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Most common site of duodenal atresia?
Duodenal obstruction is distal to the ampulla of Vater, and infants present with bilious emesis in the neonatal periodQ.
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Treatment of duodenal atresia?
Diamond-shaped duodenoduodenostomy is the treatment of choiceQ.
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Bubble signs in GI radiology?
- Single bubble sign - Congenital Hypertrophic Pyloric StenosisQ
- Double bubble sign - Duodenal atresiaQ, Annular pancreas
- Triple bubble sign - Jejunal atresiaQ
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Palpation finding in CHPS?
- • Palpation of the pyloric tumor or olive in the epigastrium or right upper quadrant by a skilled examiner is pathognomonic for the diagnosis of HPSQ.
- • If the olive is palpated, no additional diagnostic testing is necessaryQ.
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USG measurements for CHPS?
- Pyloric wall thickness of at least 4 mmQ
- Channel length of at least 17 mmQ
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Barium Meal finding in CHPS?
- −−String signQ: indicating a narrowed elongated pyloric canal that does not relax is seen
- −−Shoulder signQ: caused by the hypertrophied muscle indenting the antrum
- −−Double-track signQ: caused by the redundant mucosa
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Treatment for CHPS?
- Never a surgical emergency, although dehydration and electrolyte abnormalities may present a medical emergencyQ
- Ramstedt-Fredet pyloromyotomy (cutting across the abnormal pyloric musculatureQ while preserving the underlying mucosa). If the mucosa is inadvertently opened then feeding is delayed for 48 hoursQ
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MC cause of gastric outlet obstruction?
CA stomachQ
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Site of stenosis or obstruction in peptic ulcer disease?
1st part of the duodenumQ
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What is saline load test?
- Emptying the stomach with a nasogastric tube - instill 750 mL of saline, the patient is placed in sitting position, and 30 minutes later the nasogastric tube is aspirated, normally < 400 mL should remain in the stomach, and 90% of subjects have a residue of less than 200 mL.
- The finding of > 400 mL residual saline is consistent with a diagnosis of gastric outlet obstruction
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Surgical procedure for GOO?
- Truncal vagotomy and antrectomyQ is the ideal procedure
- The inflammation and scarring at duodenal bulb or previous proximal duodenal surgeries prevents safe performance of an antrectomy, in this setting truncal vagotomy with drainage (Gastrojejunostomy) is the preferred approachQ
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Why is there alkalosis in GOO and other conditions?
- • Gastric alkalosis is most marked with vomiting due to pyloric stenosis or obstruction because the vomitus is acidic gastric juice onlyQ.
- • Vomiting in other conditions may involve a mixture of acid gastric loss and alkaline duodenal contentsQ and the acid-base situation that results is more variable
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Types of Bezoars?
- Bezoars are collections of nondigestible materials.
- Four types of Bezoar: Phytobezoars (MC), Trichobezoars, Pharmacobezoar and Lactobezoar
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What is Stress Gastritis?
Characterized by multiple, superficial (nonulcerating) erosions that begin in the proximal or acid-secreting portion of the stomach and progress distallyQ
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What is Cushing’s ulcer?
Occur in the setting of central nervous system disease (Head trauma)Q
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What is Curling’s ulcer?
- Occurs as a result of thermal burn injury involving > 35% of BSAQ
- Increased acid secretion in Cushing’s ulcer but not in Curling’s ulcerQ
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What are cameron ulcers?
Linear gastric erosions in hiatal herniasQ
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Pathophysiology of stress gastritis?
In stress (hypoxia, sepsis, or organ failure), mucosal ischemia is the main factor responsible for the breakdown of these normal defense mechanismsQ
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Types of gastric volvulus?
- Organoaxial (two thirds): Torsion occurs along the stomach’s longitudinal axisQ
- Mesenteroaxial (one third): Torsion occurs along the vertical axisQ
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What is primary gastric volvulus?
- Seen in association with congenital asplenia and wandering spleenQ
- Usually mesenteroaxialQ
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What is secondary gastric volvulus?
- Occur secondary to some anatomic abnormality, (Most commonly diaphragmatic hernia)Q
- Usually organoaxialQ
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What is Borchardt’s triad?
Epigastric pain + Inability to vomit + Inability to pass a nasogastric tube - characteristic feature of gastric volvulusQ
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What are types of vagotomy?
- Truncal vagotomy - Performed above the celiac and hepatic branches of the vagiQ
- Selective vagotomy - Performed below the celiac and hepatic branches of the vagiQ
- Highly selective vagotomy - Performed by dividing the crow’s feet to the proximal stomach while preserving the innervation of the antral and pyloric parts of stomachQ.
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What is the pacemaker of stomach?
- Interstitial cells of Cajal (ICCs)Q
- Location: In bodyQ along the greater curvature
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Cells of stomach?
CMPE: Chief cells (44%) > Mucous cells (40%) > Parietal cells (13%) > Endocrine cells (3%)Q
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Secretions from Parietal cells and Chief cells?
- Parietal cells secrete Ghrelin, Intrinsic factor, Leptin and Acid. (GILA)Q
- Chief cells secrete pepsin and leptinQ
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Which layer of stomach is responsible for rugae?
Muscularis mucosa is responsible for the rugaeQ
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Strongest layer of GI tract?
Submucosa
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Embryology of stomach?
- Assumes normal asymmetric shape and position by the end of the 7th weekQ.
- During the 6th to 10th week as the stomach enlarges it also rotates 90 degrees in a clockwise direction
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Where is Brunner’s Gland located?
Submucosal gland found in the duodenumQ
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What is Ghrelin?
Gherlin is secreted by oxyntic cells in the fundus of the stomachQ – it has orexigenic (appetite stimulating) propertiesQ
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What are primary effects of Ghrelin?
- • Motilin like effects on gastric motilityQ
- • Stimulates release of somatostatin and PPQ
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Location of gastric cardia?
Gastric cardia occurs in posterior cardia or fundusQ
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What are features of Prune belly syndrome?
- Extremely lax lower abdominal musculatureQ
- Dilated urinary tract including the bladderQ
- Bilateral undescended testesQ
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What is Hour-Glass Stomach?
Caused by cicatricial contraction of a saddle shaped ulcer at the lesser curvatureQ
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What is Tea-Pot Stomach (Hand-bag Stomach)?
Tea-pot stomach is caused by longitudinal shortening of gastric ulcer at the lesser curvature of stomach (stomach looks like tea-pot)Q
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Treatment of duodenal adenocarcinoma?
- For 1st or 2nd portion: Whipple procedureQ
- For 3rd or 4th portion: Segmental duodenal resectionQ
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Length of stricture for Finney and Henneke Mikulicz procedure?
- Finney stricturoplasty is used for strictures > 10–15 cmQ.
- Heineke-Mikulicz stricturoplasty is appropriate strictures < 10 cmQ in length
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Various gastrectomies?
- Antrectomy or distal gastrectomy • Removal of distal 1/3rd of stomachQ
- Hemigastrectmy • Removal of half of stomachQ
- Subtotal gastrectomy • Removal of 2/3rd of stomachQ
- Total gastrectomy • Removal of whole stomachQ
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