CSW2 oesophagogastric and bariatric surgery Flashcards
What are indications for subtotal or total gastrectomy
Cancer distal to incisura= subtotal
Cancer higher up= total gastrectomy
How is reconstruction after gastrectomy done?
Roux en y- jejunum is connected to the top part of the stomach creating a bypass
What vessels supply the stomach?
Coeliac trunk
What is a D1 v D2 lymphadenectomy? Which one is GS
In gastrectomy:
D1= no lymph nodes removed
D2- all lymph nodes around stomach removed, this is GS
What symptoms might a patient experience post gastrectomy?
Nausea, vomiting, lack of appetite
Early satiety, small and frequent meals
Diarrhoea
Dumping syndrome
What is early v late dumping syndrome?
Early dumping= fluid shifts out of extravascular compartment causing hypotension and symptoms
Late dumping= food rich in sugar causes consequential signalling and insulin secretion causing hypoglycaemia and symptoms
How is dumping syndrome avoided?
Tell them to eat small frequent meals
Tell them to limit fluid intake
Tell them to avoid lots of sugar
What is the main RF for oesophageal cancer?
GORD
What change is caused in GORD in the lower oesophagus?
Metaplasia from squamous to columnar epithelium
What are symptoms of dumping syndrome?
Sweating Tremor Palpitations Dizziness Syncope
How is oesophagectomy carried out?
Resect oesophagus
Make stomach into long tube using staples (gastric conduit)
Can be 2 stage or 3 stage (these will have different scars)
What symptoms might someone experience post oesophagectomy?
Nausea, vomiting, lack of appetite
Early satiety
Nutrition problems
Leakage at anastomosis
What scar will you see in oesophagectomy on the back
Posterolateral thoracotomy
What line is seen in barrett’s oesophagus where the red extends?
Z line
What cell changes are seen progressing from GORD to cancer?
Barrets= metaplasia
Low grade dysplasia
High grade dysplasia
Cancer
