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
