Chapter 23: Stomach & Duodenum

Chapter 23. Stomach & Duodenum

The blood supply to the stomach

A. Typically includes direct branches from the celiac axis and superior mesenteric artery

B. Includes predominant supply of the greater curve of the stomach by the left gastric artery

C. Includes the right gastroepiploic artery, which is usually a branch of the splenic artery

D. May include a posterior gastric artery that is typically a branch of the splenic artery

E. Is anatomically separate from the blood supply to the spleen

D. May include a posterior gastric artery that is typically a branch of the splenic artery

The four functions of the stomach include all of these except

A. It mixes the food and controls delivery into the duodenum.

B. It is the site of the initial stage of protein and carbohydrate digestion.

C. It acts as a reservoir for food.

D. It is the site of the assembly of micelles for nutrient absorption.

E. A few substances are absorbed across the gastric mucosa.

D. It is the site of the assembly of micelles for nutrient absorption

Reconstruction of gastrointestinal continuity after resection of portions of the stomach

A. Usually includes a roux-en-Y reconstruction after distal gastrectomy

B. Cannot be done by Billroth I reconstruction after total gastrectomy

C. Includes a gastroduodenostomy for Billroth II reconstruction

D. Has a risk of duodenal stump leak after Billroth I reconstruction

E. May require conversion to a Billroth II reconstruction if a patient develops bile gastritis after a Billroth I approach

B. Cannot be done by Billroth I reconstruction after total gastrectomy

Vagotomy

A. Can impair the appropriate relaxation of the pylorus

B. Has several variations, but each denervates the pylorus

C. Has become more widely applied as ulcer therapy since the introduction of acid-suppressing medications (H2-blockers and proton pump inhibitors)

D. Impairs gallbladder emptying

E. Can include division of both the left (posterior) and right (anterior) vagus nerve trunks

A. Can impair the appropriate relaxation of the pylorus

Management of gastric outlet obstruction

A. Is typically required for complications due to distal gastric diverticulae or polyps

B. Should include urgent operation in most patients

C. Initially includes gastric decompression and acid suppression

D. Is commonly required in the management of duodenal ulcer disease

E. Is best managed operatively by distal gastrectomy and Billroth I reconstruction

C. Initially includes gastric decompression and acid suppression

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