Flashcards in Stomach and Bowel Deck (87)
management of large mesenteric cysts?
excision and resection of associated bowel , high risk of recurrence if marsupialize
management of gastric cardia adenocarcinoma?
margins for gastric adenocarcinoma?
resection with at least 5cm margins (subtotal gastrectomy can be done win distal tumors but proximal tumors usually require total)
when do you give neoadjuvant chemotherapy in gastric adenocarcinoma?
lesions >T2 or any N
what are the recommendations for lymph node dissections for gastric adenocarcinoma?
D1 or D2 resection of at least 15 lymph nodes
what's the difference between D1 and D2 dissection in lymph node dissection w gastric adenocarcinoma?
D1 = gastrectomy + the greater and lesser omental lymph nodes
D2 = all that plus the omental bursa, leaf of the transverse mesocolon, and corresponding arteries
when is a splenectomy performed during resection of gastric adenocarcinoma?
for a D2 dissection for proximal gastric tumors
what is the cell of origin of a GIST?
interstitial cells of cajal: aka the pacemaker cells
what is the cell of origin of a carcinoid tumor?
enterochromaffin cells aka Kulchitsky cells
what is the cell origin of pheochromocytomas?
neuroectodermal cells of the adrenal medulla
what are th 3 different pattens of inflammation associated with H. Pylori infection?
1. diffuse* MC, not assoc w PUD
3. stomach-body related
how does gastrin stimulate acid secretion? (2 ways)
1. stimulation of the synthesis and release of histamine from enterocrhomaffin-like cells which bind to H2 receptors on parietal cells
2. from parietal cells via cholecystokinin B receptor
side effect of metoclopramide?
two different types of dumping syndrome and causes
1. Early dumping: 30 min after eating and due to hyperosmotic load causing large fluid shift
2. Late dumping: 2-3 hours after eating and due to large insulin release from large fluid bolus hitting the duo
what is the best test to determine a) diagnosis and b) eradication of h pylori?
a) serology: IgG
b) urea breath test
treatment of low versus high grade MALToma?
low = abx alone
high = CHOP
what is triple therapy for H pylori?
PPI, clarithromycin, flagyl (metronidazole)
where is protein mostly absorbed?
what does the terminal ileum absorb?
bile salts, vitamin B12, fat soluble vitamins (ADEK)
where are the majority of small bowel adenocarcinomas found?
what is the most common neoplasm of small bowel?
metastasis: MC melanoma, lung, breast, cervix, sarcoma, colon
most common PRIMARY small bowel neoplasm?
UC or Crohns: Granulomas
UC or Crohns: Rectal Involvement
UC or Crohns: Cobblestone appearance
UC or Crohns: Transmural involvement
UC or Crohns: Patchy areas of bowel
whats a finney stricturoplasty and when do you use it?
indicated for strictures 7-15cm, fold the diseased bowel on itself and create a large opening between the two loops
what is a Heineke-Mikulicz stricturoplasty and when is it used?
strictures <7cm, MC, make a longitudinal incision on the antimesenteric side of the bowel and close transversely