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26 Cards in this Set
- Front
- Back
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Only _______ duodenum contains serosa
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anterior
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3 Phases of secretion
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Cephalic Phase: sight, smell, thought of food, Stimulates Vagus, HCL and Gastrin release
Gastric Phase: Antral Distention and Gastrin release Intestinal Phase: CCK, mild acid release |
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Locations of gastric ulcers
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Body
GE Junction High Lesser Curve Pyloric Channel |
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Med treatment of ulcers
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Medical Treatment
H2 blockers, PPI, Antacid Avoid Etoh, Tobacco, Irritating Drugs (NSAIDS) Recurrence rate 25-60% Most within 6 months |
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Surgical treatment of gastric ulcers
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Surgical Treatment
Mortality and Recurrence Rate is less than 1% Hemigastrectomy: 50% distal stomach with ulcer Billroth 1: Gastroduodenostomy Billroth 2: Gastrojejunostomy Vagotomy and Antrectomy |
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Most common cause of duodenal ulcers (EMPHASIZED)
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Acid Hypersecretion
Others: Imbalance between mucosal integrity and acid production Helicobacter pylori |
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Diag of Duodenal Ulcers
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Hx. Epigastric pain radiating to back.
Relieved by food but shorter duration Pain worse at night EGD most helpful UGI Serum Gastrin to r/o Zollinger-Ellison syndrome |
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Medical treatment of Duodenal ulcers
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Avoid Aspirin, caffeine, etoh, and tobacco
Stress Reduction Eradication of H. Pylori: Antacid and Antibiotics H2 blockers/PPI at bedtime |
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Surgery for duodenal ulcers
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Goal is to reduce acid secretion
Vagotomy & Antrectomy Vagotomy & Drainage Parietal Cell Vagotomy (Highly Selective Vagotomy) |
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Uncommon benign tumors of the somach and duodenum
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Uncommon
Leiomyomas (mc benign) Hyperplastic polyps Adenomatous polyps Aberrant Pancreatic tissue Angiomas Lipomas |
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Malignancy of teh stomach:
90-95% of gastric tumors are malignant 95% are WHAT TYPE Symptoms are pain, anorexia, Wt. Loss Diagnosis: EGD with Bx, UGI High incidence in Japanese CT, Endo US |
Malignancy of teh stomach:
90-95% of gastric tumors are malignant 95% are adenocarcinomas Symptoms are pain, anorexia, Wt. Loss Diagnosis: EGD with Bx, UGI High incidence in Japanese CT, Endo US |
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Blumer’s shelf: drop mets to pouch of ______
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Douglas
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________________: Diffuse infiltration of tumor via submucosa
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Linitis Plastica
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Surgical Tx for Cure
Surgical Tx for Palliation |
Surgical Tx for Cure
Subtotal or Total Gastrectomy Removal of Omentum and Lymph nodes Surgical Tx for Palliation Wedge Resection Bypass |
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Adjuvant Chemotherapy for gastric carcinoma
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Questionable benefit in clear margins
Some response to positive margins 5-FU, Adriamycin, Mitomycin Adjuvant Radiotherapy may help with pathologic positive margins |
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Treatment for Gastric Lymphoma
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Treatment
Medical: CTX and/ or RTX Surgery reserved for complications: bleeding or perforation Partial Gastrectomy In attempt to remove all gross disease. Prognosis: 90% 5 year survival if localized to stomach and removed |
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Large, bulky tumors
Well Localized Slow to metastasize What type of gastric malignancy Partial Gastrectomy Requires wide margins due to spread along peritoneal surfaces RTX/CTX as adjuvant tx |
Gastric Leiomyosarcomas (GIST)
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Malignant Disease: Duodenum
Most commonly _______________ Symptoms: Obstruction, bleeding, Jaundice DX: EGD/Bx Treatment: Pancreaticoduodenectomy (_________ Procedure) |
Malignant Disease: Duodenum
Most commonly adenocarcinoma Symptoms: Obstruction, bleeding, Jaundice DX: EGD/Bx Treatment: Pancreaticoduodenectomy (Whipple’s Procedure) |
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which Post Gastrectomy Syndrome?
Most common in 25% of gastrectomy patients Pain, nausea, vomiting, weight loss Dx: Endoscopy Surgical Tx: Convert B1 or B2 to Roux-en-Y anastomosis |
Alkaline Reflux Gastritis
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which Post Gastrectomy Syndromes
Intermittent obstruction of afferent limb of gastrojejunostomy Postprandial distention, pain, and nausea Emesis contains bile no food and pain relieved Surgical Tx: Convert to Roux-en-Y |
Afferent Loop Syndrome
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Early Dumping Syndrome
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Occurs 20-30 minutes after meal
Cardiovascular and GI symptoms High osmolar content of food entering the small bowel Extracellular fluid shifts in bowel cause autonomic, hormonal, and systemic changes Conservative Tx: Avoid high Carb and fluids during meals Octreotide Most cases resolve Surgical tx: Interposition of an anti-peristaltic loop of jejunum between stomach and small bowel |
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Late Dumping Syndrome
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Occurs 2-3 hours post meal
Less common than early dumping syndrome Carbohydrates enter intestine and are quickly absorbed Insulin surge results in profound hypoglycemia Conservative Tx: Eat small, frequent meals Surgical Tx: Jejunal Interposition |
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What syndrome:
Rare Young, thin women Obstruction of 3rd portion duodenum by SMA Prolonged immobilization “cast syndrome” Vomiting and Postprandial pain Treatment Remove restrictions, casts, girdles, gain wt. Surgery to release Ligament of Trietz or bypass |
Superior Mesenteric Artery Syndrome
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Tratment for esoph varices
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Endoscopic Sclerotherapy
TIPS shunt Suture/Stapling Segstaken-Blakemore tube Correct Coagulapathy |
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obstructing masses of hair, food, undigestibles
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Bezoars
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Menetrier’s disease
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hypertrophy of gastric mucosa
Malabsorption Tx: Total Gastrectomy if nutritional support fails |
