Upper GI Surgery

Question 1

What is the average age of oesophageal cancer diagnosis?

Answer 1

Slightly more male

65 y/o

Question 2

5 year survival rate of oesophageal cancer?

Answer 2

10%

Question 3

What type of cancer occurs in the proximal and middle third oesophagus?

Answer 3

Squamous cell carcinoma

Question 4

What type of cancer occurs in the distal third oesophagus?

Answer 4

Adenocarcinomas

Question 5

What are the largest risk factors for adenocarcinoma of the oesophagus?

Answer 5

Obesity

GORD

Question 6

What are the largest risk factors for squamous cell carcinoma of the oesophagus?

Answer 6

Smoking
Alcohol
Low socio-economic status

Question 7

How does oesophageal cancer present in patients?

Answer 7

Progressive dysphasia
Anorexia and weight loss
Odynophagia 
Chest pain
Haematemesis

Question 8

What is odynophagia?

Answer 8

Pain when swallowing

Question 9

How is oesophageal cancer investigated?

Answer 9

Endoscopy
Contrast swallow
CT chest/abdo (TNM)

Question 10

How is oesophageal cancer staged?

Answer 10

CT chest abdomen

Question 11

What treatment is indicated in a patient with metastatic oesophageal cancer?

Answer 11

Palliative and supportive care

Question 12

How is resectable oesophageal cancer staged?

Answer 12

T/N - EUS

M - PET CT

Question 13

How is oesophageal cancer treated in a patient unfit for surgery?

Answer 13

Stenting

Palliative radio/chemo

Question 14

When is chemo/radiotherapy alone indicated in oesophageal cancer patients?

Answer 14

Concerns about resection or fitness with NO metastatic disease

Question 15

What is the main treatment plan in a resectable + fit oesophageal cancer patient?

Answer 15

Oesophagectomy

+ chemotherapy

Question 16

How is an oesophagectomy performed?

Answer 16

Large part of oesophagus + tumour removed

Conduit connected to oesophagus

Question 17

What is the morbidity and mortality of oesophagectomy?

Answer 17

Morbidity 40%

Mortality 5-10%

Question 18

Male to female ratio of gastric cancer

Answer 18

1.8:1

Question 19

5 year survival rate of gastric cancer

Answer 19

15-20%

Question 20

How does gastric cancer present?

Answer 20

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

Question 21

Investigations in suspected gastric cancer?

Answer 21

Endoscopy (UGIE)

Contrast meal

Question 22

How is gastric cancer staged?

Answer 22

CT chest/abdo

Question 23

Types of gastric cancer surgery?

Answer 23

Total gastrectomy + roux en Y

Subtotal gastrectomy

Question 24

What is the presentation of GORD?

Answer 24

Heartburn
Water brash
Cough
(often daily)

Question 25

Risk factors for GORD

Answer 25

Obesity Smoking Alcohol

Question 26

How is GORD managed?

Answer 26

Lifestyle changes PPI Surgery

Question 27

What structural condition can increase the risk of GORD?

Answer 27

Hiatus hernia

Question 28

What investigations are used in suspected GORD?

Answer 28

Endoscopy Oesophageal pH Manometry

Question 29

Side effects of fundoplication/hiatus hernia repair

Answer 29

``` Dysphagia Difficulty to vomit/burp Gas bloating Flatulence Diarrhoea ```

Question 30

What are the main types of bariatric surgery?

Answer 30

Restrictive Malabsorptive Combination

Question 31

Advantages of adjustable gastric band

Answer 31

Minor surgery Reversible/adjustable Low complication rate Low mortality

Question 32

Disadvantages of adjustable gastric bands

Answer 32

Easy to cheat Prolapse/slippage Inplantable device 15% will require followup surgery

Question 33

Adventages of gastric bypass

Answer 33

Quick and dramatic weight loss | Pedigree

Question 34

Disadvantages of gastric bypass

Answer 34

More invasive surgery Malabsorptive components require supplementation More complex Dumping syndrome

Question 35

Advantages of sleeve gastrectomy

Answer 35

No dumping syndrome No small bowel manipulation No foregin body

Question 36

Disadvantages of sleeve gastrectomy

Answer 36

Staple line Short pedigree More invasive surgery

Question 37

Complications of bariatric surgery

Answer 37

``` Anastomotic leak DVT/PE Infections Malnutrition (vit/macro) Hair loss Excess skin ```