外科：一般外（stomach）

29 flashcards · Other · by Wanying Koh

1. MeSS MYam

   Meissner Submucosal n. plexus, submucosa layer Secretion --- Myenteric n. plexus auerbach motility, muscular layer

2. sympathetic or parasympathetic innervation? 1) Auerbach 2) Meissner

   1) sym, parasym 2) parasym

3. most common reason for upper GI bleeding

   peptic ulcer

4. gastric mucosa most common type of cells is mucous / chief / parietal / endocrine?

   chief cells (pepsinogen I & II, gastric lipase)

5. 1) histamine secreted by? 2) somatostatin secreted by?

   1) enterochromaffin-like cells 2) D cells

6. mitochondria 最多的 gastric cell

   parietal cell (HCl, IF)

7. GERD surgery indications

   Barrett's esophagus 合併 ulcer 合併 stricture PPI 無效

8. do Mallory-Weiss tears require surgical treatment?

   stop bleeding spontaneously in most pts endoscopic repair usually don't require surgery

9. Early and late complications of peptic ulcer surgery

   Early: hemorrhage, pancreatitis, sutureline leakage Late: stromal stenosis, stromal function delay stromal = 吻合處

10. is pyloroplasty needed in truncal vagotomy

    yes. truncal vagotomy 會影響pylorus function

11. biliroth I procedure: 切 distal stomach, 接 duodenum 1st part

12. DD for rebounding pain

    peritonitis perforated peptic ulcer

13. tx for perforated duodenal ulcer

    simple closure + omental patch + abdominal cavity lavage

14. diagnostic imaging for perorated ulcer 1) 2) in order of preference

    1) chest x-ray 2) water soluble contrast medium study

15. GI tract perforation, X-ray 上會看到什麼？

    subphrenic free air

16. Splash sound / succussion splash diagnosis?

    gastric outlet obstruction (sloshing sound heard through a stethoscope during sudden movement of the patient on abdominal auscultation. It reflects the presence of gas and fluid in an obstructed organ)

17. Gastric cancer Lauren classification intestinal vs diffuse type 1）哪個比較多 2）related to APC gene mutation 3）poorer prognosis 4）hematogenous vs LN spread

    1) intestinal 2) intestinal 3) diffuse 4) hematogenous: intestinal; LN: diffuse

18. indication of endoscopic surgery in gastric ca (size, 有無ulceration)

    tumor size < 3cm no ulceration

19. most common symptom of gastric lymphoma

    abdominal pain

20. GIST: LN meta 常見 or 少見

    少見

21. proportion of GIST pts with CD117

    85-90%

22. morbid obesity criteria

    weight twice that of ideal weight weight greater than ideal by 100 pounds BMI > 40kg/m2

23. stomach polyp 1) associated w what diseases 2) which one(s) need resection adenomatous hyperplastic harmartoma heterotopic

    adenomatous -- stomach ca 可能性 -- resection hyperplastic -- H. pylori infection -- may need resection if >2cm harmartoma -- check if associated w PJ syndrome, juvenile polyposis, PTEN syndrome -- may need resection heterotopic -- pancreatic heterotropia

24. early gastric Ca 定義 只會考慮？ 不包括什麼 factor？

    any (treatable) tumor w invasion into mucosa and submucosa only irregardless of: tumor location tumor size LN invasion time

25. early gastric Ca tx

    subtotal gastrectomy total gastrectomy - if at upper stomach radical lymphadenectomy - if LN invasion

26. bariatric surgery suitable for obese pts w comorbid of DM or GERD

    Roux-en-Y gastric bypass

27. gastric ca RF what kind of polyp

    adenomatous polyp - 30% (hyperplastic polyp - only 2-3%) atrophic gastritis

28. gastric ca staging dependent on

    number of LN invaded (not location) during OP, remove 16 LN samples

29. gastric fundus/cardia tumor tx

    total gastrectomy + LN clearance (cannot just local resection)