Upper Gastrointestinal surgery Flashcards
Where in the oesophagus are the 2 types of cancers likely to be found and why?
adeno - distal, barretts metaplasia and acid reflux
SCC - proximal and middle 1/3 due to smoking,alcohol
What are the main symptoms of oesophageal cancer?
progressive dysphagia and odynophagia
weight loss and anorexia
heamatemesis
chest pain/heartburn
What do endoscopy and barium swallows allow us to look for in oesophageal cancer?
E - biopsy, look at oesophagus
B.S - stricture/abnormalities
How is oesophageal cancer staged?
TNM by CT or EUS/PET
What is the algorithm for fit and unfit patients for treatment?
unfit - palliative chemo/radiotherapy and ERCP to stent
fit - oesophagectomy and chemotherapy, chemo and radiotherapy if unsure about surgery
What 2 things can be used as a conduit in oesophageal cancer oesophagectomy? What is used more and why?
stomach and colon
stomach used more as colon can introduce bacteria and infection
During an oesophagecomy what organ is collapsed?
right lung
What is the outcome for the patient following oesophagectomy?
40% morbidity, 5-10% mortality and due to LOS loss can only eat small meals often or fed through the small bowel
What infection is associated with gastric cancer?
Helicobacter pylori
How do patients with gastric cancer present?
nonspecific dyspepsia
ALARM - dysphagia, weight loss, GI blood loss, vomit, mass
If there are ALARM features what investigation should be done?
endoscopy
What is the only curative option for gastric cancer?
surgery - gastrectomy
What are the 2 types of gastrectomy and briefly describe each?
subtotal - part of stomach removed eg a distal tumour
total + roux en y reconstruction by joining small bowel
Symptoms of GORD?
heartburn, waterbrash and cough
Risk factors of GORD?
obesity, smoking and alcohol
3 possible managements of GORD
lifestyle modification
PPI therapy
surgery
What anatomical abnormality can cause GORD?
hiatus hernia - sliding and paraoesophageal
What can endoscopy show in GORD?
oesophagitis
What additional investigations are done with GORD?
oesophageal pH + manometry for acid reflux
What surgery is done for GORD due to hiatus hernia?
laparascopic hiatus hernia repair and fundoplication
What are the side effects of GORD surgery - fundoplication
dysphagia, gas bloating, belch and vomit difficulty, diarrhoea, excess flatulence
over what BMI is bariatric surgery considered?
35
What are the 3 broad categories of bariatric surgery?
restrictive, malabsorbitive and combination
Advantages of laparoscopic adjustable gastric banding?
relatively minor surgery which is reversible with low mortality and complications
disadvantages of laparoscopic adjustable gastric banding?
requires an implanted medical device which can slip and require additional surgery. Is easier to cheat
Advantages of laparoscopic gastric bypass?
quick and dramatic weight loss
Disadvantages of laparoscopic gastric bypass?
more invasive and complex with 0.5% mortality
malabsorption requires lifelong supplements
Advantages of laparoscopic sleeve gastrectomy?
no foreign body, small bowel manipulation or dumping syndrome
Disadvantages of laparoscopic sleeve gastrectomy?
more invasive and the long staple line has risk of leak and haemorrhage
Complications of bariatric surgery?
anastomotic leak, PE/DVT, infection, malnutrition, vitamin and mineral supplements, hair loss, excess skin
