Upper Gastrointestinal surgery

Question 1

Where in the oesophagus are the 2 types of cancers likely to be found and why?

Answer 1

adeno - distal, barretts metaplasia and acid reflux

SCC - proximal and middle 1/3 due to smoking,alcohol

Question 2

What are the main symptoms of oesophageal cancer?

Answer 2

progressive dysphagia and odynophagia
weight loss and anorexia
heamatemesis
chest pain/heartburn

Question 3

What do endoscopy and barium swallows allow us to look for in oesophageal cancer?

Answer 3

E - biopsy, look at oesophagus

B.S - stricture/abnormalities

Question 4

How is oesophageal cancer staged?

Answer 4

TNM by CT or EUS/PET

Question 5

What is the algorithm for fit and unfit patients for treatment?

Answer 5

unfit - palliative chemo/radiotherapy and ERCP to stent

fit - oesophagectomy and chemotherapy, chemo and radiotherapy if unsure about surgery

Question 6

What 2 things can be used as a conduit in oesophageal cancer oesophagectomy? What is used more and why?

Answer 6

stomach and colon

stomach used more as colon can introduce bacteria and infection

Question 7

During an oesophagecomy what organ is collapsed?

Answer 7

right lung

Question 8

What is the outcome for the patient following oesophagectomy?

Answer 8

40% morbidity, 5-10% mortality and due to LOS loss can only eat small meals often or fed through the small bowel

Question 9

What infection is associated with gastric cancer?

Answer 9

Helicobacter pylori

Question 10

How do patients with gastric cancer present?

Answer 10

nonspecific dyspepsia

ALARM - dysphagia, weight loss, GI blood loss, vomit, mass

Question 11

If there are ALARM features what investigation should be done?

Answer 11

endoscopy

Question 12

What is the only curative option for gastric cancer?

Answer 12

surgery - gastrectomy

Question 13

What are the 2 types of gastrectomy and briefly describe each?

Answer 13

subtotal - part of stomach removed eg a distal tumour

total + roux en y reconstruction by joining small bowel

Question 14

Symptoms of GORD?

Answer 14

heartburn, waterbrash and cough

Question 15

Risk factors of GORD?

Answer 15

obesity, smoking and alcohol

Question 16

3 possible managements of GORD

Answer 16

lifestyle modification
PPI therapy
surgery

Question 17

What anatomical abnormality can cause GORD?

Answer 17

hiatus hernia - sliding and paraoesophageal

Question 18

What can endoscopy show in GORD?

Answer 18

oesophagitis

Question 19

What additional investigations are done with GORD?

Answer 19

oesophageal pH + manometry for acid reflux

Question 20

What surgery is done for GORD due to hiatus hernia?

Answer 20

laparascopic hiatus hernia repair and fundoplication

Question 21

What are the side effects of GORD surgery - fundoplication

Answer 21

dysphagia, gas bloating, belch and vomit difficulty, diarrhoea, excess flatulence

Question 22

over what BMI is bariatric surgery considered?

Answer 22

35

Question 23

What are the 3 broad categories of bariatric surgery?

Answer 23

restrictive, malabsorbitive and combination

Question 24

Advantages of laparoscopic adjustable gastric banding?

Answer 24

relatively minor surgery which is reversible with low mortality and complications

Question 25

disadvantages of laparoscopic adjustable gastric banding?

Answer 25

requires an implanted medical device which can slip and require additional surgery. Is easier to cheat

Question 26

Advantages of laparoscopic gastric bypass?

Answer 26

quick and dramatic weight loss

Question 27

Disadvantages of laparoscopic gastric bypass?

Answer 27

more invasive and complex with 0.5% mortality

malabsorption requires lifelong supplements

Question 28

Advantages of laparoscopic sleeve gastrectomy?

Answer 28

no foreign body, small bowel manipulation or dumping syndrome

Question 29

Disadvantages of laparoscopic sleeve gastrectomy?

Answer 29

more invasive and the long staple line has risk of leak and haemorrhage

Question 30

Complications of bariatric surgery?

Answer 30

anastomotic leak, PE/DVT, infection, malnutrition, vitamin and mineral supplements, hair loss, excess skin