General Surgery Board Review Gastrointestinal Surgery Flashcards

What is the standard surgical treatment for a stable patient with a perforated duodenal ulcer presenting within 6 hours of onset?

Answer: Omental patch repair (Graham patch)

Graham patch (omental patch) closure is the procedure of choice for perforated duodenal ulcers; definitive anti-ulcer surgery is largely abandoned in the era of H. pylori eradication and PPIs.

In the AJCC staging system for gastric cancer, which T stage indicates tumor invasion through the muscularis propria into the subserosa without penetrating the serosa?

Answer: T3

T3 gastric cancer invades through the muscularis propria into the subserosal connective tissue without penetrating the visceral peritoneum (serosa); T4a penetrates the serosa.

A patient with Barrett's esophagus and confirmed high-grade dysplasia should undergo which management?

Answer: Endoscopic eradication therapy such as radiofrequency ablation

Endoscopic eradication therapy (EET), including radiofrequency ablation (RFA) and endoscopic mucosal resection (EMR), is the preferred treatment for high-grade dysplasia in Barrett's esophagus.

Which operation is the primary surgical treatment for achalasia to relieve lower esophageal sphincter obstruction?

Answer: Heller myotomy

Laparoscopic Heller myotomy (LHM), which divides the circular muscle fibers of the lower esophageal sphincter, is the surgical treatment of choice for achalasia.

The gold-standard confirmatory test for Zollinger-Ellison syndrome (gastrinoma) is:

Answer: Fasting serum gastrin >1000 pg/mL with positive secretin stimulation test

The secretin stimulation test showing a paradoxical rise in gastrin >120 pg/mL above baseline is confirmatory for ZES; fasting gastrin >1000 pg/mL with acidic gastric pH is highly suggestive.

The most common primary site of gastrointestinal stromal tumors (GISTs) is:

Answer: Stomach

Approximately 60% of GISTs arise in the stomach; they originate from the interstitial cells of Cajal and are driven by KIT (CD117) or PDGFRA mutations.