chapter 30 stomach.txt

  1. Stomach transit time
    3-4 hours
  2. nerves that sense gastroduodenal pain
    afferent sympathetic fibers T5-T10
  3. blood supply to stomach
    left gastric, splenic branches left gastroepiploic and short gastrics
  4. blood supply to greater curvature
    right and left gastroepiploic, short gastrics
  5. blood supply to lesser curvature
    right and left gastrics
  6. blood supply to pylorus
    gastroduodenal artery
  7. epithelium type in stomach
    simple columnar
  8. mucus secreting glands in stomach
    cardia glands
  9. cells that produce pepsinogen
    chief cells
  10. cells that release H+ and intrinsic factor
    parietal cells
  11. stimuli for HCl release (3)
    acetylcholine, gastrin, histamine
  12. target of histamine
    adenylate cyclase
  13. target of acetylcholine and gastrin
    phospholipase, PIP/IP3 to Ca release
  14. inhibitors of parietal cells (4)
    somatostatin, PGE1, secretin, CCK
  15. cells that release gastrin
    G cells
  16. Cells that secrete somatostatin to inhibit gastrin and acid release
    D cells
  17. Duodenal glands that secrete pepsinogen and alkaline mucus
    Brenner�s glands
  18. Substances released with antral and duodenal acidification (3)
    Somatostatin, CCK, secretin
  19. Conditions with high gastrin AND high acid (6)
    Zollinger-ellison, antral cell hyperplasia, retained antrum, renal failure, gastric outlet obstruction, short bowel syndrome
  20. Conditions with high gastrin and NORMAL acid (5)
    Pernicious anemia, chronic gastritis, gastric Ca, postvagotomy, medical acid suppression
  21. Causes of rapid gastric emptying (3)
    Zollinger-ellison, surgery, ulcers
  22. Causes of delayed gastric emptying (5)
    Opiates, anticholinergics, myxedema, hyperglycemia, diabetes
  23. Antrectomy + gastroduodenal anastamosis
    Billroth I
  24. Antrectomy + gastrojejunal anastamosis
    Billroth II
  25. Complications of Billroths (over gastrojejunostomy)
    Marginal ulcers, diarrhea
  26. Vascular malformation that can erode gastric mucosa
    Dieulafoy lesion
  27. Mucous cell hyperplasia leading to increased rugal folds
    Menetrier�s disease
  28. Pathology associated with type II hiatal hernia
    Gastric volvulus
  29. Tear of lesser curvature of stomach secondary to forceful vomiting
    Mallory-weiss tear
  30. Treatment of Mallory-weiss tear
    EGD, may need gastrostomy and oversewing
  31. Consequence of vagal denervation
    Inc. liquid emptying due to increased gastric pressure
  32. Division of nerves of Latarjet to decrease acid secretion
    Selective vagotomy
  33. Division of individual nerve fibers to decrease acid secretion
    Highly selective vagotomy
  34. Consequence of complete vagotomy
    Dec. emptying of solids
  35. Gastric effects of vagotomy (3)
    Dec. acid output, inc gastrin, gastrin cell hyperplasia
  36. Nongastric effects of vagotomy (4)
    Dec. exocrine pancreas function, dec. bile flow, inc gallbladder volume, dec. release of vagally mediated hormones
  37. Factors for rebleeding after EGD (3)
    Actively bleeding vessel (60% chance), visible blood vessel (40% chance), diffuse oozing (30% chance)
  38. Location of most duodenal ulcers
    1st part of duodenum; anterior
  39. presenting symptom of anterior duodenal ulcers
    free air
  40. presenting symptom of posterior duodenal ulcers
    bleed from GDA
  41. surgical indications for ulcer (5)
    perforation, protracted bleeding, obstruction, failure of medical management, inability to rule out cancer
  42. most frequent complication of duodenal ulcer
  43. treatment for bleeding ulcer
    duodenostomy and GDA ligation
  44. operation for gastric outlet obstruction from ulcer (2)
    gastrojejunostomy, antrectomy, truncal vagotomy OR antrectomy, Billroth II and truncal vagotomy
  45. treatment for perforated ulcer
    graham patch and highly selective vagotomy
  46. disease with circulating hypergastrinemia and severe peptic ulcers and diarrhea
    Zollinger-Ellison syndrome
  47. Diagnosis of ZES
    Secretin test
  48. Mechanism of action of H. pylori test
    Detects urease release from H. pylori
  49. Blood type associated with type I ulcers
  50. Blood type associated with type II-IV ulcers
  51. Gastric ulcer along lesser curve due to dec. mucosal protection
    Type I
  52. Gastric ulcers along lesser curve and duodenum
    Type II
  53. Treatment of type I ulcers
    Distal gastrectomy, Billroth II, +/- vagotomy
  54. Treatment of type II ulcers
    Distal gastrectomy, Billroth II, truncal vagotomy
  55. Gastric ulcers near prepylorus, high rate of bleed
    Type III ulcers
  56. Treatment of type III ulcers
    Distal gastrectomy, Billroth II, truncal vagotomy
  57. Gastric ulcers along lesser curvature along cardia of stomach
    Type IV ulcer
  58. Treatment of type IV ulcers
    Ulcer excision, highly selective vagotomy
  59. Gastric ulcer associated with NSAIDS
    Type V ulcer
  60. First location of stress gastritis
  61. Gastritis (in fundus) associated with pernicious anemia, autoimmune diseases
    Type A
  62. Gastritis (in antrum) associated with H. pylori
    Type B
  63. Most common site for gastric cancer
  64. Gastric cancer mets to supraclavicular node
    Virchow�s nodes
  65. Margins required for gastric cancer
  66. most common benign gastric neoplasm
    leiomyoma (GIST)
  67. treatment of GIST
    en bloc resection
  68. changes in gastric mucosa related to H. pylori; precursor for gastric lymphoma
    Mucosa-associated lymphoproliferative tissue (MALT)
  69. Side effects of gastric bypass (6)
    Marginal ulcer, leak, necrosis, B12 deficiency, iron deficiency anemia, gallstones
  70. Treatment of marginal ulcers
  71. Rapid entry of carbohydrates into small bowel
    Dumping syndrome
  72. First phase of dumping syndrome
    Hyperosmotic load causes fluid shift into bowel
  73. Second phase of dumping syndrome
    Reactive increase in insulin and decrease in glucose
  74. Bile reflux into stomach causing gastritis
    Alkaline reflux gastritis
  75. Stasis of chyme in roux limb due to loss of jejunal motiliby
    Roux stasis
  76. Treatment of roux stasis (2)
    Medical (metoclopramide, prokinetic), surgical (shortening of roux limb)
  77. Treatment of alkaline reflux gastritis
    Medical (H2, cholestyramine, metoclopramide), surgical (conversion to roux en Y)
  78. Delayed gastric emptying after vagotomy
    Chronic gastrc atony
  79. Surgical treatment for small gastric remnant
    Jejunal pouch construction
  80. Bacterial overgrowth and stasis in afferent limb of roux-en-Y, causing pain, diarrhea, malabsorption
    Blind-loop syndrome
  81. Treatment of blind-loop syndrome
    Medical (tetracycline, flagyl, metoclopramide) AND surgical (shortening of afferent limb)
  82. Diarrhea caused by unconjugated bile salts in the colon and sustained postprandial MMCs
    Postvagotomy diarrhea
  83. Treatment of postvagotomy diarrhea
    Medical (cholestyramine, octreotide), surgical (reversed interposition jejunal graft)
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chapter 30 stomach.txt
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