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07. Year 2: Alimentary System > Upper GI Surgery > Flashcards

Upper GI Surgery Flashcards

1
Q

What are some examples of conditions that often require upper GI surgery?

A

Oesophageal cancer

Gastric cancer

Anti-reflux

Bariatric surgery

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2
Q

How does the incidence of oesophageal cancer compare between men and women?

A

3x higher in men

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3
Q

How many people with oesophageal cancer survive 10 years?

A

10%

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4
Q

Why is the prognosis of oesophageal cancer so poor?

A

Symptoms present late

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5
Q

What are common traits of people who end up getting oesophageal cancer?

A

Smoke

Eat little fruit and veg

Overweight

Drink alcohol

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6
Q

What are the 2 kinds of oesophageal cancers?

A

Adenocarcinoma

Squamous cell carcinoma

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7
Q

Where in the oesophagus does adenocarcinoma occur?

A

Distal oesophagus

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8
Q

What are risk factors for adenocarcinoma of the oesophagus?

A

Obesity

Gastro-oesophageal reflux (such as Barrett’s metaplasia)

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9
Q

Where in the oesophagus does squamous cell carcinoma occur?

A

Proximal and middle third

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10
Q

What are risk factors for squamous cell carcinoma of the oesophagus?

A

Smoking

Alcohol

Low socio-economic status

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11
Q

What are some symptoms of oesophageal cancer?

A

Frequent and persistent hiccups

Acid indigestion, heartburn and reflux

Difficulty when swallowing (dysphagia)

Constant burping, belching and coughing

Pain between the shoulder blades

Weight loss

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12
Q

What are very important symptoms for oesophageal acid?

A

Dysphagia and weight loss

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13
Q

What investigations are done for oesophageal cancer?

A

Endoscopy or contrast swallow

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14
Q

Why is endoscopy prefered to contrast swallow for investigating oesophageal cancer?

A

Can see if is benign or malignant by doing biopsy with endoscopy

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15
Q

What must be done once the diagnosis of oesophageal cancer is confirmed?

A

Stage the tumour

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16
Q

What staging is used for oesophageal cancer?

A

TNM staging

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17
Q

Explain the algorithm for staging oesophageal cancer?

A

1) CT scan of chest and abdomen
2) If metastatic/unfit then no further staging is required and palliative/supportive therapy is given
3) If resectable/fit an EUS is done for T/N staging and a PET CT for M staging

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18
Q

For staging, what is done after the CT of the chest/abdomen if the patient is fit?

A

EUS for T/N staging

PET CT for M staging

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19
Q

Why is a PET scan done for M staging?

A

Metastasis in small number of patients is not picked up by CT scan

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20
Q

How is a tumour seen on a CT scan?

A

Oesophagus should be black due to being full of air, tumour is a different colour

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21
Q

What does the T score of a tumour tell us?

A

How much the tumour has progressed through the mucosa into the muscle wall then otno the surface and perhaps surrounding structures such as lung or pericardium

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22
Q

What does the N score of a tumour tell us?

A

If the cancer has entered the lymph nodes

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23
Q

Do node positive or node negative tumours have a worse prognosis?

A

Node positive

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24
Q

What does M staging of a tumour tell us?

A

If metastasis are present

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25
Q

What are common metastasis from oesophageal cancer?

A

Lungs or liver

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26
Q

What are treatment options for oesophageal cancer for people who are metastatic/unfit?

A

Stenting (allows them to eat)

Palliative radiotherapy (increases length of life)

Palliative chemotherapy (increases length of life)

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27
Q

What needs to be considered when giving chemotherapy?

A

Side effects, sacrificing quality of life for more time

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28
Q

What are treatment options for oesophageal cancer for people who are resectable/fit?

A

Oesophagectomy and chemotherapy

Chemotherapy and radiology if concerns about fitness

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29
Q

What is the 5 year survival rate of someone who recieves an oesophagectomy and chemotherapy for oesophageal cancer?

A

45%

30
Q

What is the 5 year survival rate for someone who recieves chemotherapy and radiotherapy for oesophageal cancer?

A

30%

31
Q

What kind of cancer responds best to chemotherapy?

A

Squamous cell cancers

32
Q

What are the different approaches for an oesophagectomy?

A

Ivor lewis

Trans-hiatal

Left thoraco-abdominal

33
Q

What determines which approach is used for an oesophagectomy?

A

Where the tumour is, patient body size and how much access is needed

34
Q

What is the operation called where part, or all, of the oesophagus is removed?

A

Oesophagectomy

35
Q

What is the morbidity of an oesophagectomy?

A

20-30% (due to operating in the abdomen and the chest)

36
Q

What is the mortality of an oesophagectomy?

A

5%

37
Q

How long is required before someone who recieved an oesophagectomy returns to pre-op quality of life?

A

10 months

38
Q

What is done in an oesophagectomy?

A

In the abdomen - gastric mobilisation

In the chest - oesophageal resection and gastro-oesophageal anastomosis

39
Q

What happens to the patient after an oesophagectomy is done?

A

Goes to ICU for recovery, then to high dependancy unit where drains are taken out and can start eating from day 5

40
Q

What day after an oesophagectomy can the patient start eating again?

A

Day 5

41
Q

What are the most common cancers worldwide ranked from 1 to 5?

A

1) Lung
2) Breast
3) Colorectal
4) Prostate
5) Stomach

42
Q

Rank the top 5 cancers for causing death?

A

1) Lung
2) Liver
3) Stomach
4) Colorectal
5) Breast

43
Q

What is the overall survival rate of stomach cancer?

A

30%

44
Q

What is the survival rate of stage IV stomach cancer?

A

4%

45
Q

What are risk factors for stomach cancer?

A

Infection with helicobacter pylori

Alcohol

Smoking

Excessive consumption of salted fish, pickled vegetables and cured meats

46
Q

What is the presentation of stomach cancer?

A

Anaemia

Loss of weight

Anorexia

Recent onset of progressive symptoms

Masses and melaena/haematemesis

Swallowing difficulty

47
Q

What pneumonic should be remembered for presentation of stomach cancer?

A

ALARMS

anaemia

loss of weight

anorexia

recent onset of progressive symptoms

masses and melaena/haematemesis

swallowing difficuly

48
Q

What investigations are done for stomach cancer?

A

Endoscopy

Contrast meal

49
Q

What staging is used to stage stomach cancer?

A

TNM

50
Q

What is used to stage stomach cancer?

A

CT chest/abdomen

Laparoscopy

51
Q

What is a surgical procedure that allows access to inside the abdomen and pelvis without having to make a large incision?

A

Laparoscopy

52
Q

What surgery can be done to treat stomach cancer?

A

Subtotal gastrectomy or total gastrectomy and Roux en Y reconstruction

53
Q

When can some of the stomach be left during a gastrectomy?

A

If the tumour is in the pyloric region

54
Q

If the tumour is in the body of the stomach is a subtotal or total gastrectomy required?

A

Total gastrectomy, can only leave part of the stomach behind if the tumour is the pyloric region

55
Q

Who plays a massive part in looking after patients after stomach surgery?

A

Dieticians

56
Q

What are the two kinds of gastrectomy?

A

Laparoscopic distal gastrectomy

Open gastrectomy

57
Q

What is a procedure where part or all of the stomach is removed?

A

Gastrectomy

58
Q

What surgery is often done for GORD?

A

Anti-reflux surgery

59
Q

What are common GORD symptoms?

A

Chest pain

Heartburn

Trouble swallowing

Sour taste in mouth

Wheezing, asthma symptoms, chronic coughing

Excessively salivating

Tooth erosion

Belching

60
Q

What are examples of hernias that lead to GORD?

A
61
Q

What investigations are done for GORD?

A

Endoscopy

Oesophageal pH studies and manometry

62
Q

What can be some side effects of laparoscopic hiatus hernia repair and fundoplication?

A

Dysphagia

Difficulty to belch and vomit

Gas bloating

Excess flatulence

Diarrhoea

63
Q

What is the procedure used to treat GORD caused by a hiatus hernia?

A

Laparoscopic hiatus hernia repair and fundoplication

64
Q

What procedure is used to reduce the size of the stomach with a gastric band or through removal of a portion of the stomach?

A

Bariatric surgery

65
Q

What BMI is considered to be overweight?

A
66
Q

What BMI is considered to be Obesity I

A
67
Q

What BMI is considered to be Obesity II?

A
68
Q

What BMI is considered to be BMI III?

A
69
Q

What what stage of obesity is obesity surgery required instead of conventional treatment?

A

Obesity II (>35)

70
Q

Other than bariatric surgery what else can be done to treat obese people?

A

Consider hormonal aspects, where hormones that trigger hunger are switched off

07. Year 2: Alimentary System (41 decks)

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