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46 Cards in this Set

  • Front
  • Back
acid production:cephalic phase
stim of cns by sight,smell, thought- vagus nerve rel acetylcholine
acid secretion; gastric phase
food in antrum promotes release of gastrin hormone effects parietal cell.
acid production; instestinal phase
histamine receptor
parietal cell secretes:
hydrogen ions in response to stimul by gastrin
acute ulcer disease may
may erode artery, perforate into abd cavity (pneumoperitoneum- free air on upright chest xray)
surgical tx acute ulcer disease: indications/surgery
perforation, hemorrhage, obstruction, intractability require surg interv; explor celiotomy (laparotomy), ulcer plicate (<6hrs old) with vagotomy and graham patch. plication alone if >6hrs old
acute ulcer tx: gi hemorr
stomach decompressed, gastric lavage, coagulation parameters, iv blood, endoscopy to establ source. surgical tx is ligation of bleeding artery. pts req >6 units of blood in intial 12 hr period
gastric outlet obst tx
NPO for 5-6 days, TPN-tx malnutrition. classic metabolic abn is hypochloremic, kypokalemic metabolic alkalosis (ng tube suction related)
Na/H pump inhibitor works by blocking
proton pump of parietal cell
diagn h pylori by
uease concentrations (serology, breath, or biopsy of gastric)
surgical tx chronic ulcer disease
truncal vagotomy w plyloroplasty , selective vagotomyw plyloroplasty , proximal vagotomy
zollingerellison syndrome
product of gastrin by gastrinoma in pancreas of paraduodenal area; 60% are malignant. MENS type I familial, fasting serum gastrin levles are high.
gastric ulcer
pian epigastrum radiate to back, ingestion food makes worse (duod food makes better) wieght lossusually in lesser curvature of stomach, <50% heal w/ medical tx, high susp for carcinoma- surgical tx= antrectomy w/o vagotomy (not us a hypersecretion problem)
complications postgastrectomy syndromes
early dumping synd; late dumping synd; postvagotomy diarrhea (truncal vagotomy); afferent loop obstruction; (billroth II); blind loopsyndrome (billroth II), alkaline reflux, gastric atony,nutritional dist (megalo anemia (vit b12 or folate def)
gastric carcinoma
premalignant: adenoma polyps, chronic gastritis, caustic injury. grp A lood type, pernic anemia
symp gastric carcinoma
adenomas, 60% distal half of stomach; metastic spread regional lymph nodes, omentum,
gastric lymphoma
confused w gastric carcinoma but survival rates >75% compared to <10% gastric carcinoma
symp gastric carcinoma
adenomas, 60% distal half of stomach; metastic spread regional lymph nodes, omentum,
Indirect ingual hernia
within continuous peritoneal coverage of patent processus vaginalis: congenital hernia; 20% males retain some degree; usually inciting event/activity
Hydrocle differs from inderect hernia in that
no bowl has yet protruded into the goin this is a communicating hydrocele which can fill with peritoneal fluid
Indirect herias are most common hernia iin both sexes and all age groups. originate through;;;
post inguinal wall (abdom ring) can incarcerate (most common cause of bowel obst in people who have not had prev abd surgery otherwise it is the second most common cause of small bowel obst.
Direct inguinal hernia proceeds directly through;;;
post abd wall; acquired; older men tend not to go to scrotum; lower rate of incarceration
femoral hernia involves enlarged femoral ring which invites herniation
very susceptible to incarceration
umbilical hernias
best ingnored until preschool as most spont resolve; adults need repair as risk of incarceration strong
operative repair of umbilical hernia is not indicated in an adult with hepatomegaly because
inceased abd pressure (ascites) may not heal, has high recurrence rate
most common cause of incisional hernia is
wound infection. not increased by obesity, early ambulation; use of transverse incision decreases risk
a sliding hernia is
hernia sac formed by one of intraabdominal structures (bowel, omentum, bladder slides into internal ring and forms part of peritoneal sac
richter's hernia is
incarcerates or strangulates part of intestinal wall
Littre's hernia is an
inguinal hernia that containes a meckels diverticulum (congen diverticul of ileus)
external oblique aponeurosis forms the
external ring that allows spermatic cord to pass from inguinal canal, anterior to pubic tuber into the scrotum.
hesselbachs triangle is the
post inguinal wall through which direct hernia protrudes. sides of triangle are rectus sheat, superior portion in cojined tendon, inferior portion is inguinal ligament
above inguinal ligament
indirect or direct hernia
bulge below inguinal ligament
femoral hernia
surgical treatment of reflux esophagitis:
laparoscopic fundoplication;
esophageal motility: achalasia-
distal esophageal circular muscle segment path. failure of high pressure zone sphincter to dilitation of proximal esoph, may have esophageal diverticula. surg tx is esophageal myotomy distal 2 inches of esophagus-1cm of stomach
esophageal diverticula: cervical, zenders
tx excision, myotomy of crocopharyngeal muscle.
esophageal neoplasms: benign tumors; leiomyomas
excise to prevent dysphagia, obst, and path r/o malignancy
esophageal malignant tumors: squamous cell carcinoma(85%), adeno(10%), melanoma(<1%)
dx upper gi/endoscopy, ct scan stages,
cure rate overall is %5
esophageal perforation; instrumentation,ng tube foriegn body
sx: mediastinal sepsis, chest pain
small intestine anatomy: duodenum, jejunum and ileum
duod: pylorus ends at ligament of treitz
jejunum; first 40% of small intestine distal to ligament of treitz
ileum: remaining 60%
small intestine blood supply
areterial; superior mesenteric artery- branches middle colic artery/right colic artery
venouse: into superior mesenteric vein- forms portal vein in conjunction with splenic and inf mesenteric veins
ileocecal valve
termination of small intestine, prevents reflux of colonic contents
absorbs greatest magnitude of ingetsted material, much passive transfer
greater active transport mechanisms, receptors for fat soluble vitamins, b12, bile salt absorption, reabs 80% fluid
intestinal motility sympathetic and parasympathetic stimuli
parasymp; originates from vagus nerve, increasing tone, enhancing motility
sympath; opp effect
ENTERIC NERVOUS PLEXUS; inhib and excit respond to var stimuli
acute appendicitis; most common surgical procedure, 4-6% pop; 80% between 5-35 years old
obstruction of appendiceal lumen; related to lymphoid hyperplasia (60%), accum of fecal meterial (35%)acute viral or bacterial illness,