General Surgery - Stomach + Oesophagus Flashcards
what is achalasia?
LOS fails to open during swallowing
Ix for achalasia?
manometry
barium swallow
endoscope
Tx for achalasia?
balloon dilatation
nifedipine
what cell type is most common in oesophageal cancer?
adenocarcinoma
squamous cell
what cell type is most common in gastric cancer?
adenocarcinoma
what are features of oesophageal cancer?
dysphagia
wt loss
hoarse
cough
risk factors for gastric cancer?
h pylori pernicious anaemia asian smoking male
features of gastric cancer?
dysphagia nausea wt loss dyspepsia early satiety vomiting
where is virchow’s node? what is it a sign of?
left supraclavicular LNs
gastric cancer
Ix for gastric cancer?
scope and biopsy
CT
difference between biliroth’s I and II?
I - partial, pylorus removed and stomach anastomosed to duodenum
II - greater curvature connected to jejeunum, antrum resected
what occurs in a roux en Y?
jejunum attached to top of stomach
duodenum attached to bottom of jejunum
what happens in afferent loop syndrome?
afferent loop = duodenum
fills with bile after a meal
causes pain and vomiting
how deep do gastric ulcers go?
submucosa
features of ulcers?
pain worse eating (gastric) pain relieved by eating (duo) epigastric tenderness dyspepsia early satiety
risk factors for gastric ulcers?
NSAIDs
smoking
age
H pylori
what causes duodenal ulcers?
hypersecretion of gastrin due to H pylori
what causes gastric ulcers?
decreased mucin (protective) due to H pylori
where are gastric ulcers commonly found?
lesser curvature
what type of tumour is found in Zollinger Ellison syndrome? associations?
gastrin secreting adenoma
MEN1
Ix for ulcers?
upper GI scope
H pylori breath test of stool antigens
(stop PPIs 2 weeks prior)
Tx for ulcers?
PPI/H2 antagonist
H pylori eradication
(PPI + amox/met if allergic + met/clarithro)
how to prevent ulcers?
ALWAYS give gastric protection with an NSAID
features of GORD?
heartburn retrosternal pain belching acid/water brash odynophagia cough hoarse
Ix for GORD?
PPI trial
OGD
H pylori
Tx for GORD?
PPI
+H2 antagonist
lifestyle changes
laparoscopic fundoplication
what change occurs in Barratt’s?
prolonged exposure leads to squamous epithelium of oesophagus changing to columnar epithelium
what is a metaplastic change?
change of one mature cell type to another
what are those with barratt’s at risk of?
oesphageal carcinoma
what happens in a sliding hiatus hernia?
displacement of GO junction above the diaphragm
what happens in a rolling hiatus hernia?
stomach herniates into chest
GO remains in abdomen
Ix for a hiatus hernia?
barium swallow
Tx for hiatus hernias?
wt loss
PPI/H2
surgery (rolling at higher risk of strangulation)
