MCQ Gastro - Stomach

Marshall and WarrenQ

Around 90% of duodenal ulcers and 75% of gastric ulcer are associated with H. pylori infectionQ.

• Gastric antrum.
• Can live only in gastric epithelium - only gastric epithelium expresses specific adherence receptors that can be recognized by organism

• Proximal esophagus
• Barrett’s esophagus
• Gastric metaplasia in the duodenum
• Meckel’s diverticulum, and
• Heterotopic gastric mucosa in the rectumQ

Spiral shaped, gram (-)ve rod, motile with lophotrichous flagellaQ

• Catalase, oxidase and urease positiveQ
• Urease provides ammonia to buffer acidQ

• Skirrow’s medium
• Chocolate mediumQ

6.0-7.0Q

H. pylori colonization decreases somatostatin producing cells →↑ Gastrin →↑Acid → Gastric metaplasia in duodenum → UlcerationQ

Ischemic heart disease and cerebrovascular diseaseQ

• If endoscope is employed - Rapid urease testQ.
• When endoscopy is not required - Serology is the test of choice
• After treatment - Urea breath test is the method of choice but should be performed after 4 weeks of therapyQ

• • Chronic inflammation on a gastric mucosal biopsy specimen is 100% sensitive testQ
• • Rapid Urease test on a gastric mucosal biopsy specimen is 100% specific testQ

• • Duodenal ulcerQ
• • Gastric ulcerQ
• • Gastric adenocarcinomaQ
• • MALT lymphomaQ

• Type A – Autoimmune, involves body and fundusQ
• Type B – Bacteria induced (H. pylori), involves antrum

• Gastric - Lesser curvature along the incisura angularis (Type 1)Q
• Duodenal - 1st part of duodenum (overall MC site for peptic ulcer)Q

• Perforation: MC complication of gastric ulcer (Into lesser sac)Q
• Bleeding: MC complication, on posterior wall, gastro¬duodenal arteryQ is most commonly involved

• I - Lesser curvature, near incisura angularis (MC)Q - Low
• II - Body of the stomach and duodenumQ - HighQ
• III - PrepyloricQ (within 2-3 cm of the pylorus) - HighQ
• IV - High on the lesser curve, near GE junctionQ - Low
• V - Anywhere, induced by medication (NSAIDs) – Low

• Type I: Blood group ‘A’Q
• Type II, III, and IV: Blood group ‘O’Q

• Endoscopic measures
• Pyloroduodenotomy and ligation of GDA
• Even in the era of H. pylori and our ability to eradicate it, a TV perhaps should be performed in those patients with a bleeding duodenal ulcer

Anterior surface of the inferior pylorusQ

Truncal vagotomy and Q

80%Q

Inhibition of acid secretion is also more prolonged because of the irreversible inhibition of the enzyme caused by the covalent bond to the proton pumpQ, requires acidic environment

Nerves of Latarjet supplying the antrum are preservedQ (and hence gastric motility)

• Posterior gastroenterostomy which is a modification of Billroth II operation.
• Resection of 2/3 of the stomach with blind closure of the duodenal stump and retrocolic anastomosis of the full circumference of the open stomach to jejunumQ.

• Heineke-Mikulicz Pyloroplasty
• Finney Pyloroplasty
• Jaboulay Gastroduodenostomy

75% GUs and 90% DUs

• Type I - Distal gastrectomy with Billroth I or II reconstructionQ
• Type II and III - Truncal vagotomy plus antrectomyQ
• Type IV - Schoemaker procedureQ, • Pouchet procedureQ, • Kelling-Madlener procedure (For unstable patientsQ), Csendes procedure (For stable patientsQ)

• Chronic duodenal ulcer never turns malignant
• < 1% of chronic gastric ulcer may transform into carcinoma

• Benign - Generally at lesser curvatureQ
• Malignant - At greater curvatureQ

• Benign - Mucosal rugae projects outwards from the margins of ulcerQ
• Malignant - Mucosal rugae stop far of the ulcerQ

• Benign - Smooth radiating foldsQ with Hampton line and collarQ, Overhanging marginsQ showing regeneration, Benign BPH: (Benign ulcer- Penetrating sign and Hampton’s hump)
• Malignant - Interrupted nodular, clubbed folds with Lasman Kirklin complexQ (malignant ulcer with no mass) • Eccentric with heaped up and everted marginsQ, Malignant CIK: (Carman’s meniscus sign, Intraluminal crater, Kirklin complex)

Posterior truncal vagotomy with anterior HSVQ.

Posterior truncal vagotomy with anterior lesser curve seromyotomyQ. The technique is very suitable for a laparoscopic approach

• Secondary to gastric reconstruction - Afferent loop syndromeQ • Efferent loop obstructionQ • Alkaline reflux gastritisQ • Retained antrumQ syndrome
• Postvagotomy syndrome - Postvagotomy diarrheaQ • Postvagotomy gastric atonyQ • Incomplete vagal transectionQ

AnemiaQ, Iron deficiency anemia (IDA) is more common than vitamin B12 deficiency anemiaQ

Occurs immediately after meals (after 15-30 minutes) Q, Dumping of hyperosmolar contents into the small bowelQ results in rapid fluid influx from the circulation into the gastrointestinal tract - leads to acute intestinal distention and peripheral and splanchnic vasodilatationQ. - gives rise to vasomotor and abdominal symptoms.

Is seen 2-3 hrs after mealQ, due to reactive hypoglycemiaQ. • The carbohydrate load in the small bowel causes a rise in plasma glucose, which in turn, causes high insulin levels leading to hypoglycemia.• Symptoms are relieved by administration of sugarQ

• Use of an antiperistaltic loop of jejunum between the residual gastric pouch and intestine
• Conversion of Billroth II to Billroth I anastomosis
• Conversion to Roux-en-Y-anastomosis

4th to 7th post-operative dayQ.