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18 Cards in this Set

  • Front
  • Back
Describe a Type 1 gastic ulcer.
Single ulcer, usually on the lesser curvature.
Describe a Type 2 gastic ulcer.
Simultaneous gastric and duodenal ulcers.
Describe a Type 3 gastic ulcer.
Pyloric channel ulcer.
Describe a Type 4 gastic ulcer.
Proximal ulcer, often near GE junction.
Which ulcers (type 1, 2, 3, or 4) are caused by acid hypersecretion?
Types 2 and 4
Which types of gastric ulcers are associated with normal gastric acid secretion?
Types 1 and 4.
List 5 indications for operating on gastric ulcers.
1. Intractibility
2. Perforation
3. Obstruction
4. Hemorrhage
5. Rule out cancer
Describe 3 types of vagotomy.
1. Truncal vagotomy: transection 3-4 cm above GE junction
2. Selective vagotomy: transection below the GE junction to preserve hepatic and celiac branches (doesn't work well)
3. Highly selective vagotomy: denervation of only the corpus and fundus of stomach (no pyloroplasty required)
Describe 3 types of pyloroplasty.
1. Heineke-Mikulicz: 4cm longitudinal full-thickness gastroduodenotomy closed transversely.
2. Finney: anterior-posterior approximation of gastroduodenotomy.
3. Jaboulay: two incisions made, one gastrotomy, one duodenotomy and are joined to one-another, leaving the pylorus intact.
List 4 complications of vagotomy and drainage.
1. Post-vagotomy diarrhea
2. Early dumping syndrome
3. Late dumping syndrome
4. Afferent loop syndrome
5. Efferent loop syndrome
6. Bile acid reflux gastritis
Describe the etiology of postvagotomy diarrhea.
The vagus usually inhibits the migrating motility complex. Without the vagus, food is rapidly transported into the colon and diarrhea results.
Describe early dumping syndrome and its etiology.
Occurs with in 30 minutes of eating with dizziness, nausea, and vomiting. Caused by dumping of non-digested highly osmotic fluid into GI tract, resulting in fluid shifts from the intravascular space and hypotension.
Describe late dumping syndrome and its etiology.
Occurs within 2-3 hours after eating with diaphoresis and tachycardia. Caused by abnormal release of enteroglucagon resulting in high insulin release, then hypoglycemia, and its sequelae.
What is the treatment for late dumping syndrome?
Somatostatin. Reversal of pyloroplasty, or conversion of B1 / B2 to Roux-en-y if somatostatin fails.
Describe the symptoms of afferent loop syndrome.
Severe post-prandial pain followed by bilious vomiting which resolves pain.
Describe the cause of afferent loop sydrome.
Obstruction of the proximal jejunum in an Bilroth II reconstruciton. This loop may decompress into the stomach, resulting in bilious vomiting and resolution of pain. If it does not decompress and remains a complete obstruction, fever, leukocytosis, and hyperamylasemia result.
Describe the treatment for afferent loop syndrome.
Conversion to Roux-en-y gastrojejunostomy.
Describe the symptoms and cause of efferent loop sydrome.
Similar to symptoms of other small bowel obstruction: nausea, vomiting, obstipation. Caused by adhesions.