3.02 General Surgery - Gastric Disease Flashcards
What are the subtypes of gastric cancer? Indicate the most common.
- adenocarcinoma arising from gastric mucosa (most common, ~90%)
- connective tissue malignancy
- lymphoid malignancy
- neuroendocrine malignancy
What are the risk factors for gastric cancer?
- male gender
- Helicobacter pylori infection
- increasing age
- smoking
- alcohol consumption
- salt in diet
- low fibre diet
- positive family history
What is the most important modifiable risk factor identified in developing gastric cancer?
Helicobacter pylori infection - a gram negative helical bacterium.
Produces urease enzyme, breaking down urea into CO2 and ammonia. The ammonia neutralises stomach acid, allowing bacterium to create an alkaline microenvironment in the stomach.
It sets of a cycle of repeated damage to epithelial cells, leading to inflammation, ulceration and gastric neoplasia.
What are the clinical features of gastric cancer?
- dyspepsia (non-response to PPI)
- dysphagia
- early satiety
- vomiting
- malena
OE an epigastric mass may be palpable in advanced disease; Troisier sign is the presence of a palpable left supraclavicular node (Virchow node) and is considered a sign of metastatic abdominal malignancy.
Other signs of metastatic disease include hepatomegatly, ascites, jaundice or acanthosis nigricans.
What are the differentials to gastric cancer?
As symptoms are non-specific, causes could include diagnoses such as peptic ulcer disease, GORD, gallstone disease and pancreatic cancer.
How is suspected gastric cancer investigated?
- FBC and LFTs
- urgent upper GI endoscopy
- biopsy of suspected gastric malignancies
For staging all patients need a CT CAB and staging laparoscopy.
What is the curative treatment of gastric cancer?
Surgery with peri-operative chemotherapy.
Proximal gastric cancers treated via total gastrectomy.
Distal gastric cancers (antrum / pylorus) treated via subtotal gastrectomy.
What are the complications of gastrectomy?
- mortality
- anastomotic leak
- dumping syndrome
- vitamin B12 deficiency*
*Patients need 3-monthly vitamin B12 injections.
What is the palliative treatment of gastric cancer?
Most pts offered a palliative approach due to extend of disease at time of presentation.
- chemotherapy
- best supportive care
- stenting
- palliative surgery
What are the main complications of gastric cancer?
- gastric outlet obstruction
- iron deficiency anaemia
- perforation
- malnutrition
- death
What is a hiatus hernia?
The protrusion of an organ from the abdominal cavity into the thorax through the oesophageal hiatus of the diaphragm.
The stomach is the most commonly involved organ, however the small bowel, colon and mesentery can also herniate through.
Describe
a) sliding hiatus hernia
b) para-oesophageal hernia
a) the GOJ, abdominal part of the oesophagus and cardia of the stomach ‘slides’ upwards through the oesophageal diaphragmatic hiatus into the thorax. (80%)
b) an upward movement of the gastric fundus to lie beside a normally positioned GOJ, creating a ‘bubble’ of stomach in the thorax. (20%)
What are the risk factors for hiatus hernia?
- age related loss of diaphragmatic tone
- increasing intrabdominal pressure
- increased size of diaphragmatic hiatus
- pregnancy
- obesity
- ascites
What are the clinical features of hiatus hernia?
- asymptomatic (most common)
- GOR symptoms (treatment-resistant)
- vomiting and weight loss
- bleeding
- anaemia
- hiccups or palpations
- swallowing difficulties
What are the differentials of hiatus hernia?
- cardiac chest pain
- gastric or pancreatic cancer
- GORD