Upper GI Surgery Flashcards

1
Q

What are the types of oesophageal cancer and their key differences?

A

Adenocarcinoma

  • Distal
  • Related to obesity
  • Can be caused by Gi reflux -> Barrett’s metaplsia -> Dysplasia -> Cancer

Squamous cell:

  • Proximal/middle
  • Related to smoking & alcohol
  • And a low socio-economic status
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How does oesophageal cancer present?

A
PROGRESSIVE DYSPHAGIA
Anorexia/weight loss
Odynophagia
Chest pain/heartburn
Haematemesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do we investigate suspected oesophageal cancer?

A

Upper GI Endoscopy

Can also do a barium swallow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Whats worse about a barium swallow?

A

Doesnt ive you an opportunity to biopsy or identify what is causing the stricture, just see where it is/that it exists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do we stage oesophageal cancer?

A

Chest & abdo CT
If unfit for surgery stop staging as theres no point
If resectable you can continue with EUS & PET CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do we treat oesophageal cancer?

A

If its metastatic or they’re unfit for surgery:

  • Stenting
  • Palliative radiotherapy/chemo

If its resectable:

  • Oesophagectomy & chemo
  • Chemo adjuvantly & neo-adjuvantly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does an oesophactomy work?

A

Cut out part or all of the oesophagus and pull the stomach into the chest then reattach.
You can also use part of the colon as a transplant.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the effects of an oesophagectomy on the patient?

A

Very radical so:

  • Mortality is up to 10%
  • Takes up to 10 months to return to pre-op QOL
  • Often have to adjust to eating small amounts often to prevent reflux
  • Must have a feeding jejunostomy for the first few months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is gastric cancer most associated with?

A

Heliobacter Pylori infection?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does gastric cancer present?

A

Mostly non-specific symptoms:
- Dyspepsia most common

Alarm features:

  • Dysphagia
  • Evidence of GI blood loss (melaena etc)
  • Weight loss
  • Vomiting
  • Upper abdominal mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do investigate/stage a suspected gastric cancer ?

A

Endoscopy
Contrast meal

Stage with a chest/abdo CT and laparoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do we treat gastric cancer ?

A

Subtotal or total gastrectomy (if total use a roux en Y reconstruction)

Can be laparascopic or open

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is roux en Y reconstruction?

A

Cut gastropeosophageal junction and duodenum/jejunum junction.
Anastomose the oesophagus to jejunum and duodenum to jejunum.
This way food bypasses stomach and duodenum but bile/gastric juice still gets in

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does GORD present?

A

Heartburn
Waterbrash
Cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the risk factors for GORD?

A

Obesity
Alcohol
Smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How do we manage GORD?

A
  • Lifestyle modifications
  • Proton Pump Inhibitors
  • Surgery (if theres somthing anatomical to fix)
17
Q

What is the most common surgery for GORD?

A

Laparascopic hiatus hernia and fundoplication .

The hernia is pull back throug then the fundos is tied round the oesophagus distally to reinforce the closing of the the LOS.

The oesophageal hiatus is also often stitched tighter to prevent anymore.

18
Q

Complications of Hiatus hernia repair + Fundoplication?

A
Dysphagia
Bloating
Excess Flatus
Diarrhoea
Difficulty vomiting/burping
19
Q

How do we investigate GORD?

A

With endoscopy

Also pH and manometry study

20
Q

What is bariatric surgery?

A

Surgery that leads to weight loss and reduction in co-morbidities

21
Q

What are the types of Bariatric surgery?

A

Restrictive - Decreases stomach size thereby inducing early satiety

Malabsorptive - Bypassing sections of intestine leading to reduced absorption of nutrients

Combination - Gold standard e.g. Roux en Y gastric bypass

22
Q

Example of restrictive bariatric surgery?

A
  • Synthetic gastric band
  • Stomach stapling
  • Sleeve Gastrectomy
23
Q

Example of malabsorptive bariatric surgery?

A

Biliopancreatic diversion (bypasses part of the duodenum to reduce calorie intake).

With or without duodenal switch and ileal interposition

24
Q

How do we decide on bariatric surgery?

A
  • Patients choice
  • Experience of available staff
  • Patients diet/BMI/co-morbidities
25
Q

How does a laparscopic adjustable gastric banding work?

A

Hollow silicon band around upper end of stomach creating a pouch and narrow passage into rest of stomach, band is inflated with isotonic fluid,

26
Q

Advantages/disadvantages of laparascopic adjustable gastric banding?

A
  • Relatively minor
  • Reversible
  • Needs an implanted device
  • Can prolapse or slip
  • Some need revisional surgery
27
Q

What is a laparascopic sleeve gastrectomy?

A

Removal of part of the stomach leaving a sleeve or banana shape close with staples
Type of partial gastrectomy.

28
Q

Advantages/disadvantages of laparascopic sleeve gastrectomy?

A
  • No foreign body, dumping syndrome or small bowel manipulation
  • Quite invasive
  • Risk of bleed/leak
29
Q

What is laparascopic gastric bypass?

A

Small stomach pouch made and anatomosed to second portion of jejunum.

First portion of jejunum anastomased to 2nd part.

Smaller food intake and avoids duodenum & 1st part of jejunum

30
Q

Advantages/Disadvantages of gastric bypass?

A
  • Quick & Dramatic weight loss
  • Invasive
  • Requires lifelong supplements due to malabsorptive side
  • Can require revision
31
Q

Complications from bariatric surgery?

A
  • Anastomotic leaks
  • DVT/PE
  • Infection
  • Malnutrition
  • Vit/Mineral deficiencies
  • Hair Loss
  • Excess Skin