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The stomach is a J-shaped pouch-like organ that lies under the ____ in the upper _____ portion of the abdominal cavity
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The stomach functions to receive food from the ____, mix it with ____, initiate the digestion of proteins, carry on a limited amt of absorption and move food to the ____
- esophagus
- gastric juices
- small intestine
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The stomach is divided up into what 4 regions?
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What region of the stomach is a small area near the esophageal opening?
Cardiac Region
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Which region of the stomach balloons above the cardiac portion, acts as a temporary storage area, and sometimes filled with swallowed air?
Fundic region
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Which region of the stomach is the main part and is located between the fundic and the pylori regions?
the body
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Which region of the stomach narrows and becomes the _____ canal as it approaches the junction with the small intestine?
- pyloric canal
- pyloric region
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What in the stomach is at the end of the pyloric canal, the muscular wall is thickened forming a powerful circular muscle
pyloric sphincter or pylorus
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What stomach muscle serves as a valve that prevents regurgitation of food from the intestine back into the stomach
pyloric sphincter or pylorus
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Which part of the stomach is located on the short, right curved border that extends from the cardiac to the pyloric openings
lesser curvature
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What lines the stomach
rugae or gastric folds
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What disappears when the stomach is filled with fluids or food?
rugae or gastric folds
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Although gastric juices contain several digestive enzymes, which is the most important?
pepsin
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Following a meal, the mixing of movements of the stomach wall aid in producing a semi fluid paste of food particales and gastric juices called
chyme
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What pushes the chyme toward the pyloric sphincter
peristaltic waves
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Which muscle relaxes allowing the chyme to move a little at a time inot the small intestine
pyloric sphincter
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what begins the digestive process?
gastric juices
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Once the stomach emptys into the ____, accessory organs add their secretions to the chyme
duodenum
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Which organs add their secreations to the chyme?
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Is stomach ca more common in men or women?
men (2:1)
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What is the peak age for stomach ca
50-70
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What is the pathology for stomach ca?
90% adenocarcinoma
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Where are 50% of the lesions found with stomach ca
distal/pyloric region
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Where are 25% of the regions found with stomach ca
Cardiac Region
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Where are 5% of lesions with stomach ca
greater curvature
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What % of lesions are found within the entire stomach
10-15% and this is called lymphoma
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What is the etiology risk factors for stomach ca
- diet (redmeat)
- coal mining
- type A blood
- rubber working
- asbestos
- ulcers.polyps
- alcohol/tobacco
- poor nutrition
- H pylori
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What are symptoms of stomach ca
- persistent indigestion
- epigastric distress or pain
- loss of appetite
- weight loss
- N&V
- dysphagia
- jaundice
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How are stomach tumors diagnosed>
- physical
- upper GI
- CT
- endoscopy
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What is included in a work up for stomach ca
- CBC (most have anemia)
- Guaiac stool test (check for blood)
- upper GIendoscopy with biopsy
- CT scan chest and abdomen
- laparoscopy
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What is the staging for stomach ca
TNM
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How many have distant mets already from stomach ca
30% or 1/3
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which lymphnodes are involved with stomach ca
- greater and lesser curvature
- splenic
- celiac
- hepatic
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What is the direct spread of stomach ca
- bowel
- omenta
- pancreas
- colon
- regional nodes
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Where in the blood does stomach ca spread to
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What is the 5 year survival rate for stomach ca
10%
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When is surgery a good option for stomach ca and what are the complications
- When no mets are present
- complications
- infection
- hemorrhage
- anemia
- anastomis
- PE
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What are treatment options for stomach ca
- all modalities
- surgery
- radiation
- chemo
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what field do you use to treat stomach ca and where
Field extends from diaphragm to L3 including duodenal loop and regional lymph nodes
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what is the curative dose for stomach ca
5000-5500 cGy
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What is the palliative dose for stomach ca
3500-4000 cGy
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What is the curative dose for gastric lymphoma
4000 cGy
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How do you postition a patient with treating stomach ca
Supine with arms overhead
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What are the side effects for radiation in stomach ca
- ulcers
- fistula
- decreased blood counts
- bowel obstruction
- transverse myelitis
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What are the critical structures to watch out for with stomach ca
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