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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