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Surgery > Upper GI Surgery > Flashcards

Upper GI Surgery Flashcards

1
Q

Gastric Cancer Risk Factors

A
  • Diet
    • Low vitamin C
    • High nitrites
  • Blood group A
  • Pernicious anaemia
  • Gastric surgery
  • Alcohol
  • Smoking

Gastric cancer may also occur as a progression from polyps, ulcers or atrophic gastritis

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2
Q

What is Murphy’s sign?

A

Tenderness under the tip of the 9th costal cartilage which catches on inspiration.

On the right side but NOT the left.

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3
Q

Signs of Acute Cholecystitis

A
  • palpable mass in RUQ (40%)
  • jaundice (15%)
  • continuous epigastric pain
  • RUQ pain
    • Murphy’s positive - helps differentiate AC from biliary colic
  • bilious vomiting
  • fever, tachycardia
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4
Q

Ultrasound findings in acute cholecystitis

A
  • thickened gallbladder wall
  • surrouding free fluid
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5
Q

Diagnosis?

A

Acute Cholecystitis

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6
Q

Management of Acute Cholecystitis

A
  1. NBM
  2. analgesia
  3. IV access
  4. IV antibiotics, e.g. cefuroxime 1.5g/8h
  5. cholecystectomy
  • laparascopic if not concerned about GB perforation
  • immediate or elective after 6 weeks
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7
Q

Ransen’s criteria for pancreatitis

A

Admission: ONCE

  • O - over 55 years old
  • N - neutrophils (WBC) > 16
  • C - caster suger - glucose > 10
  • E - enzymes
    • AST > 250
    • LDH > 350

Within 48 hours: WATCH U

  • Wet - fluid sequestration > 6L
    Acidotic - base excess < -4
  • Type 1 respiratory failure - PO2 < 60mmHg (8kPa)
  • Calcium < 2
  • Haematocrit decreased by 10%
  • Urea increased > 0.9
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8
Q

Interpreting Ransen’s Criteria

A

3 or more makes acute pancreatitis likely

  • 0 - 2 = 2% mortality
  • 3 - 4 = 15%
  • 5 - 6 = 40%
  • 7 - 8 = 100%
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9
Q

Modified Glasgow Criteria for Pancreatitis

A

PANCREAS

within 48 hours of onset of symptoms…

  • PaO2 < 8
  • Age over 55
  • Neutrophils (WBC) > 15
  • Calcium < 2
  • Renal function - urea > 16
  • Enzymes - LDH > 600, AST > 200
  • Albumin < 32
  • Sugar > 10

3 or more is severe, alert ITU/HDU

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10
Q

Causes of Acute Pancreatitis

A

GET SMASHED CUP

  • Gallstones - 38%
  • Ethanol - 35%
  • Trauma - 1.5%
  • Steroids
  • Mumps
  • Autoimmune (PAN)
  • Scorpion venom
  • High lipids and calcium, Hypothermia
  • ERCP, Emboli
  • Drugs
  • Cancer
  • Unknown
  • Pregnancy

The scorpion venom is from Tityus trinitatis, found in Trinidad and Tobago

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11
Q

What is a Sister Mary Joseph node?

A
  • a papable nodule bulging into the umibilucus
  • suggests mets from an abdominal or pelvic mass
    • 1/2 are GI mets
    • 1/4 are gyna mets
  • associated with multiple peritoneal mets and poor prognosis
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12
Q

What is this?

What does it signify?

A

Sister Mary Joseph Node/Nodule

Underlying malignancy, most likely to be GI or gynaecological

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13
Q

Borrmann’s classification of Gastric Cancer

A

Type 1 - polypoid, protruding

Type 2 - fungating, elevated distinct borders

Type 3 - ulcerated (starting to spread across surface), elevated indistinct borders

Type 4 - diffusely infiltrated, indistinct borders

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14
Q

Japanese Research Society Classification for Gastric Cancer

A
  • *Type 1** - protruded
  • *Type 2a** - superficial elevated
  • *Type 2b** - superficial flat
  • *Type 2c** - superficial depressed
  • *Type 3** - exulcerated (forming an ulcer)
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15
Q

TNM of Gastric Carcinoma

A

T1 = mucosal

  • 1a = mucosa
  • 1b = into submucosa

T2 = muscularis

T3 = serosa

T4 = through serosa

  • 4a = through but not invading
  • 4b = invading local structures

Nodes:

  • 0 = 0
  • 1 = 1 - 2
  • 3a = 7 - 15
  • 3b = 16+

M0 = no mets

M1 = mets

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16
Q

Stages of Gastric Cancer (picture)

A
17
Q

Gastric Cancer Staging

A

Stage 0 or carcinoma in situ (CIS)
If you are told you have CIS or stage 0 stomach cancer, you have a very early stage of stomach cancer. There are cancer cells in your stomach lining. But they are completely contained within the innermost layer of the lining. So there is very little risk of any cancer cells having spread. It is not usual for stomach cancer to be diagnosed this early.

Stage 1
This is the earliest stage of cancer. It is divided into 1a and 1b.

Stage 1a means the cancer has grown no further than the lining of the stomach, with no cancer in the lymph nodes (T1, N0, M0).

Stage 1b means either that

The cancer is still within the stomach lining, but nearby lymph nodes contain cancer cells (T1, N1, M0) OR
There are no cancer cells in the lymph nodes, but the cancer has grown into the muscle of the stomach wall (T2, N0, M0)
Stage 2
Stage 2 is also divided into a and b

Stage 2a means that

The cancer is still within the lining of the stomach, but between 3 and 6 nearby lymph nodes contain cancer cells (T1, N2, M0) OR
The cancer has grown into the muscle layer of the stomach wall and is also in 1 or 2 nearby lymph nodes (T2, N1, M0) OR
The cancer has grown into the outer layers of the stomach but there are no cancer cells in the lymph nodes (T3, N0, M0)
Stage 2b means that

The cancer is within the lining of the stomach wall but 7 or more lymph nodes contain cancer cells (T1, N3, M0) OR
The cancer has grown into the muscle layer of the stomach and between 3 and 6 lymph nodes contain cancer cells (T2, N2, M0) OR
The cancer has grown into the outer layer of the stomach and is also in 1 or 2 nearby lymph nodes (T3, N1, M0) OR
The cancer has grown through the outer lining but there are no cancer cells in nearby lymph nodes (T4a, N0, M0)
Stage 3
Stage 3 is divided into a, b and c.

Stage 3a means that the cancer has grown

Into the muscle layer of the stomach and 7 or more nearby lymph nodes contain cancer cells (T2, N3, M0) OR
Into the outer lining of the stomach and between 3 and 6 nearby lymph nodes contain cancer cells (T3, N2, M0) OR
Through the stomach wall and 1 to 2 nearby lymph nodes contain cancer cells (T4a, N1, M0)
In stage 3b the cancer has grown

Into the outer lining of the stomach and more than 7 nearby lymph nodes contain cancer cells (T3, N3, M0) OR
Right through the stomach wall and between 3 and 6 lymph nodes contain cancer (T4a, N2, M0) OR
Right through the stomach wall into nearby tissues and organs, and the nearby lymph nodes may contain cancer (T4b, N0 to 1, M0)
In stage 3c the cancer has

Grown right through the stomach wall and more than 7 nearby lymph nodes contain cancer (T4a, N3, M0) OR
Grown right through the stomach wall into nearby tissues and organs, and the lymph nodes contain cancer (T4b, N2 to 3, M0)
Stage 4
This means your cancer is advanced and has spread to body organs further away from the stomach, such as the lungs, brain or bones (any T, any N, M1).

18
Q

Causes of Small Bowel Obstruction

(by frequency)

A
  • adhesions = 60%
  • strangulated hernia = 20%
  • malignancy = 5% (usually caecal)
  • volvulus = 5%

Rare:

Intussusception
Gallstone ileus

19
Q

Pathophysiology of Acute Pancreatitis

A

duodenal pancreatic reflux –> duodenal fluid activates the enzymes within the pancreas

  • autodigestion by trypsin
  • fat necrosis by lipases
  • rise in blood amylase

Surgery (9 decks)

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