Stomach, Duodenum, Esophagus

Question 1

Why is a drainage procedure necessary when performing vagotomy?

Answer 1

Because the vagus nerve helps innervate the pylorus. Gastric drainage is required (either pyloroplasty or gastroeterostomy via laparoscopy)

Question 2

T/F: Fulminant diarrhea is a potential post-vagotomy syndrome

Answer 2

True

Question 3

T/F: Bile emesis is usually spontaneous.

Answer 3

True. Probably due to bile gastritis due to intestinalization of gastric mucosa

Question 4

What is the most common blood group in patients with duodenal ulcers, especially BLEEDING duodenal ulcers?

Answer 4

Type O

Question 5

Why is it possible to develop iron deficiency as a result of gastrectomy?

Answer 5

An acid environment is needed to release ferric ion from food and make it available for absorption in the intestine

Question 6

In ZES, gastrin release can be prompted with secretin or ________

Answer 6

calcium

Question 7

Where is gastrin produced?

Answer 7

antrum, duodenum, small intestine (distal gastrectomies lead to a significant decrease in gastrin)

Question 8

A barium study showing massive gastric folds in the proximal stomach is associated with (high/low) albumin.

Answer 8

= Hypertrophic gastritis/Menetrier’s disease. Low protein! A massive loss of plasma protein occurs through the affected gastric mucosa. (Can be managed by adequate nutrition)

Question 9

How are the etiologies of duodenal and gastric ulcers different?

Answer 9

Duodenal ulcers = increased acid production
Gastric ulcers = impaired mucosal defense mechanisms; much more likely to harbor cancer (should be biopsied)

This means that vagotomy is not as helpful in preventing gastric ulcers

Question 10

What makes early gastric cancer “early”?

Answer 10

It involves only the mucosa and not the muscular wall of the stomach. Treat with gastrectomy (or endoscopic mucosal resection).

Question 11

What is the treatment of antral gastric cancer?

Answer 11

Distal gastrectomy with lymph node dissection and possible postop chemo

Question 12

What is the “incisura”?

Answer 12

Located at the distal end of the the lesser curvature, it separates where the body of the stomach ends and the antrum begins

Question 13

What is a gastrointestinal stromal tumor?

Answer 13

Rare GI tumors = leiomyosarcomas. Overlying mucosa remains intact. Not responsive to radiation or chemotherapy. Characteristic “doughnut” sign on barium studies

Question 14

What is the second most common malignancy of the stomach?

Answer 14

Lymphoma (it is the highest site of extranodal non Hodgkins)

Question 15

What is the treatment of gastric lymphoma?

Answer 15

Chemo and radiation (except MALT lymphomas, associated with H Pylori and cleared up with PPIs and abx like amoxicillin + clarithomycin)

Question 16

A characteristic “doughnut” sign on barium studies is suggestive of

Answer 16

GIST (gastrointestinal stromal tumor)

Question 17

Acute gastric distention (as in surgery) can lead to a vasovagal syndrome, which results in

Answer 17

pallor, sweating, hypotension, bradycardia, abdominal pain. Treatment is NGT for 48 hours until gastric function returns to normal

Question 18

T/F: Autoimmune metaplastic atrophic gastritis is associated with an increased risk of gastric carcinoma.

Answer 18

True

Question 19

Why is a drainage procedure not necessary with highly selective vagotomy?

Answer 19

Innervation to pylorus remains intact

Question 20

What is the most common sarcoma of the gastrointestinal tract and where is it most commonly found?

Answer 20

GIST; stomach

Question 21

A Zenker’s diverticulum outpouches in Killian’s triangle, which is

Answer 21

area between cricopharyngeal muscles and the inferior constrictor of the pharynx

Question 22

Failure of relaxation of the cricopharyngeal muscles is thought to contribute to the development of

Answer 22

Zenker’s diverticulum

Question 23

What is Plummer Vinson syndrome?

Answer 23

1) esophageal web
2) iron deficiency
3) atrophic oral mucosa
4) spoon-shaped brittle nails (koilonychia)

Question 24

What is a sliding hiatal hernia?

Answer 24

The cardia is displaced into the posterior mediastinum

Question 25

What is the classic paraesophageal "rolling" hernia? What type hernia is this?

Answer 25

The GEJ remains below the diaphragm, but stomach and other viscera migrate up along with esophagus. Type 4 hernia.

Question 26

This is a thin, circumferential scar in the lower esophagus, more common in men >65, comes from repeated trauma to the mucosa with chronic inflammation and fibrosis, usually associated with hiatal hernia:

Answer 26

Schantzki's ring

Question 27

In which part of the mediastinum is the esophagus--anterior, medial, posterior?

Answer 27

Posterior

Question 28

How do infections from the subhepatic space extend to the infracolic space?

Answer 28

through the paracolic gutter

Question 29

Which part of hte pancreas is posterior to the superior mesenteric vessels?

Answer 29

The head (the uncinate)

Question 30

Infection in the subhepatic space is due to an infection where?

Answer 30

stomach, gallbladder, duodenum, liver

Question 31

Acid ingestion leads to involvement more of hte (esophagus/stomach) and (liquefactive/coagulative) necrosis.

Answer 31

Acid, stomach, coagulative | Alkali, esophagus, liquefactive

Question 32

What connects the lesser and greater omentum?

Answer 32

foramen of winslow/epiploic foramen

Question 33

What is Fothergill's sign?

Answer 33

To determine if a mass is abdominal or INTRA-abdominal, have patient attempt sitting up (will tense rectus muscles, making intra-abdominal masses difficult to palpate)

Question 34

These cancers are associated with a mutation of the c-kit oncogene:

Answer 34

GIST

Question 35

When are partial fundoplications done in the context of GERD?

Answer 35

If esophageal motility is poor

Question 36

Endoscopic findings revealing multiple ulcers and petechiae in the stomach following trauma indicate:

Answer 36

erosive gastritis

Question 37

What is the most common cause of UGI bleeding?

Answer 37

peptic ulcer disease

Question 38

Patient with ulcer in jejunum, think:

Answer 38

ZES

Question 39

A patient whose weight is ____ pounds over their ideal body weight, or whose BMI is at least ____, is morbidly obese.

Answer 39

if >35 or if >100 pounds overweight

Question 40

T/F: A patient receiving myotomy for achalasia should also get partial fundoplication.

Answer 40

True, to prevent reflux

Question 41

A corkscrew esophagus is highly suggestive of

Answer 41

DES

Question 42

T/F: Patients with severe dysplasia in Barrett's should get prophylactic esophagectomy

Answer 42

True (risk of progression to malignancy is 40-50%)

Question 43

What is "leather bottle stomach"?

Answer 43

A stomach full of diffuse gastric adenocarcinoma (signet ring cells, vs the discrete intestinal type of gastric adenocarcinoma) and difficult to insufflate

Question 44

Causes of hemobilia (x3):

Answer 44

1) instrumentation of the biliary tract 2) malignancy 3) trauma

Question 45

Patients with HIV and odynophagia:

Answer 45

esophageal candidiasis

Question 46

What is the treatment of bezoars, whether phyto (plant material) or tricho (hair)?

Answer 46

Ingestion of meat tenderizer and then endoscopy to take out any remaining fragments

Question 47

What are the two most common vascular rings?

Answer 47

Double aortic arch and right aortic arch with left ligamentum arteriosum

Question 48

Most aortoenteric fistulas occur between the aorta and the __________

Answer 48

duodenum

Question 49

What is the treatment for a bleeding duodenal ulcer that is causing hemodynamic instabilty in a patient despite transfusions?

Answer 49

oversew, vagotomy, pyloroplasty