OG Flashcards
Who should receive a 2 week wait OGD referral?
Dysphagia
Weight loss with reflux/abdo pain/dyspepsia
Upper abdominal mass
How many biopsies for suspicious mucosal lesions at OGD?
6-8
What is the characteristic finding in achalasia
Loss of ganglion cells in Auerbachs plexus
What is the classification of Peptic Ulcers
Modified Johnson
1. body of stomach (not associated with acid hyper secretion) (50%)
2. Body in combination with duodenal ulcers (acid ++) (25%)
3. Pyloric channel within 3cm of pylorus (acid ++) (20%)
4. Proximal GOJ <10%)
5. Chronic NSAID use
What are the characteristics of Gastric lymphoma?
5% of gastric malignancies - mostly B cell lymphomas
May regress with H Pylori eradication
More commonly are metastatic
What is Plummer Vinson syndrome?
Oesophageal web with Iron deficiency –> dysphagia
What is the most common site of benign gastric ulcer?
Lesser curve (50%)
Dilation of oesophageal cancer carries what risk of perforation?
4-6%
What are the characteristic histological findings of Schatzki rings?
They are typically found at the OG junction, with oesophageal mucosa above and columns epithelium below
What lymph nodes are removed in a D1 gastric resection?
Stations 1-7
Lesser/Greater curve + Left gastric
What lymph nodes are removed at a D2 gastric resection?
D1 stations (1-7) + 8-12
8 - Common hepatic
9 - Coeliac
10 - Splenic hilum
11 - Spenlic artery
12 - Hepatoduodenal ligament
What lymph nodes are removed at a D3 gastric resection?
D1 (1-7) + D2 (8-12) + 14-15
14 -root of SMA
15 - middle colic
(nb - not 13, posterior to pancreatic head)
What comprises a D4 gastric resection?
D1 (1-7) + D2 (8-12) + D3 (14-15) + 16
16- Para-aortic nodes
How are BMI categories altered in asian patients?
reduced by 2.5
What are the weight loss service tiers in the NHS?
Tier 1 - community based
Tier 2 - Advice from GP and medication (Orlistat, Mysimba [naltrexone/burprenorphine], Saxenda [liraglutide]
Tier 3 - Specialist weight management (MDT)
Tier 4 - Bariatric surgery
What are the NICE criteria for bariatric surgery?
1) BMI≥40 or 35-40 with significant disease (T2DM/HTN)
2) All appropriate measures undertaken and failed
3) Intensive Tier 3 management available (completed with weight loss ≥5%)
4) Patient generally fit for anaesthesia
5) Person commits for need to follow up
How wide is stomach typically left behind after a sleeve gastrectomy?
About 4cm
How long are the biliarypancreatico and ailmentary limbs typically made in a gastric bypass (for weight loss)?
BP 50cm
Ailmentary 100cm
Which bariatric surgery procedure has the greatest long term weight loss?
Total At 10 years:
Bypass 25%
Sleeve 17%
Band 14%
Excess body weight loss At 5 years:
Bypass 63%
Sleeve 53%
Band 48%
What follow up do patients undergoing bariatric surgery require?
For all - nutrition and CNS for 1 year
For bands - inflation increments
For sleeves and bypass - micronutrients, with regular monitoring of FBC, U&E, LFT, Folic acid, Ca, PTH, Vitamin D, Lipids, B1, B12, Vitamin A,EK
What advice is given re pregnancy after bariatric surgery?
Avoid for 12 months due to risk of foetal malnutrition
What late complications are typically associated with a gastric band (5)?
1) Port / tubing issues-Port replacement or shortening of tube
2) Oesophagitis-OGD +/-deflation or removal
3) Slippage-AXR +/-water soluble contrast- repositioning or removal
4) Gastric pouch-Water soluble contrast swallow/ OGD-Deflation +/-gradual refilling or removal
5) Erosion-Removal
What late complications are typically associated with a sleeve gastrectomy?
Reflux oesophagitis-OGD- PPI +/- convert to Roux en Y
Stricture- Endoscopic dilatation
Twist/ kink- convert to Roux en Y
What late complications are typically associated with a gastric bypass?
Marginal ulcer-Smoking cessation, avoid NSAIDS, PPI, consider anastomosis revision
Anastomotic stricture-Endoscopic dilatation
Internal hernia-Laparoscopy and reduction of hernia, closure of spaces