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MedEd GKP/AB/VP > GI Surgery - Cancer and Surgery > Flashcards

GI Surgery - Cancer and Surgery Flashcards

1
Q

Overview of GI cancer

A 
Oesophageal (+Barrett's)
Stomach cancer
Pancreatic cancer
Liver cancer
Cholangiocarcinoma
Colorectal cancer
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2
Q

A 74 ♂ presents to his GP with a 3mo history of weight loss, fatigue and loose stools. His maternal grandmother was diagnosed with bowel cancer in her 60s. O/E, you discover bright red blood PR.

What tumour marker is associated with your feared diagnoses?

Pancreatic cancer
Oesophageal cancer
Left-sided colorectal cancer
Hepatocellular carcinoma
Barrett’s oesophagus
Cholangiocarcinoma
α-fetoprotein
CA19-9
CEA
Stomach cancer
A

CEA

Carcinoembryonic antigen
Colorectal cancer tumour marker

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3
Q

A 60♀ presents complaining of vague abdominal pain and a feeling of nausea for the past 4mo. She denies any vomiting. On further questioning you find she has lost a significant amount of weight over the past 6mo or so, largely unintentionally. O/E, you discover a firm, rubbery lump in the left, supraclavicular fossa.

What is the most likely Dx?

Pancreatic cancer
Oesophageal cancer
Left-sided colorectal cancer
Hepatocellular carcinoma
Barrett’s oesophagus
Cholangiocarcinoma
α-fetoprotein
CA19-9
CEA
Stomach cancer
A

Stomach Cancer

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4
Q

A 45 ♂ with a background of IBD presents complaining of pruritus. He denies any further symptoms, but on direct questioning remarks that his stools have perhaps been slightly more pale of late. Physical examination is largely unremarkable, aside from a mild jaundice noted in his sclera. You order a series of investigations, which reveal a negative CA19-9.

What is the most likely diagnosis?

Pancreatic cancer
Oesophageal cancer
Left-sided colorectal cancer
Hepatocellular carcinoma
Barrett’s oesophagus
Cholangiocarcinoma
α-fetoprotein
CA19-9
CEA
Stomach cancer
A

Cholangiocarcinoma

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5
Q

An obese 56♂ with a PMH of chronic GORD presents complaining of a
worsening, burning pain in his chest, and of feeling a lump in his throat when eating. He describes himself as a ‘non-smoker’, having given up yesterday evening following a 40+yr history of smoking 30 a day.

What is the most likely diagnosis?

Pancreatic cancer
Oesophageal cancer
Left-sided colorectal cancer
Hepatocellular carcinoma
Barrett’s oesophagus
Cholangiocarcinoma
α-fetoprotein
CA19-9
CEA
Stomach cancer
A

Oesophageal Cancer

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6
Q

A 56 ♀ presents with a 2 week history of increasing jaundice and pruritis. Direct questioning reveals that over the past few months she has lost about 10kg in weight. An ultrasound scan shows dilated bile ducts but no evidence of gallstones.

What is the most likely diagnosis?

Pancreatic cancer
Oesophageal cancer
Left-sided colorectal cancer
Hepatocellular carcinoma
Barrett’s oesophagus
Cholangiocarcinoma
α-fetoprotein
CA19-9
CEA
Stomach cancer
A

Pancreatic cancer

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7
Q

Types of Oesophageal Cancer

A

Adenocarcinoma (commonest)

Squamous cell

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8
Q

Oesophageal Adenocarcinoma

Location, RF, Barrett’s?

A

Lower Third of Oesophagus
RF: Smoking, Obesity
Does arise from Barrett’s

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9
Q

Oesophageal Squamous cell cancer

Location, RF, Barrett’s

A

Middle third of oesophagus
RF: Smoking, Alcohol
Doesn’t arise from Barrett’s

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10
Q

Chronic Presentation of Oesophageal Cancer

A

Progressive dysphagia, solids –> liquids
Chest pain (burning)
Wt loss

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11
Q

Oesophageal Cancer Ix

A

Dx: OGD
Staging: CT

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12
Q

Barrett’s Oesophagus

Definition, Cause, Complications

A

“Columnar lined oesophagus [CLO]”
Metaplasia of the oesophagus, replacing normal squamous epithelium with columnar epithelium.

Caused by acid reflux (GORD)

Complications: Increased risk of adenocarcinoma of the oesophagus

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13
Q

Stomach Cancer Risk Factors

A

Smoking, H. Pylori infection, Chronic gastritis

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14
Q

Stomach Cancer Presentation

A 
Epigastric Pain
Nausea
Vomiting +/- blood
Anorexia, Dysphagia
Wt Loss
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15
Q

Commonest Type of Stomach Cancer

A

Adenocarcinoma

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16
Q

Stomach Cancer O/E

A

Virchow’s Node/ Troisier’s sign: Lymphadenopathy in left supraclavicular fossa
Sister Mary Joesph node: Metastatic nodule on umbilicus
Palpable epigastric mass

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17
Q

Stomach Cancer Ix

A

OGD

Biopsy

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18
Q

Courvoisier’s Law

A

Painless jaundice + Palpable Gallbladder is unlikely to be due to gallstone’s

(Likely malignancy of gallbladder or pancreas)

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19
Q

Pancreatic Cancer RF

A

Smoking
Increased BMI
Chronic pancreatitis
Diabetes

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20
Q

Pancreatic Cancer Genetics

A

K-ras mutation (95%)

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21
Q

Pancreatic Cancer Presentation

A

Painless jaundice

Obstructive jaundice picture - pale stools/dark urine

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22
Q

Pancreatic Cancer O/E

A

Courvoisier’s Law

Painless jaundice/palpable gallbladder

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23
Q

Pancreatic Cancer Commonest type

A

Ductal carcinoma

24
Q

Pancreatic Cancer Commonest location

A

Head > Body > Tail > Diffuse

25
Q

Pancreatic Cancer Tumour marker

A

Ca 19-9

26
Q

Pancreatic Cancer Ix

A

LFTs : Raised ALP
USS: Dilated biliary tree +/- pancreatic mass
Biopsy

27
Q

Commonest cause of liver cancer

A

Metastasis

28
Q

Liver Cancer RF

A 
Cirrhosis:
Infection - Viral hepatitis
Inflammation - PSC, PBC
Metabolic - NASH [Non-alcoholic steatohepatitis]
Toxins - Alcohol, Drugs
29
Q

Liver Cancer Presentation

A

Constitutional symptoms: FLAWS
+/- Ascites
+/- Abdo pain

30
Q

Liver Cancer Commonest Type

A
  1. Secondary - Metastasis

2. Primary - Hepatocellular carcinoma

31
Q

Liver Cancer Tumour marker

A

α-fetoprotein

32
Q

Liver cancer Ix

A

USS

Biopsy

33
Q

Cholangiocarcinoma

RF, Presentation, O/E

A

NB Presentation is similar to pancreatic cancer

RF: Primary sclerosing cholangitis (UC)

Presentation: Obstructive jaundice picture; Constitutional symptoms

O/E: ? Courvoisier’s law

34
Q

Colorectal cancer

RF, Commonest Type, Tumour marker, Ix

A

RF:
Age
FHx
Diet (Meat in diet; Fat in diet; Low fibre)

Commonest: Adenocarcinoma

TM: CEA

Ix:
FBC - Microcytic anaemia
Colonoscopy + Biopsy

35
Q

Colorectal cancer Presentation

A

R sided:
Iron deficiency anaemia
+/- Dark blood mixed in with stool
+/- RIF mass

L sided (Commonest):
Change in bowel habits
Rectal bleeding
Bright red blood coating stool
\+/-mucus

Rectal:
+Tenesmus
+ Worm like stool

Anal:
Pain
+/- Pruritis ani
+/- Mass

36
Q

Duke’s Staging System

A

Used for colorectal cancers

A/B1/B2/C1/C2/D

A - Limited to mucosa
B1 - Extending into muscularis propria; No lymph node involvement
B2 - Transmural invasion; No lymph node involvement
C1 - Extending into muscularis propria; + Lymph node involvement
C2 - Transmural invasion; + Lymph node involvement
D - Distant metastasis

37
Q

Progressions before colorectal cancer

A

Familial adenomatous polyposis [FAP]

Hereditary non-polyposis colorectal cancer [HNPCC]

38
Q

FAP

Inheritance, Genetics, Characteristics, Lifetime risk of CRC without treatment

A

Autosomal dominant
Gene: APC
Characteristics: >1,000 polyps
Risk: 100%

39
Q

HNPCC

Inheritance, Genetics, Characteristics, Lifetime risk of CRC without treatment

A 
AKA lynch syndrome
Autosomal dominant
Genes: Mismatch repair genes
Characteristics: Multiple CRCs and extra-colonic cancers
Risk: 60%
40
Q

A trauma Pt is rushed to AandE following a stab wound to the abdomen. On initial assessment, the Pt is septic, and it quickly becomes clear that the wound has perforated his bowel.

Which is the most appropriate procedure to perform?

Hartmann’s
Gridiron
Pfannestiel
Abdominoperineal resection
Lower abdominal resection
Proctocolectomy
Loop ileostomy
Kocher’s
Rutherford-Morrison
Lanz
A

Hartmann’s

41
Q

A patient is known to have symptomatic Familial Adenomatous Polyposis, and is recommended surgery due to avoid his otherwise inevitable progression to colorectal cancer.

Which is the most appropriate procedure to perform?

Hartmann’s
Gridiron
Pfannestiel
Abdominoperineal resection
Lower abdominal resection
Proctocolectomy
Loop ileostomy
Kocher’s
Rutherford-Morrison
Lanz
A

Proctocolectomy

42
Q

A ♀ swimsuit model requires and appendectomy. She is however refusing to sign the consent form as she is concerned about the cosmetic implications.

Which is the most appropriate procedure to perform?

Hartmann’s
Gridiron
Pfannestiel
Abdominoperineal resection
Lower abdominal resection
Proctocolectomy
Loop ileostomy
Kocher’s
Rutherford-Morrison
Lanz
A

Lanz

43
Q

A Pt with Crohn’s disease has undergone a right hemicolostomy. The surgeon is, however, concerned about the integrity of the anastamosis in the short-term, given the status of the Pt.

Which is the most appropriate procedure to perform?

Hartmann’s
Gridiron
Pfannestiel
Abdominoperineal resection
Lower abdominal resection
Proctocolectomy
Loop ileostomy
Kocher’s
Rutherford-Morrison
Lanz
A

Loop ileostomy

44
Q

Catherine Middleton, Duchess of Cambridge has been admitted to the Lindo Wing at St Mary’s, as she will imminently give birth to a future heir to the throne. She has requested a C-section.

BUT – as the surgeon scrubs in, he momentarily forgets which surgical procedure he should perform. He turn’s to the 3rd year Imperial medical student who is assisting and asks:

Which is the most appropriate procedure to perform?

Hartmann’s
Gridiron
Pfannestiel
Abdominoperineal resection
Lower abdominal resection
Proctocolectomy
Loop ileostomy
Kocher’s
Rutherford-Morrison
Lanz
A

Pfannestiel

45
Q

Hemicolectomy

Description and Indications

A

Removal of either the right or the left side of the bowel

Indications
R: Crohn’s Disease involving terminal ileum; Right sided CRC

L: Left sided CRC; Diverticular disease

46
Q

Hartmann’s Procedure

Description and Indications

A

Emergency procedure:
Resection of the recto-sigmoid colon
Formation of an end colostomy stoma

Indications:
Obstruction
Perforation
Abscess
Trauma
47
Q

“Reversal of Hartmann’s”

Description and Indications

A

Anastomosis of bowel and removal of stoma

If pt well enough - 3 months after Hartmann’s

48
Q

Proctocolectomy

Description and Indications

A

Removal of the entire colon and rectum. Results in either:
Ileo-anal pouch anastomosis (“J pouch”)
End ileostomy

Indications:
UC
Crohn's
FAP
Pts with > 1 bowel cancer
49
Q

Ileo-anal pouch anastomosis (J Pouch)

A

Formation of a new rectum - the pouch - out of loops of small bowel following proctocolectomy

50
Q

Abdominoperineal resection

Description and Indications

A

Removal of the entire rectum and anus. Formation of an end colostomy.

Indications:
Lower rectal cancer
Anal cancer

51
Q

Anterior resection of rectum - Lower anterior resection

Description and Indications

A

Removal of part or all of the rectum. Anastomosis of free ends.

Indications:
Upper rectal cancer
Diverticular disease

52
Q

Scars - Indications

Kocher’s =Right subcostal
Mercedes-Benz
Midline laparotomy
Loin
McBurney’s =Gridiron
Lanz
Rutherford-Morrison = Hockey-Stick
Pfannestiel
Inguinal
A

Kocher’s =Right subcostal
Open cholecystectomy

Mercedes-Benz
Liver transplant

Midline laparotomy
Numerous
Major GI/abdo surgery

Loin
Nephrectomy

McBurney’s =Gridiron
Appendicectomy

Lanz
Appendicectomy
(+ improved cosmetic outcome)

Rutherford-Morrison = Hockey-Stick
Renal transplant

Pfannestiel
Gynaecological procedure
Eg C-Section

Inguinal
Hernia repair
Vascular access

53
Q

Stoma

A

A conduit between the skin and a hollow viscus to divert faeces or urine outside the body to where it can be collected in a bag.

54
Q

Ileostomy

Bowel, Appearance, Location, Faeces

A

Small bowel
Spouted (sticking out)
RIF
Green, Liquid

55
Q

Colostomy

Bowel, Appearance, Location, Faeces

A

Large bowel
Flush
LIF
Formed

56
Q

Loop ileostomy/colostomy

A

Temporary procedure:
A loop of bowel is brought to the surface and half divided, allowing faecal matter to drain into a stoma bag without reaching the distal bowel. It is then later reversed once the distal anastamosis has recovered.

MedEd GKP/AB/VP (28 decks)

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