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42 Cards in this Set
- Front
- Back
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what space lies behind the stomach
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lesser sac
the pancreas lies behind the stomach |
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what is the opening into the lesser sac?
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foramen of winslow
(win was slow because he had a lesser sac) |
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what are folds of gastric mucosa called?
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rugae
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what kind of cells are in the antrum
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G cells
Gee I wish i were in the Antrum |
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what is pyrosis?
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heartburn
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what is Barrett's esophagus
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columnar metaplasia
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4 surgical options for GERD
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LAP Nissen
Belsey mark IV Hill Toupet |
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What is a LAP Nissen
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for GERD
360 degree fundoplication laparoscopically |
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What is a Belsey mark IV
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GERD surgery
240-270 degree fundoplicaiton via thoracic approach |
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What is a Hill?
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GERD surgery
Arcuate ligament repair (close large esophageal hiatus) and gastropexy to diaphragm |
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what is a Toupet
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incomplete (around 200 degree) posterior wrap, often with severe decreased esophageal motility
laparoscopic |
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% effectiveness of LAP Nissen
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90%
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post op complications of LAP Nissen
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gas-bloat syndrome
stricture dysphagia spleen injury esophageal perforation pneumothorax |
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blood type associated with gastric cancer
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A
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symptoms of gastric cancer
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WEAPON
Weight loss Emesis Anorexia Pain/epigastric discomfort Obstruction Nausea |
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Most common early symptoms of stomach cancer
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mild epigastric discomfort and indigestion
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most common symptom of stomach cancer
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weight loss
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what is a Blumer's shelf?
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solid peritoneal deposit anterior to the rectum, forming a shelf, palpated on rectal exam
Shelf near your blumers |
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what is Virchow's node on?
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left supraclavicular fossa
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Irish's node?
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left axillary adenopathy from gastric cancer metastasis
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surveillance lab finding for gastric cancer
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CEA elevated in 30% of cases
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workup for gastric cancer
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EGD with biopsy
endoscopic US to evaluate level of invasiton CT for mets CXR labs |
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histology of gastric cancer
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adenocarcinoma
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differential diagnosis for gastric tumors
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adenocarcinoma
leiomyoma leiomyosarcoma lymphoma carcinoid ectopic pancreatic tissue gastrinoma benign gastric ulcer polyp |
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where are gastric cancers more common, on lesser or greater curvature
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lesser (lesser is greater)
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what is more common, proximal or distal gastric cancer
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proximal
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how to gastric cancers metastasize
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blood and lymph
(stomach will eat anyting!) |
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genetic alteration in more than half pf patients with gastric cancer
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p53
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tx for stomach cancer
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surgical resection with wide (>5cm) margins and lymph nod dissection
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what operation for tumor in Antrum
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distal subtotal astrectomy
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surgery for stomach cancer in midbody of stomach
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total gastrectomy
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surgery for proximal stomach cancer
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total gastrectomy
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with what kind of a structure is esophagus handled in a total gastrectomy
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Roux-en-Y to connect esophagus to duodenum (so both esophagus and CBD come into the duodenum
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type of anastomosis for total gastrectomy
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Billroth II or Roux-en-Y
NOT Billroth I |
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symptoms of gastric volvulus
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Brochardt's triad
distention of epigastrium Cannot pass an NGT emesis followed by inability to vomit |
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tx for gastric volvulus
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exploratory laparotomy to untwist and gastropexy
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BMI for morbid obesity
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>40
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medical conditions associated with morbid obesity
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sleep apnea
CAD pulmonary disease DM venous stasis ulcers arthritis infections sex-hormone abnormalities HTN breast cancer colon cancer |
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what is a gastric bypass
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stapling off of small gastric pouch
Roux en Y limb to gastric pouch |
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what does gastric bypass cause?
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dumping of food in the the Roux en Y limb, where it bypasses the small bowel
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mean weight loss iwth gastric bypass
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50%
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possible complications after bariatric surgery
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gallstones
anastomotic leak marginal ulcer stenosis of pouch/anastomosis malnutrition incisional hernia spleen injury iron deficiency B12 deficiency |
