Pathophysiology

Question 1

Barrett’s oesophagus

Answer 1

Reflux damage squamous cell. Causes intestinal metaplasia and is defined by columnar epithelium lining ≥1 cm of the distal and histology shows columnar cell and the presence of goblet cell.

GOJ defined by proximal extent of gastric fold or end of the palisade vessels.

100x increase in cancer
LGD 1%
HGD 6-8%

Prague to classify extent of disease

Seattle protocol 4 biopsies every 2cm . if previous dysplasia every 1 cm . Narrow band imaging

Risk factors; H+ reflux, Obesity esophagus, smoking, age

2 yearly otherwise 3 yearly

Fundoplication ameliorates symptoms

pT1b

Question 2

Oesophageal cancer AJCC 8th

Answer 2

tis - HGD confined to BM
t1a - pass LP or MM
t1b - submucosa
t2 - invades MP
t3 - invades adventitia
t4a - invades the pleura, pericardium, azygos vein, diaphragm, or peritoneum
t4b - invades other adjacent structures, such as the aorta, vertebral body, or airway

N1 - 1 to 2
N2 - 3 to 6
N3 - >7

Question 3

Siewart classification

Answer 3

5cm to 1cm above GOJ
1cm above to 2cm below GOJ
2 to 5cm below GOJ

Question 4

Staging for all Upper GI cancer

Answer 4

PET cancer (upstaging)
Diagnostic Laparoscopy
Cytology washing
CT Chest/Abdomen/Pelvis

Question 5

Abdominal Compartment syndrome

Answer 5

APP = MAP - IAP (20mmHg) - increase in abdominal pressure that is persistent >20mmHg

Can be separated into primary or secondary
Primary - Pathology being intraabdominal, pelvic
Secondary - shock, burns

Pathophysiology - Shock, resus odema and tight abdomen - abdominal distension till compliance. reduced an increase in IAP causes reduced APP resulting in ischemia to end organ

12-20 - sedation, pain control, restrict fluid bolus
>20 without end organ dysfunciton - paralysis, drain, decompress, haemofiltration
>20 organ dysfunction - Laparotomy

Question 6

How to measure compartment pressures

Answer 6

Level of the heart, transducer, serial measurements

Question 7

Sepsis

Answer 7

Clinical syndrome Dysregulated host’s response to an infectious source that manifest as a spectrum of disease organ dysfunction, to shock and organ failure.
or another way is to define it as an
- End organ dysfunction with lactate >2

Identification qSoFA Criteria - RR<22/Altered mental state/sBP<100 (>2 poor outcomes due to sepsis)

Determine source of sepsis and support patient

IV Access, Bloods
Culture 
Oxygen 
Early Empiric Antibiotics 
IVF 
Monitor

Question 8

Gastric Cancer TNM

Answer 8

Tis - HGD 
T1a - invades LP and MM 
T1b - Subserosal 
T2 - Invades MP 
T3 -  invades Serosa w/o invasion of the visceral peritoneum 
T4a - invades visceral peritoneum 
T4b - invades adjacent organs