Absite Stomach

Front 1

secrete pepsinogen

Back 1

chief cells

Front 2

1st enzyme in proteolysis

Back 2

pepsinogen

Front 3

Releases H+ and intrinsic factor

Back 3

parietal cells

Front 4

Name 3 that causes HCl release

Back 4

ACh, gastrin and histamine

Front 5

which acts on phospholipase to secrete HCl?

Back 5

ACH and Gastrin

Front 6

What acts on adenylate cyclase ?

Back 6

Histamine to produce cAMP which activates protein kinase A

Front 7

4 that inhibits parietal cells

Back 7

Somatostatin, PGE1, secretin, CCK

Front 8

Type of cells found in antrum

Back 8

G and D cells

Front 9

Role of G cells

Back 9

release gastrin
inhibited by acid in duodenum
stimulated by amino acids and ach

Front 10

Role of D cells

Back 10

secrete somatostatin

Front 11

stimulates release of somatostatin, CCK, and secretin

Back 11

duodenal and antral acidificaiton

Front 12

causes of increased acid and gastrin

Back 12

ZES
antral cell hyperplasia
retained antrum
renal failure
gastric outlet obstruction
short bowel syndrome

Front 13

causes of increased gastrin and nl/decreased acid

Back 13

pernicious anemia
chronic gastritis
gastric CA
postvagotomy
medical acid supression

Front 14

rapid gastric emptying causes

Back 14

#1 previous surgery
ZES
ulcers

Front 15

B1/2 vs RYGJ

Back 15

more marginal ulceration and diarrhea

Front 16

what is Dieulafoy's ulcer

Back 16

vascular malformation

Front 17

Menetrier's disease

Back 17

mucous cell hyperplasia
increased rugal folds

Front 18

Gastric volvlus is a/w?

Back 18

Type 2 paraesophageal hernia
usually organoaxial
management --> reduction and nissen

Front 19

All vagotomies result in ?

Back 19

increased liquid emptying

Front 20

Truncal vs selective vs highly selective vagotomy

Back 20

decreased solid emptying except in highly seelctive

Front 21

effect of pyloroplasty

Back 21

increased solid empyting

Front 22

Effects of truncal vagotomy

Back 22

90% reduction in acid output
increased gastrin
gastrin cell hyperplasia
decreased exocrine pancreas function
decreased postprandial bile flow
increased GB volumes

Front 23

MC problem following vagotomy

Back 23

diarrhea due to sustained MMcs forcing bile acids into colon

Front 24

Chance of rebleeding with
1) Spurting blood vessel
2) visible blood vessel
3) diffuse oozing

Back 24

1) 60%
2) 40%
3) 30%

Front 25

Management of esophageal varices

Back 25

EGD sclerotherapy or banding --> IV vasopressin, balloon tamponade --> repeat sclerotherapy or banding --> TIPS --> esophageal stapling or portosystemic shunt

Front 26

symptoms of duodenal ulcers

Back 26

epigastric pain radiating to back that abates with eating but recurs 30mins postprandially

Front 27

Surgical options in dudodenal ulcers

Back 27

truncal vagotomy and pyloroplsaty
truncal vagotomy, antrectomy, B1 or B2 recon (best for prevention of recurrence)
Proximal or highly selective vagotomy - lowest rate of postop complications, 10% recurrence
no antral or pylorus procedure needed

Front 28

surgical options for bleeding duodenal ulcer

Back 28

1st duodenostomy
GDA ligation
plus vagotomy and pyloroplasty if pt had been on PPI

Front 29

Initial management of obstruction from duodenal ulcer

Back 29

serial dilation

Front 30

obstructing duodenal ulcer near Amp of vater

Back 30

B2, antrectomy and vagotomy

Front 31

obstructing duodenal ulcer prosimal to amp of vater

Back 31

antrectomy with ulcer excision, B2 and vagotomy

Front 32

best surgical option for perforated duodenal ulcer

Back 32

G patch and highly selective vagotomy if pt had been on PPI

Front 33

Other options for perforated duodenal ulcer

Back 33

truncal vagotomy and pyloroplasty
TV and antrectomy with B1 or B2
need to include ulcer

Front 34

Intractable duodenal ulcer

Back 34

>3 months of PPI without relief
recurrence <1 year after medical therapy
based on EGD not symptoms?`

Front 35

Management of pancreatic tumors causing ZES that's <2cm

Back 35

enucleation

Front 36

test for ZES

Back 36

secretin causes high gastrin

Front 37

Management of unresectable ZES

Back 37

total gastrectomy

Front 38

RF for gastric ulcers

Back 38

male
tobacco
ETOH
NSAIDs
H. Pylori
uremia
stress (burns, sepsis, trauma)
steroids
chemo

Front 39

which types of gastric ulcers have normal acid secretion?

Back 39

Type 1 and 4

Front 40

Most gastric ulcers are located on

Back 40

lesser curve

Front 41

T/F bleeding gastric ulcers are a/w higher mortality than duodenal

Back 41

true

Front 42

biopsy for H. Pylori needs to be from where?

Back 42

antrum

Front 43

What blood type is associated with type 1 gastric ulcers

Back 43

A
type O a/w type II-IV ulcers

Front 44

surgical options for all types of gastric ulcers

Back 44

1 distal gastrectomy + B1 or B2
2 & 3 - distal gastrectomy, B1/B2, + truncal vagotomy/pyloroplasty
Type 4 - ulcer excision +/- highly selective vagotomy or TV + P

Front 45

H. Pylori treatment regimen

Back 45

PPI + amoxicillin (or flagyl) + clarithromycin X 14 days
OR
PPI/H2 + bismuth + flagyl + tetracycline for 10-14 days

Front 46

RF for gastric CA

Back 46

adenomatous polyps (10-20%)
tobacco
previous gastric ops
intetinal metaplasia
atrophic gastritis
pernicious anemia
type A blood
nitrosamines

Front 47

Intestinal vs diffuse gastric cancer

Back 47

blood vs lymphatic invasion
presence of glands
less favorable prognosis
subtotal vs total gastrectomy
Chemo (5FU, doxorubicin, mitomycin C)

Front 48

GIST

Back 48

hypoechoic on U/S (smooth edges)
chemo if >5cm?
1cm margins needed

Front 49

How do gastric leiomyosarcomes spread?

Back 49

hematogenously

Front 50

MALT

Back 50

precursor to gastric lymphoma
should regress after H Pylori treatment
if not, need CHOP

Front 51

surgical eligibility of morbid obesity

Back 51

BMI>40 or >35 with comorbidities

Front 52

What is dumping syndrome?

Back 52

Diarrhea, dizziness, hypotension from rapid entering of carbs into SB

Front 53

Treatment of dumping syndrome

Back 53

Small low fat, low carb, increased protein meals
no liq with meals
surgery rarely needed (10%) convert to RYGB

Front 54

Name 10 complications from gastrectomy

Back 54

Dumping syndrome
Afferent loop obstruction
Efferent loop obstruction
Gastric atony
Alkaline reflux gastritis
Roux stasis
Small gastric remnant
Duodenal stump blowout
Blind loop syndrome
Postvagotomy diarrhea

Front 55

Alkaline reflux gastritis

Back 55

postprandial epigastric pain with N/V (no relief)
evidence of bile reflux into stomach
treat w/ H2 blockers, cholestyramine, reglan
surgery --> convert to RYGJ

Front 56

Roux Stasis

Back 56

Chyme stasis in roux limb due to loss of jejunal motility

Front 57

Management of Roux stasis

Back 57

reglan, prokinetics, if not shorten roux limb to 40cm

Front 58

Blind looop syndrome

Back 58

with B2 or RYGJ
pain, diarrhea, malabsorption, B12 deficiency, steatorrhea
from bacterial overgrowth and stasis in afferent limb
treatment: tetracycline, flagyl, reglan
surgery: reanastomosis with shorter afferent limb (40cm)

Front 59

Afferent loop Obstruction

Back 59

B2 or RYGJ
Nonbilious vomiting, pain relieved with bilious emesis
EGD, dilation?, reanastomosis w/ shorter limb (40cm)

Front 60

efferent loop obstruction

Back 60

UGI, EGD, balloon dilation

Front 61

postvagotomy diarrhea

Back 61

from nonconjugated bile salts in colon (from sustained postprandial MMCs)
cholestyramine, octreotide
if not reversed interposition jejunal graft

Front 62

What does not get absorbed in jejunum?

Back 62

Iron (duodenum)
Bile acids (ileum)
B12 and folate (terminal ileum)

Front 63

classic triad of gastric volvulus

Back 63

severe epigatric pain
retching without vomiting
inability to pass NGT