30 Stomach ANATOMY AND PHYSIOLOGY

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Questions and Answers

Which enzyme is primarily secreted by chief cells in the stomach?

  • Trypsin
  • Amylase
  • Lipase
  • Pepsinogen (correct)

What is the final pathway for H+ release in parietal cells?

  • Adenylate cyclase activation
  • H+/K+ ATPase inhibition (correct)
  • Phosphorylase kinase activation
  • Protein kinase A activation

Which artery supplies the greater curvature of the stomach?

  • Left gastric artery
  • Right gastroepiploic artery (correct)
  • Left gastroepiploic artery
  • Right gastric artery

What causes the release of H+ from parietal cells in the stomach?

<p>Acetylcholine and gastrin activation (B)</p> Signup and view all the answers

Where does peristalsis primarily occur in the stomach?

<p>Antrum (D)</p> Signup and view all the answers

Which part of the stomach receives blood from the gastroduodenal artery?

<p>Pylorus (A)</p> Signup and view all the answers

Which surgical procedure has the lowest rate of ulcer recurrence?

<p>Truncal vagotomy and antrectomy (C)</p> Signup and view all the answers

What is the most frequent complication of duodenal ulcers?

<p>Hemorrhage (B)</p> Signup and view all the answers

What is the initial treatment of choice for obstruction due to duodenal ulcers?

<p>Serial dilation and PPI (C)</p> Signup and view all the answers

What is the best test for H. pylori eradication?

<p>Urea breath test (C)</p> Signup and view all the answers

Which type of gastric ulcer is associated with diffuse ulcers and NSAIDs?

<p>Type V (C)</p> Signup and view all the answers

What is the primary risk factor associated with gastric ulcers?

<p>H. pylori presence (C)</p> Signup and view all the answers

Which surgical procedure is the initial treatment for refractory obstruction due to gastric ulcers?

<p>Truncal vagotomy and antrectomy (A)</p> Signup and view all the answers

What is the primary risk factor associated with gastric adenocarcinoma?

<p>Intestinal metaplasia (B)</p> Signup and view all the answers

Which type of gastritis occurs 3–10 days after events such as multiple trauma or burns?

<p>Stress gastritis type A (fundus) (B)</p> Signup and view all the answers

What are Virchow's nodes associated with in gastric cancer?

<p>Metastases to supraclavicular node (A)</p> Signup and view all the answers

What is the most common area for gastric adenocarcinoma?

<p>Antrum (C)</p> Signup and view all the answers

What is the primary symptom associated with gastric adenocarcinoma?

<p>Pain unrelieved by eating and weight loss (D)</p> Signup and view all the answers

What is the most effective diagnostic test for alkaline reflux gastritis?

<p>EGD with biopsy (A)</p> Signup and view all the answers

Which surgical option is indicated for post-vagotomy diarrhea that is unresponsive to medical treatment?

<p>Reversed interposition jejunal graft (C)</p> Signup and view all the answers

What is the main cause of blind-loop syndrome in patients with Billroth II or Roux-en-Y procedures?

<p>Bacterial overgrowth (B)</p> Signup and view all the answers

What is the most appropriate initial diagnostic test for retained antrum after gastrectomy?

<p>CT scan of the abdomen (A)</p> Signup and view all the answers

Which surgical option is recommended for afferent-loop obstruction causing symptoms of obstructive jaundice and pancreatitis?

<p>Reanastomosis with shorter (40-cm) afferent limb (B)</p> Signup and view all the answers

What is the primary treatment for chronic gastric atony presenting with delayed gastric emptying and nausea?

<p>Gastric electric stimulator (B)</p> Signup and view all the answers

Which surgical procedure can be considered for small gastric remnant leading to early satiety in gastric bypass patients?

<p>Jejunal pouch construction (D)</p> Signup and view all the answers

What is the most likely diagnosis for a patient presenting with pain, steatorrhea, and B12 deficiency after Billroth II surgery?

<p>Blind-loop syndrome (A)</p> Signup and view all the answers

What imaging study would be most appropriate for diagnosing afferent-loop obstruction in a patient with long afferent limb after Roux-en-Y surgery?

<p>CT scan (B)</p> Signup and view all the answers

What is the main treatment option for efferent-loop obstruction following Billroth II or Roux-en-Y surgery?

<p>Balloon dilation (D)</p> Signup and view all the answers

Which of the following inhibits the release of gastrin and acid?

<p>Somatostatin (A)</p> Signup and view all the answers

What is the function of D cells in the stomach?

<p>Secrete somatostatin (D)</p> Signup and view all the answers

Which condition is associated with mucous cell hyperplasia and increased rugal folds in the stomach?

<p>Ménétrier’s disease (C)</p> Signup and view all the answers

What is the most common risk factor for duodenal ulcers?

<p>H. pylori infection (D)</p> Signup and view all the answers

Which surgical indication for ulcers requires resection of the ulcer?

<p>Inability to rule out cancer (B)</p> Signup and view all the answers

What is the most common symptom of upper gastrointestinal bleeding (UGI bleeding)?

<p>Hematemesis (C)</p> Signup and view all the answers

Which factor is associated with the highest risk of mortality in non-variceal UGI bleeding?

<p>Continued or rebleeding (D)</p> Signup and view all the answers

What is the primary treatment for bleeding varices in a patient with liver failure?

<p>EGD with variceal bands or sclerotherapy (A)</p> Signup and view all the answers

Which surgical procedure results in an increase in solid emptying?

<p>&quot;Pyloroplasty formation&quot; (B)</p> Signup and view all the answers

What is the treatment for diarrhea, the most common problem following vagotomy?

<p>&quot;Cholestyramine and loperamide&quot; (A)</p> Signup and view all the answers

Which mutation is associated with a 70% lifetime risk of gastric cancer and a 40% lifetime risk of breast cancer in women?

<p>CDH1 mutation (C)</p> Signup and view all the answers

What is the primary treatment for MUCOSA-ASSOCIATED LYMPHOID TISSUE LYMPHOMA (MALT LYMPHOMA) if it does not regress after treatment for H. pylori?

<p>Radiotherapy (C)</p> Signup and view all the answers

What surgery is recommended for stage I gastric lymphomas (tumor confined to stomach mucosa)?

<p>Partial resection (C)</p> Signup and view all the answers

What is the most common benign gastric neoplasm, which can also be malignant if certain criteria are met?

<p>Gastrointestinal stromal tumor (GIST) (C)</p> Signup and view all the answers

What is the primary treatment modality for gastric lymphomas?

<p>Chemotherapy (A)</p> Signup and view all the answers

In morbid obesity, what is the approximate operative mortality associated with bariatric surgery?

<p>~1% (C)</p> Signup and view all the answers

Which of the following complications can occur after gastrectomy or after vagotomy and pyloroplasty?

<p>Dumping syndrome (D)</p> Signup and view all the answers

What is the primary cause of leak in the context of Roux-en-Y gastric bypass surgery?

<p>Ischemia (B)</p> Signup and view all the answers

'Dumping syndrome' is primarily caused by rapid entering of which substance into the small bowel?

<p>Carbohydrates (A)</p> Signup and view all the answers

What is the most common location for MUCOSA-ASSOCIATED LYMPHOID TISSUE LYMPHOMA (MALT LYMPHOMA)?

<p>Stomach (D)</p> Signup and view all the answers

Which of the following symptoms are usually associated with Gastrointestinal Stromal Tumors (GISTS)?

<p>Asymptomatic (C)</p> Signup and view all the answers

What is the primary symptom associated with diffuse-type gastric cancer (linitis plastica)?

<p>Weight loss and anorexia (B)</p> Signup and view all the answers

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