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Surgery > The oesophagus, stomach, and duodenum > Flashcards

The oesophagus, stomach, and duodenum Flashcards

1
Q

Sphincters of the Oesophagus

A

1) Cricopharyngeus
2) 3-5cm at level of hiatus(T10)

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2
Q

(Oesophagus) Thickened ligament at hiatus

A

Phrenoesophageal Ligament

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3
Q

(Oesophagus) Blood Supply

A

1) Cervical: Inferior thyroid arteries
2) Thoracic: Bronchial arteries + thoracic aorta
3) Abdominal: Left gastric + inferior phrenic

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4
Q

(Oesophagus) Drainage

A

1) Cervical: Inferior thyroid veins
2) Thoracic: Hemi-azygous and azygous
3) Abdominal: Left Gastric (portal circulation)

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5
Q

(Oesophagus) Sympathetic Nerve Supply

A

1) Pre-ganglionic: T5-T6
2) Post-ganglionic: Coeliac ganglia and cervical vertebrae

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6
Q

(Oesophagus) Parasympathetic Nerve Supply

A

Glossopharyngeal, laryngeal, and vagus nerves

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7
Q

Stomach Borders

A

Anteriorly: Diaphragm and Left lobe
Posteriorly: Diaphragm, left adrenal, upper left kidney, pancreas, spleen, splenic artery

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8
Q

(Stomach) Parts

A

1) Cardia
2) Fundus
3) Body
4) Antrum

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9
Q

(Stomach) Sphincters

A

1) Oesophagogastric Junction
2) Pylorus

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10
Q
A
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11
Q

(Stomach) Nerve Supply

A

1) Parasympathetic: Anterior and posterior vagal trunks, moving along the greater and lesser curvatures
2) Sympathetic: Coeliac ganglion

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12
Q

Parasympathetic effects ont he stomach

A

1) Motor fibres of stomach wall
2) Inhibitory fibres for pyloric sphincter
3) Secretomotor fibres

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13
Q

Sympathetic effetcs on the stomach

A

1) Motor fibres to pyloric sphincter

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14
Q

Nerve Supply Duodenum

A

Sympathetic + Parasympathetic: Superior mesenteric and coeliac plexuses

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15
Q

Dysphagia Onset

A

1) Sudden: Foreign body
2) Over weeks: Carcinoma
3) Years: Achalasia / Benign strictures

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16
Q

Dysphagia Sites

A

Poor correlation. If high, maybe pharyngeal pouch

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17
Q

Dysphagia Progression

A

1) Progressive: stricture (benign or malignant)
2) Intermittent: motility disorders

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18
Q

Dysphagia Severity

A

1) Solids: initially indicative of carcinoma
2) Solids + Liquids: achalasia/ other motility disorder

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19
Q

Intraluminal Causes of Dysphagia

A

Foreign Body

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20
Q

Intramural Causes of Dysphagia

A

1) Pharynx/ upper oesophagus:

Pharyngitis/tonsillitis
Moniliasis
Sideropenic web
Corrosives
Carcinoma
Myasthenia gravis
Bulbar palsy

2) Body of oesophagus:

Corrosives
Peptic oesophagitis
Carcinoma

3) Lower oesophagus:

Corrosives
Peptic oesophagitis
Carcinoma
Diffuse oesophageal spasm
Systemic sclerosis
Achalasia
Postvagotomy

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21
Q

Extrinsic causes of Dysphagia

A

1) Upper oesophagus:

Thyroid enlargement
Pharyngeal pouch

2) Body of oesophagus:

Mediastinal lymph nodes
Aortic aneurysm

3) Lower oesophagus:

Paraoesophageal hernia

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22
Q

Odynophagia

A

1) Oesophagitis
2) Oesophageal spasm (stricture/dysmotility)

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23
Q

Heartburn

A

Treat with PPIs. Worse on:

1) Bending over
2) Heavy meal
3) Alcohol

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24
Q

Red flag symptoms for dyspepsia

A

1) Weight loss
2) Anaemia (Iron deficiency)
3) Persistent vomiting
4) Mass
5) Progressive Nature

25
Q

Causes of regurgitation

A

1) Achalasia
2) Hiatus hernia
3) Pharyngeal pouch

26
Q

Causes of vomiting

A

1) Infection
2) Inflammation
3) Endocrine disorders
4) Obstruction
5) Pregnancy
6) Drugs

27
Q

Types of Ulcers

A

1) Duodenal: relieved by eating
2) Gastric: aggravated by eating

28
Q

Iron deficiency Anaemia signs

A

1) Pallor
2) Koilonychia
3) Smooth tongue

29
Q

GI Causes of iron deficiency aneamia

A

1) Carcinoma
2) Oesophagitis
3) Pulmer-Vinson Syndrome

30
Q

Signs of GI Malignancy on Examination

A

1) Lymphadenopathy (Virchow’s Node, Troisier’s sign)
2) Hepatomegaly
3) Abdominal Mass
4) Weight loss
5) Ascites

31
Q

Crepitus in the neck of the vomiting patient

A

Surgical emphysema - perforation of the oesophagus

32
Q

Acid-Base balance in chronic outlet obstruction

A

Hypochloraemic, hypokalaemic, hyponatraemic metabolic alkalosis

33
Q

Blood tests in metastatic Disease

A

1) Elevated enzymes
2) Low protein
3) Deranged clotting

+ Portal hypertension

34
Q

CXR findings in aspiration

A

1) Pulmonary consolidation
2) Fibrosis

Think:

1) Motility Disorders
2) Carcinoma

35
Q

Air-fluid level behind heart shadow

A

Intrathoracic stomach

36
Q

Indications for barium meal

A

1) Alternative to endoscopy when contra-indicated
2) Exclude pharyngeal pounch prior to endoscopy
3) Complement endoscopy (e.g. hiatus herniae)
4) Diagnose upeer G.I. perforation

37
Q

Requirements for endoscopy

A

1) 4 hour fast
2) Light sedation/ local anaesthetic spray
3) Pulse and Sat monitoring (to identify resp depression)

38
Q

Presentation: GORD/ Barrett’s Oesophagus

A

1) Heartburn
2) Regurgitation
3) Epigastric Pain
4) Vomiting
5) Hypersalivation
6) Nausea

39
Q

Diagnosis of GORD

A

1) History
2) Endoscopic Studies
3) Lower oesophagus pH studies (sometimes)

40
Q

Treatment of GORD

A

1) Lifestyle advice: weight loss, stop smoking, avoid spicy/fatty foods, alcohol and caffeine
2) OTC medications (antacids, alginates, low dose H2 antagonists)
3) PPIs as definitive treatment

41
Q

Diagnosis of Barrett’s Oesophagus

A

Histological diagnosis following biopsy

42
Q

Treatment of Barrett’s Oesophagus

A

Surveillance programme to detect and treat early neoplastic changes (squamous to columnar)

43
Q

Types of hiatus hernia

A

1) Sliding (90%): stomach slides through the hiatus leading to an intrathoracic gastroesophageal junction
2) Rolling : gastoesophageal sphincter remains intact - stomach rolls anteriorly

44
Q

Hiatus hernia clinical features

A

1) Heartburn and regurgitation: aggravated by posture, respond to antacids
2) Oesophagitis: can cause bleeding, anaemia , fibrosis, stricture formation
3) Epigastric and lower chest pain: can lead to strangulation of the stomach
4) Palpitations and hiccups

45
Q

Hiatus hernia management

A

1) Treat as with GORD
2) if obstructive symptoms, consider surgical repair
3) If emergency: decompress using an NG tube

46
Q

Achalasia Clinical Features

A

1) Typically female (3:2) aged 30-40
2) Progressive dysphagia, liquids>solids
3) Patient prefers to eat standing
4) Retrosternal pain, weight loss, halitosis, regurgitation
5) Barium swallow reveals proximal dilatation with inverted bird beak sign

47
Q

Achalasia Management

A

1) Balloon dilatation: 80-90% effective, risk of perforation
2) Surgical (Heller’s) myotomy:

48
Q

Pouches Clinical Features

A

1) Elderly male
2) Regurgitation
3) Halitosis
4) Dysphagia
5) Gurgling
6) Aspiration
7) Lump

49
Q

Pouches Investigations

A

1) Barium swallow
2) Avoid endoscopy - risk of perf

50
Q

Pouches treatment

A

1) Stapling
2) Surgical myotomy

51
Q

Types of perforation

A

1) Intraluminal: commonly iatrogenic (dilatation procedures, endoscopies)
2) Extrinsic: typically stab wounds
3) Spontaneous: following vomiting (Booerhaave’s Syndrome). Simple tears are Mallory-Weiss

52
Q

Perforation Investigation

A

Consider in every patient presenting with chest pain, shortness of breath, vomiting

1) Erect chest xray: likely to show surgical emphysema
2) Chest CT or water soluble swallow: confirm diagnosis. Can show whether the perforation is localised to the mediastinum or involves the pleural/peritoneal cavities

Important to exclude spontaneous pneumomediastinum which presents similarly and is treated conservatively

53
Q

Perforation Management

A

1) Cervical: conservative. IV fluids Abx and anti-fungals. If abscess, surgically drain it
2) Thoracic: Small perforations can be managed conservatively, larger ones require surgery

54
Q

Benign Oesophageal Tumours

A

<1% of neoplasms. Typically asymptomatic, treated with local enucleation. Most are leiomyomas

55
Q

Oesophageal Carcinoma

A

1) 15/100,000
2) Male: Female 3:1
3) Reverse thirds: 2/3 in bottom 1/3 (adenocarcinomas) and 1/3 in top 2/3 (squamous carcinomas)
4) Spread: haematogenously, direct invasion, lyphatics

56
Q

Oesophageal Carcinoma Clinical Features

A

1) Progressive dysphagia (liquids–>solids)
2) Regurgitation
3) Weight loss
4) Odynophagia
5) Fistula formation
6) Horner’s Syndrome
7) Hoarseness of voice

Typically late presentation (3-9 months)

57
Q

Oesophageal Carcinoma Investigations

A

1) Initially barium swallow
2) Must always be confirmed by endoscopy and biopsy (endoscopy is the best 1st line investigation for dysphagia)

58
Q
A
59
Q
A

Surgery (1 decks)

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