General Surgery: Stomach & Duodenum

Front 1

Gastroduodenal pain fibers

Back 1

Afferent sympathetic fibers from T5 to T10

Front 2

Secretions of Proximal Cardiac Glands

Back 2

Mucus

Front 3

Where are parietal and chief cells located within the stomach?

Back 3

Fundus
Body

Front 4

Function of parietal cells

Back 4

Secretions:
1) HCl
2) Intrinsic factor (for B12 absorption)

Front 5

Chief cell secretion

Back 5

Pepsinogen (protein digestion)

Front 6

Contained in Antrum of stomach

Back 6

1) Gastrin-producing G cells
2) Mucus-secreting cells

Front 7

Brunner's glands

Back 7

Unique to duodenum
*Secrete alkaline mucus

Front 8

Hormone receptors sites on parietal cell

Back 8

1) Gastrin
2) Histamine (H2)
3) Acetylcholine

Front 9

Vagotomy

Back 9

Division of vagus nerve to decrease stimulation of parietal cell by acetylcholine

Front 10

Pernicious Anemia

Back 10

Megaloblastic anemia due to deficiency of intrinsic factor and consequent deficiency of vitamin B12

**Associated with atrophic gastritis and hypergastronemia

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Signs and symptoms of ulcer disease

Back 11

1) Epigastric pain (burning, gnawing)
2)

Front 12

MCC of peptic ulcers

Back 12

H. pylori infection

**2nd MCC is NSAID use (blockage of prostaglandin production w/ COX1 inhibitor)

Front 13

Misoprostol

Back 13

Analogue of prostaglandin

SE: Cramps & diarrhea

Front 14

H. pylori

Back 14

-Gram negative organism
-Lives in Antrum of stomach in mucus-bicarbonate layer
-Secretes urease (creates alkaline environment)
-Major cause of duodenal and gastric ulcers
-Diagnosed by biopsy, breath test (exhaled urease), or blood test (least accurate)

Front 15

Treatment for H. pylori

Back 15

Antibiotics:
1) Metronidazole
2) Clarithromycin
3) Amoxicillin
4) Bismuth (Pepto Bismol)
5) Proton pump inhibitors

**Treat for 14 days

Front 16

MC location of duodenal ulcers

Back 16

95% found within 2 cm of pylorus (1st portion of duodenum)

Front 17

Common symptoms of duodenal ulcers

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1) Epigastric pain
2) Nausea
3) Vomiting
4) Hematemesis
5) Melena (guaiac positive stool)

Front 18

Diagnosis of peptic ulcer disease

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Esophagogastroduodenoscopy (EGD)

Front 19

MC location of gastric ulcers

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Lesser curvature of the stomach

*Acid secretion may not be elevated

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Indications for surgery of gastric ulcers

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1) Intractability
2) Severe hemorrhage
3) Perforation
4) Obstruction

Front 21

Complications of peptic ulcers

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1) Bleeding
2) Pancreatitis (posterior penetration)
3) Perforation (surgical emergency)
4) Gastric outlet obstruction

Front 22

Zollinger-Ellison Syndrome

Back 22

Condition caused by hypersecretion of gastrin, usually by tumor of pancreas or duodenum, leading to excessive acid production in the stomach

Front 23

Secretin stimulation test

Back 23

-Used in diagnosis of Zollinger-Ellison syndrome
-Measures evoked gastrin levels

Front 24

Gastroparesis

Back 24

Damage in neuroinnervation of stomach decreasing peristalsis
Patient feels full very quickly

Front 25

Medical treatment of Gastroparesis

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1) Metoclopramide
2) Sissapride (off market because increases QT syndrome)
3) Erythromycin

Front 26

Erythromycin in GI tract

Back 26

Stimulates motilin receptors --> improved gastric emptying

Front 27

H. pylori and gastric cancer

Back 27

Associated with MALT Lymphoma

Front 28

Characteristics of Zollinger-Ellison Syndrome

Back 28

1) Epigastric pain
2) Diarrhea
3) Melena
4) Vomiting
5) Weight loss

*Suspect when ulcer symptoms are resistant to treatment

Front 29

Malignant potential of adenomatous polyps of the stomach

Back 29

10 - 20% risk of carcinoma

Front 30

MC malignant gastric neoplasm

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Adenocarcinoma

**Common in Japan

Front 31

Risk factors for gastric adenocarcinoma

Back 31

1) Dietary nitrates
2) Adenomatous polyps
3) H. pylori infection
4) Chronic gastritis
5) Pernicioius anemia
6) Achlorhydria

Front 32

Si & Sx of gastric adenocarcinoma

Back 32

Often indistinguishable from PUD
1) Weight loss / anorexia
2) Pain
3) Nausea & Vomiting
4) Dysphagia

Front 33

Signs of Advanced gastric adenocarcinoma

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1) Virchow's node (left supraclavicular nodule)
2) Krukenberg's tumor (ovarian metastasis)

Front 34

Diagnosis of gastric adenocarcinoma

Back 34

Endoscopy & biopsy

**75% of patients have metastatic disease at diagnosis

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Treatment of gastric adenocarcinoma

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1) Surgical resection (total or subtotal gastrectomy)
2) Surgical palliation with gastric resection
3) Radiation therapy and chemotherapy

Front 36

% of patients with MALT who present with occult bleeding and anemia

Back 36

50% of patients

Front 37

Diagnosis of MALT

Back 37

1) Endoscopic biopsy (brush cytology and US)
2) Chest and abdominal CT + BM biopsy (identifies systemic disease)

Front 38

MC treatment of MALT

Back 38

Combination chemoradiation therapy

*May regress with treatment of H. pylori

Front 39

Overall survival for all stages of gastric lymphoma

Back 39

> or = to 50%

Front 40

Upper GI Bleeding (UGIB)

Back 40

Bleeding proximal to Ligament of Treitz

Front 41

Risk factors for UGIB

Back 41

1) PUD
2) NSAIDs
3) Alcohol abuse
4) Smoking
5) Liver disease
6) Esophageal varices

Front 42

Morbid obesity

Back 42

More than 100 lbs above ideal body weight or BMI >35

Front 43

Morbidity associated with obesity

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1) Cardiac and pulmonary dysfunction
2) Diabetes mellitus
3) Degenerative joint disease
4) Sexual dysfunction

Front 44

Average weight loss with bariatric surgery

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50 - 67% of excess weight within 1.5 years

Front 45

Improvements after bariatric surgery

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1) Most type 2 diabetics no longer require insulin
2) HTN resolves or improves in 80% of patients
3) Obstructive sleep apnea resolves
4) Self-image improves

Front 46

Surgical options for weight loss

Back 46

1) Gastroplasty
2) Gastric bypass - small stomach pouch with gastrojejunostomy

Front 47

SEs with gastroplasty

Back 47

1) Mesh may erode into the stomach
2) GE reflux may occur, requiring conversion to gastric bypass

Front 48

Operative mortality of gastric bypass surgery

Back 48

0.5%

Front 49

Complications of gastric operations

Back 49

1) Perforation or leak at anastomosis site
2) Necrosis of distal stomach
3) Ulcer formation
4) Obstruction or stenosis
5) Vitamin B12 deficiency or anemia
6) GALLSTONE FORMATION with rapid weight loss

Front 50

Mallory-Weiss tear

Back 50

Cause of UGIB resulting from longitudinal tear of mucosa and submucosa near GE junction

Front 51

Risk factors for Mallory-Weiss tear

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1) Severe retching or coughing
2) Alcohol abuse
3) Hiatal hernia

Front 52

Symptoms of Mallory-Weiss tear

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1) Epigastric pain
2) Substernal pain
3) HEMATEMESIS after forceful retching

Front 53

Diagnosis of Mallory-Weiss tear

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Endoscopic exam

Front 54

Do Mallory-Weiss tears require surgery?

Back 54

Refractory bleeding may require surgical repair of the laceration

*Bleeding stops spontaneously in 90% of patients
*Persistent bleeding is managed with endoscopic electrocautery

Front 55

Dumping Syndrome

Back 55

Nausea, vomiting, abdominal pain, flatus, palpitations, dizziness, and diaphoresis experienced after rapid entry of carbohydrate load into small bowel after Billroth II (bypass of pylorus)

Front 56

Treatment for severe cases of Dumping syndrome

Back 56

Conversion to a Roux-en Y gastrojejunostomy

Front 57

Afferent Loop Syndrome

Back 57

Obstruction of the afferent limp after a Billroth II with accumulations of biliary secretions

Front 58

Symptoms of afferent loop syndrome

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1) Post-prandial RUQ pain
2) Non-bilious vomiting
3) Fever
4) Steatorrhea (not properly absorbing fats)

Front 59

Alkaline reflux gastritis

Back 59

Post-prandial epigastric pain, nausea, and vomiting resulting from bile reflux into the stomach

Front 60

Diagnosis of alkaline reflux gastritis

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Endoscopic confirmation of bile reflux and biopsy-proven gastritis

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Treatment of alkaline reflux gastritis

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Sucralfate is used to bind bile

Front 62

Gastric volvulus is frequently associated with...

Back 62

Diaphragmativ hernia

Front 63

Gastric volvulus is frequently associated with...

Back 63

Diaphragmativ hernia

Front 64

Cushing's Ulcer

Back 64

Acute gastritis associated with severe neurologic injury

*Located anywhere from distal esophagus to 4th portion of duodenum

Front 65

Curling's Ulcer

Back 65

Acute gastritis associated with a thermal burn injury greater than 35% total body surface area

*Usually found in duodenum; tends to perforate