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Flashcards in Upper GI Surgery Deck (32):
1

What are the histological types of oesophageal cancer?

Adenocarcinoma
Squamous cell carcinomas

2

What histological type of oesophageal cancer affects the distal oesophagus?

Adenocarcinoma

3

What histological type of oesophageal cancer affects the proximal and middle third of the oesophagus?

Squamous cell carcinoma

4

What histological type of oesophageal cancer is related to obesity and consequent Barrett's oesophagus?

Adenocarcinoma

5

What histological type of cancer is related to smoking, high alcohol intake and low socio-economic status?

Squamous cell carcinoma

6

What is the typical presentation of oesophageal cancer?

Progressive dysphagia
Weight loss and anorexia
Odynophagia
Chest pain/heartburn
Haematemesis

7

What is the first line investigation in a patient presenting with dysphagia?

Endoscopy - will show cause of dysphagia and gives opportunity for biopsy and diagnosis

8

What imaging investigations might be used to determine whether an oesophageal cancer is resectable/whether the patient is fit for surgery?

CT chest/abdomen
EUS
PET CT

9

If a patient with oesophageal cancer has metastatic disease or is unfit for surgery, what would you use to treat them?

Palliative stenting
Palliative chemo/radiotherapy

10

What would be the treatment for a resectable oesophageal cancer?

Oesophagectomy and chemotherapy

11

How long would it take for the quality of life of the patient to return to pre-operative quality after an oesophagectomy?

10 months

12

What additional measure would be taken with a patient following an oesophagectomy to aid recovery?

Feeding tube into the small bowel for a couple of months until patient adapts to eating

13

What is the typical presentation of gastric cancer?

Non specific presentation with dyspepsia

14

What are the 'alarm features' of a presentation of gastric cancer, suggesting severe disease?

Dysphagia
Evidence of GI blood loss
Weight loss
Vomiting
Upper abdominal mass

15

What two investigations would be done first if suspecting gastric cancer?

Endoscopy
Contrast meal

16

How would you ensure that a tumour was mobile and resectable, and determine surgical viability?

Laparoscopic investigation

17

What are the benefits of a subtotal gastrectomy?

Some of the stomach is preserved which gives a better surgical outcome and better quality of life

18

What are the symptoms of gastro-oesophageal reflux disease?

Heartburn
Water brash
Cough

19

How would a hiatus hernia causing gastro-oesophageal reflux disease typically present?

Chest pain and vomiting

20

What are the risk factors for gastro-oesophageal reflux disease?

Obesity
Smoking
Alcohol excess

21

What are the treatments for gastro-oesophageal reflux disease?

Lifestyle changes
PPI therapy
Surgery

22

What side effects might occur after surgery to treat gastro-oesophageal reflux disease?

Dysphagia
Difficulty belching/vomiting
Gas bloating
Excess flatulence
Diarrhoea

23

What investigations would be done in gastro-oesophageal reflux disease?

Endoscopy
Oesophageal pH studies
Manometry

24

Why is the incidence of bariatric surgery increasing?

Due to increasing obesity

25

Why might bariatric surgery be the best option for obese people?

Co-morbidities associated with obesity may be more severe than the risks associated with surgery

26

What are the options for bariatric surgery?

Restrictive
Malabsorptive
Combination of both

27

What are the advantages of laparoscopic adjustable gastric banding?

Relatively minor surgery
Reversible and adjustable
Low operative complication rate
Low mortality rates

28

What are the disadvantages of laparoscopic adjustable gastric banding?

Requires implanted medical device
Risk of prolapse or slippage
15% require revision surgery
Easier for the patient to 'cheat'

29

What are the bariatric surgeries commonly used to aid weight loss?

Laparoscopic adjustable gastric banding
Laparoscopic gastric bypass
Laparoscopic sleeve gastrectomy

30

What are the disadvantages of a laparoscopic gastric bypass?

Invasive surgery
Malabsorptive component requires lifelong supplements
More complex if it requires revision

31

What are the advantages of a laparoscopic sleeve gastrectomy?

Good medium-term outcomes
No dumping syndrome
No small bowel manipulation
No foreign body put into body

32

What are the possible complications of bariatric surgery?

Anastomotic leak
DVT/PE
Infection
Malnutrition
Vitamin and mineral deficiencies
Hair loss
Excess skin