Term
| segment of stomach with peristalsis? |
|
Definition
|
|
Term
| What relays gastroduodenal pain? |
|
Definition
| afferent sympathetics T5-T10 |
|
|
Term
| what are the branches of the celiac? |
|
Definition
left gastric
splenic
common hepatic |
|
|
Term
| what supplies the greater curvature? |
|
Definition
-right and left gastroepiploics
-short gastrics |
|
|
Term
| origin of right vs left gastroepiploic a? |
|
Definition
right = GDA
left = splenic |
|
|
Term
| lesser curve blood supply? |
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Definition
|
|
Term
| whats is the origin of the right gastric a? |
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Definition
| proper hepatic (AFTER gda take-off) |
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Term
|
Definition
|
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Term
| where are the stomach mucus glands located? |
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Definition
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|
Term
| where are chief and parietal cells located? |
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Definition
|
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Term
| what does chief cell secrete? |
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Definition
|
|
Term
| what does parietal cell secrete? |
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Definition
|
|
Term
| what three factors cause H+ release? |
|
Definition
-ACh (vagus)
-gastrin (antral G cells)
-histamine (mast cells) |
|
|
Term
| what is the mechanism of ACh to stimulate H+ release? |
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Definition
| ACh -->phospholipase (causes Ca increase via DAG/IP3)-->Ca-calmodulin-->Phosphorylase kinase ==>H+ release (same as gastrin) |
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|
Term
| what is mech of gastrin to stimulate H+ release? |
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Definition
| gastrin-->Phospholipase = Ca release-->Ca-calmodulin-->Phosphorylase kinase = H+ release (same as ACh) |
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|
Term
| what is mech of histamine to cause H+ release? |
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Definition
| Histamine-->adenylate cyclase --> cAMP -->PKA = H+ release |
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Term
| What is mech of phosphorylase kinase and PKA to ultimately cause H+ release? |
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Definition
-Phosph. kinase (ACh and gastrin)
-PKA (histamine)
---->both phosphorylate H/K ATPase = H+ secretion/K absorption |
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Term
|
Definition
| block H/K ATPase @ parietal cell |
|
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Term
| what factors inhibit parietal cells? |
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Definition
| SStatin, PGE1, Secretin, CCK |
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Term
|
Definition
| binds B12-->B12::IF complex reabsorbed in the TI |
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Term
| What gland are present in the antrum? |
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Definition
-mucus and bicarb secreting glands
-antral G cells |
|
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Term
| what inhibits vs stims G cells? |
|
Definition
-inhib by H+ in duodenum
-stim by amino acids, ACh |
|
|
Term
| Where is SStatin secreted from? |
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Definition
| D cells antrum (inhib gastric and acid release) |
|
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Term
| What do Brunner's glands do? where? |
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Definition
| duodenal cells that secrete alkaline mucus |
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Term
| causes of rapid vs delayed gastric emptying? |
|
Definition
rapid: hx surgery, ulcers
delay: DM, opiates, Antichol, hypothy |
|
|
Term
|
Definition
EGD usually fails
-gastrostomy and removal |
|
|
Term
|
Definition
-MCC is DM pt with poor gastric emptying.
-Tx EGD, diet alteration, |
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|
Term
| What is a dieulafoy's ulcer? |
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Definition
a dialted, tortuous arteriole in the stomach wall (subM). MC Loc in the stomach, often proximally at GEJ/Lesser curve.
-bleeding risk. Tx EGD/angio |
|
|
Term
| What is Menetier's disease? |
|
Definition
mucous cell hyperplasia
-inc rugal folds |
|
|
Term
Gastric volvulus:
-MC presentation?
-MC associated condition? |
|
Definition
-p/w nausea w/out vomiting.
-a/w type 2 paraesoph hernia
-MC organoaxial volvulus |
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|
Term
|
Definition
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|
Term
| Mallory-Weiss presentation/location? |
|
Definition
-p/w hematemesis after severe vomiting
-Lesser curve/GE junction |
|
|
Term
|
Definition
-most stop spontaneously
- if not..EGD and hemo-clips
- if fails.. gastrostomy and oversew |
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|
Term
| Vagotomy effect on liquids emptyin? |
|
Definition
inc liquid emptying due to removal of receptive relaxation-->inc gastric pressures squeeze out liquids
(true for truncal and proximal forms) |
|
|
Term
| truncal vagotomy effect on solids? |
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Definition
| truncal vagotomy = dec solid emptying-->need drainage procedure (pyloroplasty or antrectomy ) |
|
|
Term
| gastrin levels after vagotomy? |
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Definition
| increased gastrin release and G cell hyperplasia due to loss of feedback inhibition. Antrectomy decreases this (removes antral G cells) |
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|
Term
| non gastric effects of turncal vagotomy? |
|
Definition
-Dec exocrine panc secretions
-dec CCK
-->diarrhea and gallstones are MCCx |
|
|
Term
| Chances of UGI re-bleeding based on EGD findings? |
|
Definition
-spurting vessel = 60%
-visible vessel = 40%
-diffuse oozing = 30% |
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|
Term
| highest RF for mortality with non-variceal UGI bleed? |
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Definition
|
|
Term
| Pt with slow UGI bleeidng, can't find source...next test? |
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Definition
|
|
Term
| MC peptic ulcer location? |
|
Definition
duodenum
-usually first part
-ant = perf, post = bleed |
|
|
Term
|
Definition
| epiG pain, dec with eating but returns after 30 min |
|
|
Term
|
Definition
bismuth salts
amoxicillin
metro/tetracycline
--->BAM/BAT |
|
|
Term
| ucler disease: surgical indications |
|
Definition
-perforation
-obstruction
-uncontrolled hem
-intractability
-need to r/o Ca
*if on PPI already, needs acid-reducing procedure* |
|
|
Term
| ulcer recurrence rates of acid reducing surgical options? |
|
Definition
-Prox vagotomy = 10-15%
-truncal + pylorplasty = 5-10%
-truncal + antrectomy = 1-2% |
|
|
Term
| mortality rates of acid reducing surgical options? |
|
Definition
-proximal vago = 0.1%
-truncal + plyoropl = 1%
-truncal + antrectomy = 2% |
|
|
Term
| recurrence rates and mortality rates in vaogotmy options (in words)...? |
|
Definition
-proximal vagotomy has highest recurrence, but lowest mortality, and doesnt need drainage proceudre
-truncal + vagotomy has lowest recurrence but highest mortality |
|
|
Term
| benefit of Roux vs B1 or B2? |
|
Definition
| less dumping syndrome, less alkaline reflux gastritis |
|
|
Term
| major ulcer bleeding definitions? |
|
Definition
>6 units PRBC in 24 hrs
persistent hypoTN despite transfusion |
|
|
Term
| surgical option for bleeding duod ulcer? |
|
Definition
duodenotomy and GDA ligation +/- vagotomy
-watch for CBD (posterior to GDA) |
|
|
Term
| Tx of duod obstruction 2/2 ulcer? |
|
Definition
PPI, serial dilation
TPN x 1 week |
|
|
Term
| surgical option for ulcer causing duod obstruction? |
|
Definition
antrectomy and truncal vagotomy
-biopsy area of resection to r/o CA |
|
|
Term
|
Definition
Graham patch (omental cover of ulcer)
-80% p/w free air |
|
|
Term
| intractable duod ulcer definition? |
|
Definition
> 3 months w/out relief on escalating PPI.
-based on EGD mucosal findings..NOT Sx! |
|
|
Term
|
Definition
|
|
Term
| relative mortality of gastric vs duod ulcer hemorrhage? |
|
Definition
|
|
Term
| gastric vs duod ulcer and effect of eating on sxs? |
|
Definition
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|
Term
|
Definition
|
|
Term
| Type 1 ucler location/cause |
|
Definition
| lesser curve/low along body 2/2 dec protection |
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|
Term
| type 2 ulcer location/cause |
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Definition
| lesser curve AND duodenal, 2/2 inc acid |
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|
Term
| type 3 ulcer location/cause |
|
Definition
| pre-pyloric. 2/2 high acid |
|
|
Term
| type 4 ulcer location/cause |
|
Definition
| lesser curve, high @ cardia. 2/2 dec protection |
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|
Term
| type 5 ulcer location/cause |
|
Definition
|
|
Term
| ulcer types a/w high acid output? |
|
Definition
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|
Term
| best test, h pylori eradication? |
|
Definition
|
|
Term
| cushings ulcer definition? |
|
Definition
| head trauma and gastric ulcer |
|
|
Term
| curlings ulcer definition? |
|
Definition
|
|
Term
stress gastritis
-time frame
-location |
|
Definition
3-10 days after stressor
-fundus first |
|
|
Term
| cause of type A vs type B chronic gastritis? |
|
Definition
A = fundus, a/w pernicious anemia, AI dz
B = antral, a/w h pylori |
|
|
Term
|
Definition
|
|
Term
|
Definition
-adenomatous polyps,intestinal metaplasia, atrophic gastritis
-tobacco, nitrosamines
-hx gastric surg
-Pernicious anemia
-Type A blood |
|
|
Term
| risk of gastric CA with adenomatous polyps? |
|
Definition
15%
tx with endoscopic rsxn |
|
|
Term
| Krukenberg tumor definition? |
|
Definition
|
|
Term
| Virchows node definition? |
|
Definition
| gastric mets to supraclavicular node |
|
|
Term
Intestinal type gastric CA
-MC pt pop
-histo findings
-tx |
|
Definition
-high risk populations. older men. Higher in Japan, developing countries. rare in US
-glands
-10 cm margins, subtotal gastrectomy |
|
|
Term
diffuse gastric cancer
-aka
-mc population
-5YSR?
-tx |
|
Definition
-aka linitis plastica
-low risk populations(MC in USA, F>M)
-25% 5YSR (worse than intestinal)
-total gastrectomy |
|
|
Term
| gastric Ca chemo regimen? |
|
Definition
| 5FU, doxorubicin, mitimycin C |
|
|
Term
Gastri CA palliation
-proximal lesion option
-distal lesion option
-pain/bleeding |
|
Definition
-prox: stent
-distal: bypass w/Gastro-J
-pain/bleed: XRT
fail??palliative gastrectomy |
|
|
Term
| MC benign gastric neoplasm? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Criteria for GIST malignancy? |
|
Definition
> 5 cm size
> mitoses/50 HPF |
|
|
Term
|
Definition
resection with 1 cm margins + imatinib (Gleevec = TyrKinase inhib)
-no nodal dissection |
|
|
Term
|
Definition
|
|
Term
|
Definition
tx H pylori
2nd line = XRT |
|
|
Term
| Gastric lymphoma symptoms |
|
Definition
ulcer-like symptoms
(stomach = MCL extra-nodal lymphoma) |
|
|
Term
| MC type of gastric lymphoma? |
|
Definition
|
|
Term
|
Definition
| Chemo/XRT +- surgery for complications |
|
|
Term
|
Definition
|
|
Term
| Criteria for bariatric surgery selection? |
|
Definition
-BMI > 40 OR >35 w/co-morbidities
-non-surgical failure
-stable physio
-no drug/EtOH abuse |
|
|
Term
| operative mortality of bariatric surgery? |
|
Definition
|
|
Term
| What DOES NOT get better after bariatric surg? |
|
Definition
|
|
Term
| what DOES get better after bariatric surgery? |
|
Definition
| DM, Chol, OSA, HTN, incontinence, GERD, venous disease, pseudotumor cerebri, joint pain, migraines, depression, PCOS, non alcoholic FLD |
|
|
Term
| best operation for weight loss? |
|
Definition
| Roux > banding for inc weight loss |
|
|
Term
|
Definition
|
|
Term
| failure rate of roux for weight loss? |
|
Definition
10%
-2/2 high carb snacking |
|
|
Term
|
Definition
|
|
Term
|
Definition
tachycardia, tachypnic, fever, leukocytosis
-often no abd pain |
|
|
Term
tx roux leak
-early vs late |
|
Definition
-early: re-op
-late (weeks): likely contained-->perc drain, abx |
|
|
Term
location of marginal ulcer?
-tx? |
|
Definition
jejunum. occur in 10%
-tx PPI |
|
|
Term
| tx of dilated excluded stomach after roux? |
|
Definition
|
|
Term
|
Definition
SURGICAL EMERGENCY
-due to high herniation/strangulation risk |
|
|
Term
Jejuno-ileal bypass
-complications? |
|
Definition
cirrhosis
kidney stones
osteoporosis |
|
|
Term
|
Definition
| -rapid entering of carbs into SB |
|
|
Term
|
Definition
1. hyper-osmotic fluid shift (hypoTN, dizzy, diarrhea)
2. Hypoglycemia (2/2 reactive insulin increase) |
|
|
Term
| lifestyle Tx of dumping syndrome? |
|
Definition
-small, low fat, low carb, high-protein meal
-no liq with meals
-no lying down after meals
-Octreotide |
|
|
Term
| surgical options for dumping syndrome? |
|
Definition
-Convert B1/B2 to Roux
-inc gsatric reservoir (j pouch)
-inc emptying time (reversed J loop?) |
|
|
Term
| dumping syndrome occurs w/what operations? |
|
Definition
| after gastrectomy OR vago w/pyloroplasty |
|
|
Term
Alkaline reflux gastritis
-sxs |
|
Definition
postprandial epiG pain with N/V
-pain NOT relieved with vomiting |
|
|
Term
| Dx of alkaline reflux gastritis? |
|
Definition
-evidence of bile reflux into stomach
-histo showing gastritis |
|
|
Term
| Tx alkaline reflux gastritis? |
|
Definition
PPI, cholystyramine, metoclopramide
-convert B1/2 to Roux with afferent limb 60 cm distal to GJ |
|
|
Term
| tx chronic gastric atony? |
|
Definition
reglan +/-
near total gastrectomy with roux |
|
|
Term
blind loop syndrome
-what surgeries can cause it? |
|
Definition
B2 or Roux
2/2 poor motility |
|
|
Term
Blind loop synd
-sxs
-cause
-dx
-tx |
|
Definition
-pain, steatorr, B12 def (bacterial use it up)
-Bacterial overgrowth 2/2 aff limb stasis
-dx = EGD afferent limp with aspirate/cx
-tx = tetracyc and flagyl. Reglan
Surg option = re-anast w/ shorter limb (40 cm afferent limb) |
|
|
Term
afferent loop obstruction
-surgeries that cause it
-cause ?
-dx |
|
Definition
-B2 or Roux
-mechanical obstruction of aff limb
-CT scan |
|
|
Term
|
Definition
RUQ pain,
pain relieved with non-bili emesis |
|
|
Term
| RF for aff loop obstruction? |
|
Definition
|
|
Term
| aff limb obstruction tx options? |
|
Definition
| dilation vs shorten the aff limb to 40 cm |
|
|
Term
efferent loop obstruction
tx |
|
Definition
| find obstruction, relieve it? |
|
|
Term
post vagotomy diarrhea
-PPHys? |
|
Definition
| 2/2 non-conj bile salts in the colon (osmotic D). caused by sustained post-prandial MMCs |
|
|
Term
| post vago diarrhea tx options |
|
Definition
-cholystyramine, loperamide
-surg options: reversed interposition jejunal graft |
|
|
Term
duodenal stump blow-out after gastrectomy
-Tx |
|
Definition
| lateral duodenostomy tube and drains |
|
|
Term
|
Definition
| placed into liver or colon |
|
|
