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