Absite Stomach

Front 1

Describe a Type 1 gastic ulcer.

Back 1

Single ulcer, usually on the lesser curvature.

Front 2

Describe a Type 2 gastic ulcer.

Back 2

Simultaneous gastric and duodenal ulcers.

Front 3

Describe a Type 3 gastic ulcer.

Back 3

Pyloric channel ulcer.

Front 4

Describe a Type 4 gastic ulcer.

Back 4

Proximal ulcer, often near GE junction.

Front 5

Which ulcers (type 1, 2, 3, or 4) are caused by acid hypersecretion?

Back 5

Types 2 and 4

Front 6

Which types of gastric ulcers are associated with normal gastric acid secretion?

Back 6

Types 1 and 4.

Front 7

List 5 indications for operating on gastric ulcers.

Back 7

1. Intractibility
2. Perforation
3. Obstruction
4. Hemorrhage
5. Rule out cancer

Front 8

Describe 3 types of vagotomy.

Back 8

1. Truncal vagotomy: transection 3-4 cm above GE junction
2. Selective vagotomy: transection below the GE junction to preserve hepatic and celiac branches (doesn't work well)
3. Highly selective vagotomy: denervation of only the corpus and fundus of stomach (no pyloroplasty required)

Front 9

Describe 3 types of pyloroplasty.

Back 9

1. Heineke-Mikulicz: 4cm longitudinal full-thickness gastroduodenotomy closed transversely.
2. Finney: anterior-posterior approximation of gastroduodenotomy.
3. Jaboulay: two incisions made, one gastrotomy, one duodenotomy and are joined to one-another, leaving the pylorus intact.

Front 10

List 4 complications of vagotomy and drainage.

Back 10

1. Post-vagotomy diarrhea
2. Early dumping syndrome
3. Late dumping syndrome
4. Afferent loop syndrome
5. Efferent loop syndrome
6. Bile acid reflux gastritis

Front 11

Describe the etiology of postvagotomy diarrhea.

Back 11

The vagus usually inhibits the migrating motility complex. Without the vagus, food is rapidly transported into the colon and diarrhea results.

Front 12

Describe early dumping syndrome and its etiology.

Back 12

Occurs with in 30 minutes of eating with dizziness, nausea, and vomiting. Caused by dumping of non-digested highly osmotic fluid into GI tract, resulting in fluid shifts from the intravascular space and hypotension.

Front 13

Describe late dumping syndrome and its etiology.

Back 13

Occurs within 2-3 hours after eating with diaphoresis and tachycardia. Caused by abnormal release of enteroglucagon resulting in high insulin release, then hypoglycemia, and its sequelae.

Front 14

What is the treatment for late dumping syndrome?

Back 14

Somatostatin. Reversal of pyloroplasty, or conversion of B1 / B2 to Roux-en-y if somatostatin fails.

Front 15

Describe the symptoms of afferent loop syndrome.

Back 15

Severe post-prandial pain followed by bilious vomiting which resolves pain.

Front 16

Describe the cause of afferent loop sydrome.

Back 16

Obstruction of the proximal jejunum in an Bilroth II reconstruciton. This loop may decompress into the stomach, resulting in bilious vomiting and resolution of pain. If it does not decompress and remains a complete obstruction, fever, leukocytosis, and hyperamylasemia result.

Front 17

Describe the treatment for afferent loop syndrome.

Back 17

Conversion to Roux-en-y gastrojejunostomy.

Front 18

Describe the symptoms and cause of efferent loop sydrome.

Back 18

Similar to symptoms of other small bowel obstruction: nausea, vomiting, obstipation. Caused by adhesions.