II

treat gastrinoma with somatostatin analogues

114

[type of gastric carcinoids]

sporadic, solitary, worse prognosis, worse in med

Type III

en-block resection with regional LN

115

[diagnose]

____ associated with protein losing enteropathy and hypochlorydia; spares the antrum

menetrier disease

116

[diagnose]

middle aged man, with epigastric pain, weight loss, diarrhea, hypoproteinemia

biopsy: diffuse hyperplasia of surface mucus-secreting cells and decrease parietal cells

menetrier disease

117

___ is also called watermelon stomach

Gastric Antral Vascular Ectasia

118

[diagnose]

dilated mucosal blood vessels in the distal stomach; associated with autoimmune connective tissue disorder

Gastric antral vascular ectasia

treat with neodymum ytrrium-aluminum garnet

antreactomy

119

[diagnose]

congenital AV malformation, large tortous suubmucosal artery

Pulsating blood from a normal appearing gastric mucosa

Dieulafoy lesion

120

[diagnose]

regurgitation of feeding
projectile non-bilous emesis
peristaltic gastric waves visible
hypokalemic hyperchloremic metabolic acidosis

pyloric stenosis

Fredet-Ramstedt pyloromyotomy

121

olive-shaped mass in RU epigastrium

pyloric stenosis