Upper GI surgery Flashcards
What cancer has been shown to be on the rise, and what has been decreasing
Oesophageal on the rise thought to be due to obesity causing acid reflux
Stomach decreasing
What are the two types of oesophageal cancer
Adenocarcinoma
Squamous cell carcinoma
Where is adenocarcinoma found along the oesophageal
Distally
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
Adenocarinoma
A smoker has suspected of oesophageal cancer, is it more likely to be adenocarcinoma or squamous cell carcinoma
Squamous cell carcinoma
What are causes of oesophageal squamous cell carcinoma
Smoking
Alcohol
Low economic status
What are the warning signs of oesophageal cancer (there are 6 bitch)
1) frequent and persistent hiccups
2) heartburn
3) difficulty swelling
4) burping
5) pain between shoulder blades
6) weigh loss
What investigations would you do with someone with suspected oesophageal cancer
Endoscopy
Contrast swallow
Describe the staging algorithm with one with eosphogeal cancer
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
What are the treatment options for someone unit or metastic
Stunting
Palliative radiotherapy
Palliative chemotherapy
What are the treatment options for respectable/fit
If 5 year survival %45 then oesophagectomy and chemotherapy
If 5 year and 30% then oesophagectomy and chemotherapy/radiation therapy
What are the 3 approaches for oesophagectomy
Ivor Lewis
Trans hiatal
Left thoraco abdominal
Describe the journey through the hospital of a patient out of oesophagectomy given no complications occur
ICU - 48-72 hours
High dependency
Ward
What is important to specially look out for with someone who has had abdominal surgery
Lungs, ensure well ventilated, prehabilitation of lung function occurs, this stands for any surgery opening up cell wall
What prerhabilitation tests are ran before surgery
ECG
Lung function test
Excerise prescribed
Diet sorted
What are the modifiable risk factors for stomach cancer
Infection of H pylori Alcohol Smoking Salted fish Pickled veg Cured meats
What is the presentation of stomach cancer
ALARM Anemia Loss of weight Anorexia Recent onset, progressive symptoms Masses and melaena Swelling difficulty
Clinically what is wrong with ALARM
Late stage
What investigations are given to someone with suspected stomach cancer
Endoscopy
Contrast meal
How is stomach cancer stages, what investigations are used
Ct abdomen and chest
Laparoscopy
When would a subtotal gastrectomy be used
If tumour is in distal end, keep part of stomach
When would a total gastrectomy and roux en Y reconstruction be used
If it is more proximal
What are the symptoms of someone with hiatus hernia
Chest pain.
Vomitting
What investigations are done with someone it’s hiatus hernia
Endoscopy
Oesophageal pH and manometry
What is performed to repair a hiatus hernia
Laparoscopic hiatus repair and fundoplication
What pH in oesophageal pH study is pathological
<4
What percentage of reflux is considered normal
4% per day
What are the side affects of laparoscopic hiatus repair and fundoplication
Dysphagia Difficulty to belch and vomit Bloating Excessive flatulence Diarrhoea
