Upper GI Surgery

Question 1

What are the histological types of oesophageal cancer?

Answer 1

Adenocarcinoma

Squamous cell carcinomas

Question 2

What histological type of oesophageal cancer affects the distal oesophagus?

Answer 2

Adenocarcinoma

Question 3

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

Answer 3

Squamous cell carcinoma

Question 4

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

Answer 4

Adenocarcinoma

Question 5

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

Answer 5

Squamous cell carcinoma

Question 6

What is the typical presentation of oesophageal cancer?

Answer 6

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

Question 7

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

Answer 7

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

Question 8

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

Answer 8

CT chest/abdomen
EUS
PET CT

Question 9

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

Answer 9

Palliative stenting

Palliative chemo/radiotherapy

Question 10

What would be the treatment for a resectable oesophageal cancer?

Answer 10

Oesophagectomy and chemotherapy

Question 11

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

Answer 11

10 months

Question 12

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

Answer 12

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

Question 13

What is the typical presentation of gastric cancer?

Answer 13

Non specific presentation with dyspepsia

Question 14

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

Answer 14

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

Question 15

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

Answer 15

Endoscopy

Contrast meal

Question 16

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

Answer 16

Laparoscopic investigation

Question 17

What are the benefits of a subtotal gastrectomy?

Answer 17

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

Question 18

What are the symptoms of gastro-oesophageal reflux disease?

Answer 18

Heartburn
Water brash
Cough

Question 19

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

Answer 19

Chest pain and vomiting

Question 20

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

Answer 20

Obesity
Smoking
Alcohol excess

Question 21

What are the treatments for gastro-oesophageal reflux disease?

Answer 21

Lifestyle changes
PPI therapy
Surgery

Question 22

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

Answer 22

Dysphagia 
Difficulty belching/vomiting 
Gas bloating 
Excess flatulence 
Diarrhoea

Question 23

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

Answer 23

Endoscopy
Oesophageal pH studies
Manometry

Question 24

Why is the incidence of bariatric surgery increasing?

Answer 24

Due to increasing obesity

Question 25

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

Answer 25

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

Question 26

What are the options for bariatric surgery?

Answer 26

Restrictive Malabsorptive Combination of both

Question 27

What are the advantages of laparoscopic adjustable gastric banding?

Answer 27

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

Question 28

What are the disadvantages of laparoscopic adjustable gastric banding?

Answer 28

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

Question 29

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

Answer 29

Laparoscopic adjustable gastric banding Laparoscopic gastric bypass Laparoscopic sleeve gastrectomy

Question 30

What are the disadvantages of a laparoscopic gastric bypass?

Answer 30

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

Question 31

What are the advantages of a laparoscopic sleeve gastrectomy?

Answer 31

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

Question 32

What are the possible complications of bariatric surgery?

Answer 32

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