3. Upper GI surgery

Question 1

What are the modifiable risk factors associated with stomach cancer?

Answer 1

Infection with H. pylori
Alcohol
Smoking
Excessive consumption of salted fish, pickled veg and cured veg

Question 2

How does stomach cancer presents (ALARMS)?

Answer 2

• Anemia
• Loss of weight
• Anorexia
• Recent onset of progressive symptoms
• Masses and melaena (dark black tarry smelly faeces) or haematemesis (vomiting blood)
• Swallowing difficulty

Question 3

What investigation would you perform to diagnose stomach cancer?

Answer 3

Upper GI endoscopy if patient presents with ALARMS or >55 years old.
Contrast barium swallow
Staging (TNM): CT chest/abdomen
Staging laparoscopy

Question 4

What treatment options are available for stomach cancer?

Answer 4

• Subtotal Gastrectomy
• Total Gastrectomy and Roux en Y reconstruction
• Laparoscopic distal gastrectomy
• Open gastrectomy

Question 5

What are the side effects of laparoscopic hiatus hernia repair and fundoplication performed for GORD?

Answer 5

Dysphagia
Difficulty to belch and vomit
Gas Bloating
Excess flatulence
Diarrhoea

Question 6

When is bariatric surgery performed?

Answer 6

Conventional treatment offered if overweight (BMI 25-29) or obesity I (BMI 30-34.9).
Obesity/bariatric surgery performed if obese (obesity II: BMI 35-39.9) or morbidly obese (obesity III: BMI >40).