Joe smells food and his digestive system gets ready for digestion. What phase of acid secretion is this?
Cephalic Phase
Joe's stomach is now distended with food. What phase of acid secretion is this?
Gastric phase
The chyme has now entered and distended joes small intestine. what phase of acid secretion is this?
Intestinal phase
Joe has smoked for 10 years. He drinks a couple beers a week, has a cup of coffee every morning, takes aspirin everyday and is on steroids so he can build muscle. what is he at risk for?
Peptic ulcer disease
Joe is a firefighter and recently got extensive burns during a job putting out a large fire. what type of ulcer is he at risk of developing?
Curling ulcer
Donna has a brain tumor. what type of ulcer is she at risk for?
Cushing ulcers
Kim is critically ill and has been in the ICU for 5 days. what type of ulcer and hemorrhage is she at risk of developing?
Stress ulcer and upper GI hemorrahage
John comes into your office complaining of epigastric pain. He states that it feels like a burning sensation, started 2-3 hours after he ate. He took an antacid to relief the pain. It radiates to his back. The pain has awakened him at night. He had an epi
Peptic ulcer disease
Matt woke up and felt great. Midmorning he noticed a little pain. Ignoring it he eats breakfast. After a couple hours the pain got worse. He took some antacids and ate an apple and it felt better. That night he woke up again due tot he pain returning. Wha
Duodenal ulcer
What test would you do on Matt or john? Hint: this is the most highly sensitive diagnostic test for pt with ulcers
EGD-esaphgogastroduodenoscopy
How would you treat you pt's with PUD?
Abx
PPI
Bismuth
If your pt's ulcers were recurrend, what surgical consult would you get?
Consult for:
Vagotomy
Antrectomy
Pt has an ulcer along the lesser curvature. What type of ulcer is this
type 1 ulcer
pt has an ulcer on the body of the stomach along with a DU. what type of ulcer is this
type II ulcer
Pt has a prepyloric ulcer. what type of ulcer is this?
Type III
Pt has an ulcer next to the GE junction. what type of ulcer do they have?
Type IV
35 yo F comes into your office with tarry stools. She feels dizzy and weak and her Hgb is 7.5. What does she have?
Hemorrhage
36 yo present to ED with excruciating, sharp, knife-like abdominal pain. The pain came on acutely after a heavy meal. Located in epigastrium and is constant. Pain worsens when stomach is empty and relieved with food and antacids. His breathing is shallow
Free perforation
(Erosion of anterior surface of stomach leads to acute peritonitis and later bacterial peritonitis)
(Posterior wall perforation leads to bleeding due to gastroduodenal artery.)
40 yo M pt with a past hx of ulcers come in with complaints of frequent vomiting that occurs at the end of the day about 6 hours after their last meal. He has bloating, fullness after eating and loss of appetite and succussion splash. what does he have?
Gastric outlet obstruction
caused by scarring, spasm or inflammation assoc. with an ulcer.
Male pt with a past hx of ulcers was tx with H2 blocker and PPIs. He has recurrence. What is the most common cause of recurrence and what are some risk factors for ulcer recurrence? What other condition can lead to ulcer recurrence?
MCC= failure to eradicate previous H. pylori infx
RF= smoking and NSAID use
Gastrinoma (zollinger-ellison syndrome) can cause recurrence
Tarry stools or coffee ground emesis indicate
GI bleed
Sudden onset, severe, generalized abd pain and penetration into adjacent organs such as the pancrease indicate
perforation
Pain worsening with meals, vomiting of undigested food, inflammation and edema indicate
gastric outlet obstruction
what is the term used to describe the vagus nerve branching below the esophageal plexus?
anterior nerve of laterjet branches
transection of the anterior vagus trunk during truncal vagotomy can result in
dilated gall bladder with inhibited contractility and subsequence cholelithiasis
Division of the posterior trunk of the vagus nerve may lead to
postop ileus
when is truncal vagotomy indicated
chronic duodenal ulcers
gastric outlet obstruction
Operation in which the pylorus is removed in addition to the antrum and the proximal stomach is anastomosed directly on the duodenum
Billroth I
Truncal vagotomy, distal gastrectomy/antrectomy, anastomosis to distal duodenum and removal of pyloris. (gastroduodenostomy)
Billroth I
Greater curvature of stomach connected to first part of jejunum in side to side anastamosis-->gastrojejunostomy
Billroth II
Gastrojejunostomy with closure of duodenal stump
billroth II
Esaphgo-jejunal anastomosis is done in an end to end fashion with an end to end anastomosis (eea) stapler
Total gastrectomy
Roux-en-y esaphgojujunostomy is done in in what procedure?
total gastrectomy
Recurrent ulcers at surgical anastomosis. most often a gastric ulcer in the jejunal mucosa near site of gastrojejunostomy
marginal ulcer
Pt post op for ulcer surgery develops nausea, vomiting, tachycardia, weakness and syncope. What complication is he experiencing? how would you treat him? If it is severe what surgical procedure is performed?
Early" Dumping syndrome
Tx-anticholinergics, PPI's
Surgery-convert bilroth I to Roux-en-y
Complete or partial mechanical obstruction at gastrojujonstomy site or at a portion of the afferent loop
afferent loop syndrome
(main cause of duodenal stump blowout)
(leads to steatorrhea, malnutrition and vitamin b-12 deficiency)
82 yo woman presents with early satiety, post prandial vomiting with weight loss and anemia. Endoscopy shows ulcerated mass with prominent folds. what does she have?
Adenocarcinoma-->gastric cancer
What type of ulcer is a submucosal vascular malformation usually located in the gastric fundus and can be the cause of recurrent massive GI bleeds if undetected.
Dieulafoy's ulcer (EC ?)
Longitudinal tear in the proximal gastric mucosa near the EG junction. Bleeding usually resolves spontaneously. Older male > 60 yo
Mallory Weiss Tear