stomach.txt

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Author:
nsmallwood
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124135
Filename:
stomach.txt
Updated:
2011-12-17 13:35:41
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stomach
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  1. gastroduodenal pain comes from where
    afferent sympathetic fibers of t5-19
  2. stomach transit time
    3-4 hours
  3. causes of rapid gastric emptying
    surgery, gastrinoma, ulcers
  4. three types of glands in stomach
    cardiac, oxyntic, antral
  5. what cells are found in antrum
    • g cells
    • d cells
    • mucous and bicarb secreting cells
  6. what are released with antral and duodenal acidification
    somatostatin, cck, secretin
  7. what are the causes of increased gastrin and gastric acid
    • gastrinoma,
    • antral cell hyperplasia
    • renal failure
    • gastric outlet obstruction
    • short bowel syndrome
  8. causes of increased gastrin but normal or low acid
    • pernicious anemia
    • chronic gastritis
    • gstric ca
    • post vagotomy
    • ppi/H2 blocker
  9. type of gastric ulcers with normal acid secretion
    this includes most gastric ulcers but specifically I and IV
  10. most common location of gastric ulcer
    lesser curve
  11. best test for dx of h pylori
    histopathology
  12. compared to billroth I or II a roux y has less
    bile reflux and dumping syndrome
  13. definition of intractable gastric ulcer
    • persistent despite 3 months of tx
    • recurrence with in one year
  14. r/o what when gastric or duodenal ulcers are found
    • ca (mainly just gastric)
    • gastrinoma
    • hyperparathyroidism so check ca and pth
    • ulcerogenic meds
    • h pylori
  15. what test can you do to determine h pylori eradication
    urease breath test or stool antigen
  16. dose of protonix gtt
    8mg/hr
  17. risks factors for rebleed at time of egd
    • spurting blood vessel
    • visible blood vessel
    • diffuse oozing
  18. criteria for surgery following egd for ulcer
    • >4 units and still bleeding
    • shock despite transfusion
    • recurrent bleed after 2 egd attempts
  19. how long to medically manage gastric/duodenal obstruction before surgery
    1 week
  20. when should you do a vagotomy and pyloroplasty for a duodenal perf
    if the patient has been previously treated for h. pylori, PPI, small perf and is stable
  21. post vagotomy diarrhea caused by
    sustained postprandial organized mmcs and nonconjugated bile salts
  22. surgical option for refractory post vagotomy diarrhea
    reversed jejunal graft
  23. dx test for dumping syndrome
    gastric emptying study (radionuclide colloid scintography)- stomach will dump the colloid quickly
  24. non surgical treatment of dumping syndrome
    small, high protein, low fat and carbohydrate meals with no liquids
  25. medical tx of alkaline reflux
    PPI, cholestyramine, reglan
  26. surgical treatment for alkaline reflux
    convert to Roux en Y with afferent limb 60cm
  27. sxs of afferent loop syndrome
    abd pain and nonbilious vomiting relieved with bilious emesis
  28. symptoms of blind loop syndrome
    abd pain, malabsorption, b12 def, steatorrhea
  29. dx of afferent loop syndrome
    • EGD with aspirate and cx
    • also can check for fecal fat
  30. tx for blind loop syndrome
    tetracycline + flagyl +reglan/erythromycin
  31. how can you test for retained gastric antrum
    technetium scan
  32. what is the most common cause of recurrent peptic ulcer disease after surgery
    incomplete vagotomy
  33. how do you diagnose an incomplete vagotomy
    sham feeding
  34. most common cause of isolated gastric varices
    thrombosed splenic vein
  35. where are mallory weiss tears found
    lesser curve by GE junction
  36. sxs of menetrier's disease
    epigastric pain, weight loss, anemia
  37. pathology seen in menetriers
    • ulcers and protein loss
    • mucus cell hyperplasia
    • increase rugal folds
  38. childhood form of menetriers disease is from
    cmv or h pylori
  39. what is the surgical eligibility for weight loss surgery
    • bmi >40 or 35 with comorbidities
    • psych/nutrition eval
    • 2 failed weight loss attempts
    • can not gain weight in the interim
    • weight is seriously affecting the quality of life
  40. most common cause of leak in Gastric bypass
    ischemia
  41. when do you have to operate for stenosis after gastric bypass
    if it occurs early
  42. malignant GIST defined as
    >5-10 mitosis/50hpf or size >5
  43. margins needed for GIST
    1 cm
  44. treatment of MALT
    • confined to stomach (IE)/limited to perigastric nodes (IIE-1): need quadruple therapy then xrt if still present
    • IIE and greater or if above fails the pt needs CHOP-R +/- XRT
  45. surgery for gastric lymphoma indicated for
    stage I only- must be limited to gastric submucosa
  46. most common site of gastric cancer
    gastric antrum
  47. histology of intestinal gastric cancer shows
    glands
  48. standard surgery for gastric ca requires
    • stomach with 5cm margin
    • omentectomy
    • perigastric and celiac nodes
  49. palliative treatment for bleeding or pain with gastric ca
    xrt
  50. palliative treatment for obstructive symptoms in proximal gastric ca
    stent
  51. T for tumor extending beyond serosa
    T3
  52. T4 is defined as
    diffuse involvment of gastric wall
  53. N2 defined as
    mets to LN to both curvatures or distant from primary tumor
  54. lymph node involvment means the pt is atleast what stage
    III

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