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Alimentary System: Pathology SA > Upper GI Surgery > Flashcards

Upper GI Surgery Flashcards

1
Q

What is the two different cell types for oesophageal cancer

A

Adenocarcinoma

Squamous cell carcinoma

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2
Q

What cell type of oesophageal cancer affecting the distal oesophagus going to be

A

Adenocarcinoma

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3
Q

What cell type of oesophageal cancer affecting the proximal and middle third of the oesophagus going to be

A

Squamous cell carcinoma

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4
Q

What is the patholopgy of gastro-oseophagus reflux

A

Causes metaplasia to the epithelium

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5
Q

What is the two pathologies ofgastro-oseophagus reflux

A

Barrets metaplasia

Dysplasia leading to carcinoma

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6
Q

What is the aetiology of squamous cell carcinoma in oesophageal cancer

A

Smoking
Alcohol
(low social-economic status)

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7
Q

What is the symptoms of oesophageal cancer

A

Progressive dysphagia - difficulty swallowing

Anorexia and weight loss

Odynophagia - pain when swalloing

Chest pain/heartburn

Haematemesis- vomit in the blood

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8
Q

What is the investigations for oesophageal cancer

A

Endoscopy

CT contrast

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9
Q

What is the benefit of an endoscopy in oesophageal cancer

A

Can follow up with a biopsy

Endoscopic ultrasound investigates T/N staging

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10
Q

What is the benefit of CT

A

Allows staging to occur:

Metastatic staging - PET CT

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11
Q

What happens if oesophageal cancer metastases

A

Patient deemed unfit

No more staging required

Receives Palliative are

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12
Q

What is the treatment options if oesophageal metastases

A

Stenting

Palliative radiotherapy

Palliative chemotherapy

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13
Q

What is the treatment options if a patient is deemed fit in oesophageal cancer and metastases hasn’t occurred

A

Oesophagectomy

+ Chemotherapy

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14
Q

What is the treatment options if you have concerns about resection or patient fitness in oesophageal cancer and metastases hasn’t occurred

A

Chemo/Radiotherapy

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15
Q

What are the three approaches to Esophagectomy

A

Ivor Lewis

(esophageal tumor is removed through an abdominal incision and a right thoracotomy)

Trans-hiatal

(dissection from a cervical incision from above and transhiatal approach through an abdominal incision)

Left thoraco-abdominal

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16
Q

What are two conduits in Esophagectomy

A

Stomach

Colon

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17
Q

How does the procedure of Esophagectomy work

A

Takes 2 hours,

Removal of oesophagus
stomach/colon is pulled up into the chest and reattached

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18
Q

Why do patients need to be fit to undergo Esophagectomy

A

As during surgery only lies on one lung for ventilation

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19
Q

What is the symptoms experienced after Esophagectomy

A

Reflux

Need to eat a small amount go food but often
receive feeding tube

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20
Q

What is gastric cancer usually associated with

A

H.Pylori

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21
Q

What is the presentation of Gastric cancer

A

Dyspepsia

Alarm symptoms:
Dysphagia 
GI blood loss
weight loss 
Vomiting 
Upper abdominal mass
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22
Q

What is the investigations used for Gastric Cancer

A

Endoscopy
Contrast meal
CT Chest/abdomen
(allows staging)

23
Q

What is the four kinds of gastric cancer surgerys

A

Sub total gastrectomy - preserves some of the stomach

Total Gastrectomy and roux en Yreconstruction

Laparoscopic distal gastrorectomy

Open gastrorectomy

24
Q

What therapy do you receive before gastric surgery in gastric cancer

A

Chemotherapy

25
Q

When does a

Total Gastrectomy and roux reconstruction occur

A

In proximal tumours of gastric cancer

26
Q

What occurs inTotal Gastrectomy and roux reconstruction

A

Stomach is fully resected

The oesophagus is reconstructed to join with the jejunum
and duodenal is reconstructed also to join to a later part of the jejunum

27
Q

What is the symptoms of Gastro-Oesophageal Reflux Disease

A

Heartburn
Water brash
Cough

28
Q

What is the risk factors ofGastro-Oesophageal Reflux Disease

A

Obesity
Smoking
Alcohol

29
Q

What is the management of Gastro-Oesophageal Reflux Disease

A

Lifestyle modification

PPI therapy (omeprazole)

Surgery

30
Q

What is potential aetiology of Gastro-Oesophageal Reflux Disease

A

A Hiatus hernia
(sliding or paraeoesophageal)

Failed lower oesophageal spinchter

31
Q

What are the additional symptoms of Gastro-Oesophageal Reflux Disease if caused by a hiatus hernia

A

Pain
Vomiting
Terrible reflux

32
Q

What is the investigations for Gastro-Oesophageal Reflux Disease

A

Endoscopy

Oesophageal pH studies and manometry (pressure evaluation)

33
Q

What is the surgery undertaken inGastro-Oesophageal Reflux Disease

A

laparoscopic hiatus hernia repair and (fundoplication)

34
Q

What is the side effects of fundoplication

In the repair of GORD

A

Dysphagia

Difficulty to belch and vomit

Gas Bloating

Excess flatulence

Diarrhoea

35
Q

How does he procedure oflaparoscopic hiatus hernia repair and (fundoplication) work in the repair of hernia and relfux

A

Tightening the opening in your diaphragm with stitches to keep your stomach from bulging upward through the opening in the muscle wall (fixes hiatus hernia)

Wrap the fundus around the end of your esophagus with stitches to create pressure and prevent reflux

36
Q

What is Bariatric surgery used to tackle

A

Obesity

BMI >35

37
Q

What is the affect of decreasing obesity

A

Reduces mortaility

and decreases the risk of co-morbidities

38
Q

What are the three bariattric surgery options

A

Restrictive

Malabsorption

Combination

39
Q

How do restrictive bariatric surgeries work in tackling obesity

A

Decrease the size of the stomach leading to satiety with smaller volumes of food that eventually leads to food intolerance and weight loss

40
Q

How do malabsorbtive bariatric surgeries work in talking obesity

A

Bypassing segments of bowel, thereby causing malabsorption of nutrients

41
Q

How does a combination bariatric surgery work in tackling obesity

A

Combination of restrictive and malabsoptive

= Roux-en-Y gastric bypass,

42
Q

What is taken into account with bariatric surgeries

A 
Patients BMI 
Co-morbidites 
Diet 
Safety 
Personal experience
43
Q

What is taken into account with Bariatris surgeries

A 
Patients BMI 
Co-morbidites 
Diet 
Safety 
Personal experience
44
Q

How does laparoscopic adjustable gastric banding occur

A

Hollow silicon band is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the larger remainder of the stomach.

The band is then inflated with isotonic fluids.

It can be tightened or loosened over time to change the size of the passage by increasing or decreasing the amount of fluid

45
Q

What is the advantage of a gastric band

A

Relatively minor surgery
Reversible and adjustable
Low operative complication rate
Mortality 0.1%

46
Q

What is the disadvantage of gastric banding

A

Requires an implanted medical device
Easier to ‘cheat’
Risk of prolapse or slippage
15% will require revisional surgery

47
Q

How does the procedure of laparscopoc gastric bypass occur

A

A small stomach pouch is created to restrict food intake.
A Y-shaped section of the small intestine is then attached to the pouch to allow food to bypass the lower stomach, the duodenum and the first portion of the jejunum

  • reduces absorbtion of nutrients
48
Q

What is the advantages to laparoscopic gastric bypass

A

Quick and dramatic weight loss

reduces calories intake

49
Q

What is the disadvantages to laparoscopic gastric bypass

A

More invasive surgery

Malabsorptive component requires lifelong supplements

More complex if requires revision

Mortality 0.5%

Dumping syndrome - evacuate bowels quick

50
Q

What happens in the procedure of laparoscopic sleeve gastrectomy,

A

Removal or part of the stomach

decrease in the stomach size inhibits distentson of the stomach
becomes full sooner, thereby increasing the patient’s sensation of fullness and decreasing their appetite

51
Q

How doeslaparoscopic sleeve gastrectomy reduce obesity

A

decrease in the stomach size inhibits distentson of the stomach
becomes full sooner, thereby increasing the patient’s sensation of fullness and decreasing their appetite

as well removal decreases the release of ghrelin hormone which decreases the size of your appetite

52
Q

What is the advantages of laparoscopic sleeve gastrectomy

A

Good medium term outcomes

No ‘dumping’ syndrome

No small bowel manipulation

No foreign body

53
Q

What is the disadvantages of laparoscopic sleeve gastrectomy

A

More invasive surgery

Long staple line (bleeding/leak)

Mortality 0.4%

54
Q

What is the overall complications of bariatric surgery

A

Anastomotic leak

DVT/PE

Infection

Malnutrition

Vitamin and mineral deficiencies

Hair loss

Excess Skin

Alimentary System: Pathology SA (27 decks)

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