-
gastroduodenal pain comes from where
afferent sympathetic fibers of t5-19
-
stomach transit time
3-4 hours
-
causes of rapid gastric emptying
surgery, gastrinoma, ulcers
-
three types of glands in stomach
cardiac, oxyntic, antral
-
what cells are found in antrum
- g cells
- d cells
- mucous and bicarb secreting cells
-
what are released with antral and duodenal acidification
somatostatin, cck, secretin
-
what are the causes of increased gastrin and gastric acid
- gastrinoma,
- antral cell hyperplasia
- renal failure
- gastric outlet obstruction
- short bowel syndrome
-
causes of increased gastrin but normal or low acid
- pernicious anemia
- chronic gastritis
- gstric ca
- post vagotomy
- ppi/H2 blocker
-
type of gastric ulcers with normal acid secretion
this includes most gastric ulcers but specifically I and IV
-
most common location of gastric ulcer
lesser curve
-
best test for dx of h pylori
histopathology
-
compared to billroth I or II a roux y has less
bile reflux and dumping syndrome
-
definition of intractable gastric ulcer
- persistent despite 3 months of tx
- recurrence with in one year
-
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
-
what test can you do to determine h pylori eradication
urease breath test or stool antigen
-
dose of protonix gtt
8mg/hr
-
risks factors for rebleed at time of egd
- spurting blood vessel
- visible blood vessel
- diffuse oozing
-
criteria for surgery following egd for ulcer
- >4 units and still bleeding
- shock despite transfusion
- recurrent bleed after 2 egd attempts
-
how long to medically manage gastric/duodenal obstruction before surgery
1 week
-
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
-
post vagotomy diarrhea caused by
sustained postprandial organized mmcs and nonconjugated bile salts
-
surgical option for refractory post vagotomy diarrhea
reversed jejunal graft
-
dx test for dumping syndrome
gastric emptying study (radionuclide colloid scintography)- stomach will dump the colloid quickly
-
non surgical treatment of dumping syndrome
small, high protein, low fat and carbohydrate meals with no liquids
-
medical tx of alkaline reflux
PPI, cholestyramine, reglan
-
surgical treatment for alkaline reflux
convert to Roux en Y with afferent limb 60cm
-
sxs of afferent loop syndrome
abd pain and nonbilious vomiting relieved with bilious emesis
-
symptoms of blind loop syndrome
abd pain, malabsorption, b12 def, steatorrhea
-
dx of afferent loop syndrome
- EGD with aspirate and cx
- also can check for fecal fat
-
tx for blind loop syndrome
tetracycline + flagyl +reglan/erythromycin
-
how can you test for retained gastric antrum
technetium scan
-
what is the most common cause of recurrent peptic ulcer disease after surgery
incomplete vagotomy
-
how do you diagnose an incomplete vagotomy
sham feeding
-
most common cause of isolated gastric varices
thrombosed splenic vein
-
where are mallory weiss tears found
lesser curve by GE junction
-
sxs of menetrier's disease
epigastric pain, weight loss, anemia
-
pathology seen in menetriers
- ulcers and protein loss
- mucus cell hyperplasia
- increase rugal folds
-
childhood form of menetriers disease is from
cmv or h pylori
-
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
-
most common cause of leak in Gastric bypass
ischemia
-
when do you have to operate for stenosis after gastric bypass
if it occurs early
-
malignant GIST defined as
>5-10 mitosis/50hpf or size >5
-
margins needed for GIST
1 cm
-
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
-
surgery for gastric lymphoma indicated for
stage I only- must be limited to gastric submucosa
-
most common site of gastric cancer
gastric antrum
-
histology of intestinal gastric cancer shows
glands
-
standard surgery for gastric ca requires
- stomach with 5cm margin
- omentectomy
- perigastric and celiac nodes
-
palliative treatment for bleeding or pain with gastric ca
xrt
-
palliative treatment for obstructive symptoms in proximal gastric ca
stent
-
T for tumor extending beyond serosa
T3
-
T4 is defined as
diffuse involvment of gastric wall
-
N2 defined as
mets to LN to both curvatures or distant from primary tumor
-
lymph node involvment means the pt is atleast what stage
III
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