Stomach

Question 1

Recommended position for G-tube through skin (perc)

Answer 1

3cm below costal margin

3cm to L of midline

Question 2

Most likely diagnosis?

Young pt, months after RnY BP, lost 40 pounds, chronic abd pain in epigastrium, no bloating or PO intolerance, recently started smoking

Answer 2

Marginal ulcer

MC on jejunal side of anastomosis d/t irritation from gastric acid distal to new gastrojejunal anastomosis

Tx: upper endoscopy (dx), then high dose PPI, smoking cessation, tx H. pylori, avoid NSAIDs

Question 3

gastrogastric fistula following RnY BP

Answer 3

connection b/w gastric pouch and excluded stomach. counteracts restrictive and malabsorptive goals of RnY BP as food passes through biliopancreatic limb