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Systems: Alimentary AB > Upper GI Surgery > Flashcards

Upper GI Surgery Flashcards

1
Q

What is the prevalence of oesophageal cancer?

A

-M:F 5:2

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2
Q

Where do adenocarcinomas occur in the oesophagus?

A

Distal oesophagus

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3
Q

What risk factors are linked to adenocarcinomas in the oesophagus?

A
  • Obesity
  • Gastro-oesophageal reflux
  • Barrett’s metaplasia
  • Dysplasia
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4
Q

Where do squamous cell carcinomas occur in the oesophagus?

A

Proximal and middle third oesophagus

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5
Q

What risk factors are linked to squamous cell carcinomas in the oesophagus?

A
  • Smoking
  • Alcohol
  • Low socio-economic status
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6
Q

How does oesophageal cancer present?

A
  • Progressive dysphagia
  • Anorexia and weight loss
  • Odynophagia
  • Chest pain/heartburn
  • Haematemesis
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7
Q

What investigations are carried out for oesophageal cancer?

A
  • Endoscopy and biopsy
  • Contrast swallow
  • CT chest and abdomen
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8
Q

What is the staging algorithm for those deemed metastatic or unfit in oesophageal cancer?

A
  • No further staffing required

- Palliative/supportive therapy

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9
Q

What is the staging algorithm for those deemed resectable/ fit in oesophageal cancer?

A
  • EUS for T/N staging

- PET CT for M staging

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10
Q

What are the treatment options for those deemed metastatic or unfit in oesophageal cancer?

A
  • Stenting
  • Palliative radiotherapy
  • Palliative chemotherapy
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11
Q

What are the treatment options for those deemed resectable/fit in oesophageal cancer?

A
  • Oesophagectomy and chemotherapy

- Chemotherapy and radiotherapy

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12
Q

What approaches are there for oeosophagectomy?

A
  • Ivor Lewis
  • Trans-hiatal
  • Left thoraco-abdominal
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13
Q

What can be used as a conduit in an oesophagectomy?

A
  • Stomach

- Colon

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14
Q

What takes place in the abdomen during an oesophagectomy?

A

Gastric mobilisation

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15
Q

What takes place in the chest during an oesophagectomy?

A

-Oesophageal resection and gastro-oesophageal anastomosis

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16
Q

What is the prevalence of gastric cancer?

A

M:F 9:5

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17
Q

Where in the world is there a high prevalence of gastric cancer?

A

East Asia

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18
Q

What bacterium is gastric cancer associated with?

A

Helicobacter Pylori

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19
Q

How can gastric cancer present?

A
  • Nonspecific
  • Dyspepsia
  • Alarm features
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20
Q

What are the alarm features of gastric cancer?

A
  • Dysphagia
  • Weight loss
  • Vomiting
  • Upper abdominal mass
21
Q

What should be done if there are alarm features of gastric cancer present?

A
  • Endoscopy

- Contrast meal

22
Q

What investigation is used to stage gastric cancer?

A

CT chest/abdomen

23
Q

What surgery is there available for gastric cancer?

A
  • Subtotal gastrectomy

- Total gastrectomy and Roux en Y reconstruction

24
Q

GORD

A

Gastro-oesophageal reflux disease

25
Q

What are the symptoms of GORD?

A
  • Heartburn
  • Water brush
  • Cough
26
Q

What are the risk factors for GORD?

A
  • Obesity
  • Smoking
  • Alcohol excess
27
Q

How is GORD managed?

A
  • Lifestyle modification
  • PPI therapy
  • Surgery
28
Q

What structural abnormality can cause GORD?

A

Hiatus hernia

29
Q

Give 2 examples of hiatus hernias.

A
  • Sliding hiatus hernia

- Para oesophageal hiatus hernia

30
Q

What investigations should be carried out for GORD?

A
  • Endoscopy

- Oesophageal pH studies and manometry

31
Q

What side effects can occur with laparoscopic hiatus hernia repair and fundoplication?

A
  • Dysphagia
  • Difficulty to belch and vomit
  • Gas bloating
  • Excess flatulence
  • Diarrhoea
32
Q

When is conventional treatment offered to lower BMI?

A

BMI 30.0-34.9

33
Q

When should surgery be considered for lowering BMI?

A

-BMI 35->40

34
Q

Give examples of conditions can obesity put you at risk of developing.

A
  • Idiopathic intracranial hypertension
  • Stroke
  • Cataracts
  • Pulmonary disease
  • Coronary heart disease
  • NAFLD
  • Diabetes
  • Dyslipidaemia
  • Hypertension
  • Severe pancreatitis
  • Cancer
  • Phlebitis
  • Gout
  • Osteoarthritis
  • Gynaecological abnormalities
  • Gall bladder disease
35
Q

Bariatric surgery

A

Surgical procedures utilised to achieve reduction of excess weight

36
Q

What are the 3 types of bariatric surgeries available?

A
  • Restrictive
  • Malabsorptive
  • Combination
37
Q

Restrictive bariatric surgery

A

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

38
Q

Malabsorptive bariatric surgery

A

Operations consisting of bypassing bowel which thereby cause malabsorption of nutrients

39
Q

Combination bariatric surgery

A

Involves aspects of restriction and malabsorption

40
Q

What may influence the patient in bariatric surgery choice?

A
  • Peers
  • Celebrities
  • Safety
41
Q

What may influence the surgeon in bariatric surgery decisions?

A
  • Personal/units experience

- Patients BMI/ co-morbidities/ diet

42
Q

What are the advantages of laparoscopic adjustable gastric banding?

A
  • Relatively minor surgery
  • Reversible and adjustable
  • Low operative complication rate
  • Mortality 0.1%
43
Q

What are the disadvantages of laparoscopic adjustable gastric banding?

A
  • Requires an implants medical device
  • Easier to cheat
  • Risk of prolapse or slippage
  • 15% will require revisional surgery
44
Q

What are the advantages of gastric bypass?

A
  • Quick and dramatic weight loss
  • Pedigree
  • Dumping syndrome
45
Q

What are the disadvantages of laparoscopic gastric bypass?

A
  • More invasive surgery
  • Malabsorptive component requires lifelong supplements
  • More complex if requires revision
  • Mortality 0.5%
46
Q

What are the advantages of laparoscopic sleeve gastrectomy?

A
  • Good medium term outcomes
  • No dumping syndrome
  • No small bowel manipulation
  • No foreign body
47
Q

What are the disadvantages of laparoscopic sleeve gastrectomy?

A
  • More invasive surgery
  • Long staple line (bleeding/leak)
  • Short pedigree
  • Mortality 0.4%
48
Q

What are the possible complications of bariatric surgery?

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

Systems: Alimentary AB (37 decks)

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