• Gastric Anatomy

  • Drugs

  • Benign Gastric Disease

  • Gastric CA

  • Bariatric surgery

  • Transduodenal sphincteroplasty

  • Ampullary Mass

  • Digestive hormones

  • Bile reflux - lifestyle modification/medical management first

  • Stomach polyps - fundic polyps

  • Duodenal ulcer - indications for operative intervention

  • Malignant gastric cancer - venting G tube [8/25]

  • Indication for open anti-reflux surgery [9/6]

  • H pylori - spiral shaped, gram negative, mucosal layer, flagella, increased risk of PUD and gastric CA [9/24]

  • Stomach/duo - 6/10 [MOCK ABSITE]

    • Metoclopramide - dopamine (D2 receptor) antagonist, 5-HT3 antagonist, 5-HT4 agonist
      • Domperidone (motilium) - D2 antagonist
      • Erythromycin - motilin agonist
      • Cisapride (propulsid) - 5-HT4 agonist, 5-HT3 antagonist
      • Gastroparesis, delayed gastric emptying, >10% at 4 hours, >60% at 2 hrs
    • B2 complication - bilious vomiting/epigastric pain → afferent loop syndrome → Tx: shortening of afferent limb = converting B2 to B1 + RNYGB
      • Prokinetic agents - Tx for gastric atony s/p vagotomy, gastroparesis, etc
    • Vagotomy complications
      • post-op gastroparesis → Sx: abd pain, N/V, weight loss
        • Dx of exclusion
        • Pathophys: loss of vagal innervation → NOT LOSS OF SYMPATHETICS
        • Tx: RNYGB
      • Post-op Diarrhea
        • Dx of exclusion
        • Tx: cholestyramine
        • If refractory → 10 cm interposition of anti-peristaltic portion of jejunum 100 cm distal to LOT
    • Peptic ulcer disease
      • Lesser curve = I → normal acid secretions
      • II or III = high acid → PPI

  • Transduodenal sphincteroplasty

    1. Extensive Kocher
    2. Transverse or longitudinal duodenotomy on the lateral duodenal wall at the junction of the lower 1/3 and upper 2/3 of the duodenum
    3. ID the papilla
    4. Cut the ampullary sphincter in the 11 o’clock position on the papilla using cautery or scissors
    5. Extend this to include the entire common tract of the sphincter of Oddi
    6. Extract all stones
    7. Suture the wall of the CBD to the duodenal mucosa using interrupted fine absorbable sutures
    8. Close the lateral duodenotomy