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Stomach and Duodenum Surgery Exam Questions And Answers
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Stomach and Duodenum Surgery ExamWhat is a bezoar? - ANS a mass of undigested material that becomes trapped in the stomach
What type of peptic ulcer gets worse with food and causes weight loss? - ANS Gastric ulcer
What type of peptic ulcer gets better with food and causes weight gain? - ANS duodenal
T/F Gastric ulcers are more common than duodenal ulcers - ANS False! duodenal ulcers are MC
What are initial labs for epigastric pain? - ANS CBC, CMP, Lipase
What is the first line imaging for ulcer symptoms if no red flags? - ANS Upper GI series
What are red flags with epigastric pain? - ANS weight loss
coughing up blood
blood in stool
What imaging for epigastric pain with red flags? - ANS EGD
H. Pylori General Considerations - ANS Stop ulcerogenic agents
Treat H .pylori
TEST ALL PATIENTS TO CONFIRM ERADICATION-FECAL TEST
Ongoing Acid suppression
Consider adding cytoprotection- sucralfate for gastric protection
H. Pylori Management (starting vs. failure/high-resistance) - ANS Start -> Triple Therapy:
PPI BID + Clarithromycin 500mg BID + Amoxicillin 1g BID
- Clinical Guidelines - 14 DAYS
Failure/High-Resistance: Quadruple Therapy—10-14d
PPI+ Bismuth 525 mg QID + Metronidazole 250 QID + Tetracycline 500mg QID
Location of gastric ulcer types (image) - ANS IV is the only one at the top of the stomach
What type of gastric ulcers are associated with low/normal gastric acid? - ANS 1 and 4
What type of gastric ulcers are associated with high gastric acid? - ANS 2 and 3
What type of gastric ulcer is related to drugs - ANS type 5
REMOVE the DRUG, tx ulcer, and make sure eradicated
Which type of ulcer is more highly associated with cancer: gastric or duodenal? - ANS Gastric
, duodenal usually aren't associated with cancer
T/F duodenal ulcers are associated with high acid? - ANS True
What are the reasons to do gastric ulcer surgery? - ANS Failure of GASTRIC ulcers to heal (high CA
risk or ZE) after 8-12 weeks of PPI -> resection
What are the 3 reasons for emergent peptic ulcer surgeries? - ANS perforation
hemorrhage
gastric outlet obstruction of pylorus
What are the 4 parts of surgery for PUD? - ANS (1) Resection: removal of disease
(2) Reconstruction: plumbing after resection
(3) Repairs: abbreviated emergent interventions
(4) Vagotomy for acid control: 3 types
T/F elective surgery is necessary for duodenal ulcers - ANS False
not concerning for CA- can just stick with medical therapy
A partial gastrectomy would not get what type of gastric ulcer? - ANS Type 4 (juxtaesophageal)
Describe Billroth I - ANS stomach attached to duodenum
most physiologic PUD reconstruction surgery
Describe Billroth II - ANS stomach attached to small intestine
maintaining C loop to keep connection w/ hepatobiliary tree
Describe subtotal gastrectomy with Roux-en-Y - ANS the stomach has been removed
stomach remnant is then attached to the Jejunum
The duodenal stump is sewn closed and pancreatic biliary secretions flow into the lower portion of
the jejunum
What are the 3 types of vagotomy? - ANS 1. Truncal
2. Selective
3. Highly Selective
Describe truncal vagotomy - ANS cuts R/L Vagus N above the GEJ- Denervates parietal cell mass,
antral pump, pyloric sphincter and abdominal viscera
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