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Year 3 Upper GI Surgery > Gastric outlet obstruction and Gastric CA > Flashcards

Gastric outlet obstruction and Gastric CA Flashcards

1
Q

Causes of gastric outlet obstruction

A
  • Late complication of peptic ulcer disease due to fibrotic stricturing
  • Gastric Ca
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2
Q

Presentation of gastric outlet obstruction

A
  • Bloating
  • early satiety
  • nausea
• Outlet obstruction
- Copious projectile, non-bilious vomiting a few
hrs after meals.
-  Contains stale food.
-  Epigastric distension
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3
Q

Investigation of gastric outlet obstruction

A 
• ABG: Hypochloraemic hypokalaemic met alkalosis
• AXR
- Dilated gastric air bubble
- Collapsed distal bowel
• OGD
• Contrast meal
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4
Q

Tx of gastric outlet obstruction

A
  • Correct metabolic abnormality: 0.9% NS + KCl
  • Benign
  • Endoscopic balloon dilatation
  • Pyloroplasty or gastroenterostomy

• Malignant

  • Stenting
  • Resection
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5
Q

Hypertrophic Pyloric Stenosis epidemiology

A
  • Sex: M>F=4:1

* Race: ↑ in Caucasians

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6
Q

Hypertrophic Pyloric Stenosis presentation

A
  • 6-8wks
    • Projectile vomiting minutes after feeding
    • RUQ mass: olive shaped
    • Visible peristalsis
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7
Q

Investigations for Hypertrophic Pyloric Stenosis

A
  • Test feed: palpate mass + see peristalsis
  • ABG - Hypochloraemic hypokalaemic metabolic alkalosis
  • US
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8
Q

Management for Hypertrophic Pyloric Stenosis

A
  • Resuscitate and correct metabolic abnormality
  • NGT
  • Ramsted pyloromyotomy: divide muscularis propria
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9
Q

Gastric cancer RF

A

• Atrophic gastritis (→ intestinal metaplasia)

  • Pernicious anaemia / AI gastritis
  • H. pylori

• Diet: ↑ nitrates – smoked, pickled, salted (↑ Japan)
- Nitrates → carcinogenic nitrosamines in GIT

  • Smoking and alcohol
  • Familial: E. cadherin abnormality
  • Partial gastrectomy
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10
Q

Pathology of gastric CA

A
  • Mainly adenocarcinomas
  • Usually located on gastric antrum
  • H. pylori may cause MALToma
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11
Q

Presentation of gastric CA

A 
Usually present late:
• Wt. loss + anorexia
• Dyspepsia: epigastric or retrosternal pain/discomfort
• Dysphagia
• N+V
Signs:
• Anaemia
• Epigastric mass
• Jaundice
• Ascites
• Hepatomegaly
• Virchow’s node = Troisier's sign
• Acanthosis nigricans
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12
Q

Complications

A
  • Perforation - peritonitis
  • Upper GI bleed: haematemesis, melaena
  • Gastric outlet obstruction → succussion splash
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13
Q

Krukenberg tumour

A

Transcoelomic spread of gastric CA to ovaries

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14
Q

Investigations for gastric CA

A 
• Bloods 
- FBC: anaemia
- LFTs and clotting - liver mets
• Imaging
- CXR: mets
- USS: liver mets
- Gastroscopy + biopsy (gold standard) 
- Ba meal

• Staging

  • Endoluminal USS
  • CT- CAP
  • Diagnostic laparoscopy
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15
Q

Management of gastric CA

A

Curative Surgery:
• early - resected endoscopically

  • Proximal - total gastrectomy with lymph node dissection and Roux en Y reconstruction
  • Distal - subtotal gastrectomy with roux-en-Y to prevent bile reflux.
  • Spleen and part of pancreas may be removed
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16
Q

Palliative care for gastric CA

A 
Medical Palliation:
• Analgesia: e.g. fentanyl patch
• PPI
• Secretion control
• Chemo
• Palliative care team package

Surgical Palliation:
• Pyloric stenting
• Bypass procedures

17
Q

Zollinger-Ellison Syndrome

A
  • Gastrin-secreting tumour (gastrinoma) found in the small intestine or pancreas.
  • ↑ Gastrin → ↑HCL→ PUD + chronic diarrhoea
  • Diarrhoea due to inactivation of pancreatic enzymes
  • Enterochromaffin like cell proliferation can cause carcinoid tumours - malignant
  • Associated with MEN1
18
Q

Zollinger-Ellison Syndrome presentation

A
  • Abdominal pain and dyspepsia
  • Chronic diarrhoea / Steatorrhoea
  • Refractory PUD
19
Q

Zollinger - Ellison Syndrome investigations and management

A

Ix
• ↑ gastrin with ↑↑ HCl
• MRI/CT
• Somatostatin receptor scintigraphy

Tx
• High dose PPI
• Surgery
- Tumour resection
- May do subtotal gastrectomy with Roux en Y
20
Q

Roux-en-Y Gastric Bypass

A

Connect oesophagus to distal jejunum

• Oesophagojejunostomy allows bypass of stomach,
duodenum and proximal jejunum.

• Alters secretion of hormones influencing glucose
regulation and perception of hunger / satiety

  • Greater wt. loss and lower reoperation rates
  • Complications
  • Dumping syndrome
  • Wound infection
  • Hernias
  • Malabsorption
  • diarrhoea
21
Q

Dumping syndrome

A

Food is dumped into the small intestines too quickly causing:

  • early fullness
  • Abdominal cramping or pain
  • Nausea or vomiting
  • Severe diarrhoea
  • Sweating, flushing, or light-headedness
  • Rapid heartbeat
22
Q

Investigations on biopsy

A

Histology
CLO
FISH

23
Q

Staging of gastric cancer

A

CT CAP and staging laparoscopy - peritoneal mets

24
Q

Paraneoplastic syndrome associated with gastric cancer

A

Acanthosis nigricans - dark patches

Year 3 Upper GI Surgery (8 decks)

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