General Surgery - Stomach + Oesophagus

Question 1

what is achalasia?

Answer 1

LOS fails to open during swallowing

Question 2

Ix for achalasia?

Answer 2

manometry
barium swallow
endoscope

Question 3

Tx for achalasia?

Answer 3

balloon dilatation

nifedipine

Question 4

what cell type is most common in oesophageal cancer?

Answer 4

adenocarcinoma

squamous cell

Question 5

what cell type is most common in gastric cancer?

Answer 5

adenocarcinoma

Question 6

what are features of oesophageal cancer?

Answer 6

dysphagia
wt loss
hoarse
cough

Question 7

risk factors for gastric cancer?

Answer 7

h pylori
pernicious anaemia
asian
smoking 
male

Question 8

features of gastric cancer?

Answer 8

dysphagia
nausea
wt loss
dyspepsia
early satiety 
vomiting

Question 9

where is virchow’s node? what is it a sign of?

Answer 9

left supraclavicular LNs

gastric cancer

Question 10

Ix for gastric cancer?

Answer 10

scope and biopsy

CT

Question 11

difference between biliroth’s I and II?

Answer 11

I - partial, pylorus removed and stomach anastomosed to duodenum

II - greater curvature connected to jejeunum, antrum resected

Question 12

what occurs in a roux en Y?

Answer 12

jejunum attached to top of stomach

duodenum attached to bottom of jejunum

Question 13

what happens in afferent loop syndrome?

Answer 13

afferent loop = duodenum
fills with bile after a meal
causes pain and vomiting

Question 14

how deep do gastric ulcers go?

Answer 14

submucosa

Question 15

features of ulcers?

Answer 15

pain worse eating (gastric)
pain relieved by eating (duo)
epigastric tenderness
dyspepsia
early satiety

Question 16

risk factors for gastric ulcers?

Answer 16

NSAIDs
smoking
age
H pylori

Question 17

what causes duodenal ulcers?

Answer 17

hypersecretion of gastrin due to H pylori

Question 18

what causes gastric ulcers?

Answer 18

decreased mucin (protective) due to H pylori

Question 19

where are gastric ulcers commonly found?

Answer 19

lesser curvature

Question 20

what type of tumour is found in Zollinger Ellison syndrome? associations?

Answer 20

gastrin secreting adenoma

MEN1

Question 21

Ix for ulcers?

Answer 21

upper GI scope
H pylori breath test of stool antigens
(stop PPIs 2 weeks prior)

Question 22

Tx for ulcers?

Answer 22

PPI/H2 antagonist
H pylori eradication
(PPI + amox/met if allergic + met/clarithro)

Question 23

how to prevent ulcers?

Answer 23

ALWAYS give gastric protection with an NSAID

Question 24

features of GORD?

Answer 24

heartburn
retrosternal pain
belching 
acid/water brash
odynophagia
cough 
hoarse

Question 25

Ix for GORD?

Answer 25

PPI trial
OGD
H pylori

Question 26

Tx for GORD?

Answer 26

PPI
+H2 antagonist
lifestyle changes
laparoscopic fundoplication

Question 27

what change occurs in Barratt’s?

Answer 27

prolonged exposure leads to squamous epithelium of oesophagus changing to columnar epithelium

Question 28

what is a metaplastic change?

Answer 28

change of one mature cell type to another

Question 29

what are those with barratt’s at risk of?

Answer 29

oesphageal carcinoma

Question 30

what happens in a sliding hiatus hernia?

Answer 30

displacement of GO junction above the diaphragm

Question 31

what happens in a rolling hiatus hernia?

Answer 31

stomach herniates into chest

GO remains in abdomen

Question 32

Ix for a hiatus hernia?

Answer 32

barium swallow

Question 33

Tx for hiatus hernias?

Answer 33

wt loss
PPI/H2
surgery (rolling at higher risk of strangulation)