Upper GI surgery

Question 1

What cancer has been shown to be on the rise, and what has been decreasing

Answer 1

Oesophageal on the rise thought to be due to obesity causing acid reflux
Stomach decreasing

Question 2

What are the two types of oesophageal cancer

Answer 2

Adenocarcinoma

Squamous cell carcinoma

Question 3

Where is adenocarcinoma found along the oesophageal

Answer 3

Distally

Question 4

If a patient is obese and has suffered from gastric reflux what cancer are they more likely to have in the oesophagus adenocarcinoma or squamous cell carcinoma

Answer 4

Adenocarinoma

Question 5

A smoker has suspected of oesophageal cancer, is it more likely to be adenocarcinoma or squamous cell carcinoma

Answer 5

Squamous cell carcinoma

Question 6

What are causes of oesophageal squamous cell carcinoma

Answer 6

Smoking
Alcohol
Low economic status

Question 7

What are the warning signs of oesophageal cancer (there are 6 bitch)

Answer 7

1) frequent and persistent hiccups
2) heartburn
3) difficulty swelling
4) burping
5) pain between shoulder blades
6) weigh loss

Question 8

What investigations would you do with someone with suspected oesophageal cancer

Answer 8

Endoscopy

Contrast swallow

Question 9

Describe the staging algorithm with one with eosphogeal cancer

Answer 9

Ct chest and abdomen
If unfit or metastatic no further staging, palliative and supportive
If respectable/ fit is EUS for TN, PET CT M stage

Question 10

What are the treatment options for someone unit or metastic

Answer 10

Stunting
Palliative radiotherapy
Palliative chemotherapy

Question 11

What are the treatment options for respectable/fit

Answer 11

If 5 year survival %45 then oesophagectomy and chemotherapy

If 5 year and 30% then oesophagectomy and chemotherapy/radiation therapy

Question 12

What are the 3 approaches for oesophagectomy

Answer 12

Ivor Lewis
Trans hiatal
Left thoraco abdominal

Question 13

Describe the journey through the hospital of a patient out of oesophagectomy given no complications occur

Answer 13

ICU - 48-72 hours
High dependency
Ward

Question 14

What is important to specially look out for with someone who has had abdominal surgery

Answer 14

Lungs, ensure well ventilated, prehabilitation of lung function occurs, this stands for any surgery opening up cell wall

Question 15

What prerhabilitation tests are ran before surgery

Answer 15

ECG
Lung function test
Excerise prescribed
Diet sorted

Question 16

What are the modifiable risk factors for stomach cancer

Answer 16

Infection of H pylori 
Alcohol 
Smoking 
Salted fish 
Pickled veg 
Cured meats

Question 17

What is the presentation of stomach cancer

Answer 17

ALARM 
Anemia
Loss of weight
Anorexia 
Recent onset, progressive symptoms 
Masses and melaena 
Swelling difficulty

Question 18

Clinically what is wrong with ALARM

Answer 18

Late stage

Question 19

What investigations are given to someone with suspected stomach cancer

Answer 19

Endoscopy

Contrast meal

Question 20

How is stomach cancer stages, what investigations are used

Answer 20

Ct abdomen and chest

Laparoscopy

Question 21

When would a subtotal gastrectomy be used

Answer 21

If tumour is in distal end, keep part of stomach

Question 22

When would a total gastrectomy and roux en Y reconstruction be used

Answer 22

If it is more proximal

Question 23

What are the symptoms of someone with hiatus hernia

Answer 23

Chest pain.

Vomitting

Question 24

What investigations are done with someone it’s hiatus hernia

Answer 24

Endoscopy

Oesophageal pH and manometry

Question 25

What is performed to repair a hiatus hernia

Answer 25

Laparoscopic hiatus repair and fundoplication

Question 26

What pH in oesophageal pH study is pathological

Answer 26

<4

Question 27

What percentage of reflux is considered normal

Answer 27

4% per day

Question 28

What are the side affects of laparoscopic hiatus repair and fundoplication

Answer 28

Dysphagia 
Difficulty to belch and vomit
Bloating 
Excessive flatulence 
Diarrhoea