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26 Cards in this Set

  • Front
  • Back
Only _______ duodenum contains serosa
anterior
3 Phases of secretion
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
Locations of gastric ulcers
Body
GE Junction
High Lesser Curve
Pyloric Channel
Med treatment of ulcers
Medical Treatment
H2 blockers, PPI, Antacid
Avoid Etoh, Tobacco, Irritating Drugs (NSAIDS)
Recurrence rate 25-60%
Most within 6 months
Surgical treatment of gastric ulcers
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
Most common cause of duodenal ulcers (EMPHASIZED)
Acid Hypersecretion

Others:
Imbalance between mucosal integrity and acid production
Helicobacter pylori
Diag of Duodenal Ulcers
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
Medical treatment of Duodenal ulcers
Avoid Aspirin, caffeine, etoh, and tobacco
Stress Reduction
Eradication of H. Pylori: Antacid and Antibiotics
H2 blockers/PPI at bedtime
Surgery for duodenal ulcers
Goal is to reduce acid secretion
Vagotomy & Antrectomy
Vagotomy & Drainage
Parietal Cell Vagotomy (Highly Selective Vagotomy)
Uncommon benign tumors of the somach and duodenum
Uncommon
Leiomyomas (mc benign)
Hyperplastic polyps
Adenomatous polyps
Aberrant Pancreatic tissue
Angiomas
Lipomas
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
Blumer’s shelf: drop mets to pouch of ______
Douglas
________________: Diffuse infiltration of tumor via submucosa
Linitis Plastica
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
Adjuvant Chemotherapy for gastric carcinoma
Questionable benefit in clear margins
Some response to positive margins
5-FU, Adriamycin, Mitomycin

Adjuvant Radiotherapy may help with pathologic positive margins
Treatment for Gastric Lymphoma
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
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)
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)
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
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
Early Dumping Syndrome
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
Late Dumping Syndrome
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
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
Tratment for esoph varices
Endoscopic Sclerotherapy
TIPS shunt
Suture/Stapling
Segstaken-Blakemore tube
Correct Coagulapathy
obstructing masses of hair, food, undigestibles
Bezoars
Menetrier’s disease
hypertrophy of gastric mucosa
Malabsorption
Tx: Total Gastrectomy if nutritional support fails