Upper GI Surgery

Question 1

Cause, location and aetiology of Adenocarcinoma

Answer 1

Found in the distal oesophagus, caused by obesity and gastro-esophageal reflux Via Barrett’s metaplasia,
Dysplasia –> carcinoma.

Question 2

Cause, location and aetiology of squamous cell carcinomas

Answer 2

Found in the proximal and middle third of the oesophagus caused by smoking, alcohol and low socio-economic status

Question 3

Signs of oesophageal cancer

Answer 3

Frequent Persistent Hiccups
Indigestion and acid reflux
Dysphagia
Constant burping and coughing
Pain between the shoulder blades
Weight loss

Question 4

How is oesophageal cancer investigated

Answer 4

Endoscopy
Contrast Swallow
CT chest/abdomen for staging (TNM)

If cancer is metastatic, no further staging required and palliative and supportive therapy should be provided

Question 5

Treatment of Metastatic Oesophageal Cancer - Unresectable

Answer 5

Stenting

Palliative Radiotherapy & Chemotherapy

Question 6

Treatment of non-metastatic oesophageal cancer - resectable

Answer 6

Oesophagectomy & Chemotherapy survival rate of ~45% after 5 years

If concerns about recection, chemo/radiotherapy ~30% after 5 years

Question 7

Risk Factors for Gastric Cancer

Answer 7

H.pylori
Alcohol
Smoking
Excessive consumption of salted fish, pickled vegetables and cured meats.

Question 8

ALARMS Symptoms for endoscopy

Answer 8

Anaemia 
Loss of Weight
Anorexia
Recent onset of progressive symptoms
Mass, Melaena/haematemesis
Swallowing Difficulty 
>55

Question 9

Gastric Cancer Investigations

Answer 9

Endoscopy
Contrast Meal

Staging - CT chest/abdo + laproscopy

Question 10

Gastric Cancer Surgery

Answer 10

Subtotal Gastectomy
Total Gastectomy and roux en Y reconstruction,

May be open or laproscopic

Question 11

GORD - Gastro-oesophageal reflux

Answer 11

Caused by Hiatus Hernia. Investigated via endoscopy and oesophageal pH.studies and manometry.

Treated by fundiplication and hiatus hernia repair

Question 12

Symptoms of GORD

Answer 12

Heartburn
Dysphagia
Sour taste in mouth
Wheezing, chronic coughing, difficuly breathing.
Excess salviating.
Tooth Erosion
Belching
Chest Pain

Question 13

Define Manometry

Answer 13

Esophageal Manometry identifies problems with movement and pressure in the oesophagus. It measures the strength and muscle coordinaition of swallowing

Question 14

Define Fundoplication

Answer 14

The top-part of the stomach is wrapped around the lower oesophagus used to treat GORD.

In GORD. the lower oesophageal spinchter doesn’t work well.

Question 15

Complications of Hernia Repair and Fundoplication

Answer 15

Dysphagia
Difficulty to belch and vomit
Gas bloating
Excess flatulence
Diarrhoea

Question 16

What is Bariatric Surgery?

Answer 16

Weight Loss Surgery. Stomach Size reduction.