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Ailimentary 2 > Upper GI Surgery > Flashcards

Upper GI Surgery Flashcards

1
Q

What types of gi cancers are there?

A

Adeno and squamous carcinomas

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2
Q

How are they investigated?

A

Endoscopy is gold standard.

Can be useful contrast swallows but more for benign

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3
Q

Oesophageal cancer. Then what?

A

Staging

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4
Q

Common metastatic sites for oesophageal cancer

A

Lung and liver

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5
Q

Fit and healthy, no metastatic obvious, what scans?

A

EUS (Eosophageal ultra sound) nodes etc - can stage T/N (Tumour size/Nodes affected)
PET CT - can stage M (Metastases)

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6
Q

Treatment options if metastatic/unfit

A

Stenting - keep oesophagus open, able to swallow.

palliative radiotherapy, palliative chemotherapy

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7
Q

Treatment options if resectable/fit

A

Oesophagectomy and chemotherapy 5 year survival approx 45%

Radical radio/chemo therapy 5 year survival approx 30%

Adenocarcinomas have bettwe outcomes with an oesophagealectomy and chemotherapy

Squamous cell carcinomas have simelar outcomes for radical or surgery. Radical is sometimes better because no surgery/invasiveness is required, so if concerns about resection/fitness and no metastatic disease.

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8
Q

What is used to replace oesophagus?

A

Stomach, colon

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9
Q

Morbidity/mortality oesophagectomy

A

Morbidity 20-30%
Mortality 5%

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10
Q

What is prehabilitatio?

A

Fitness before surgery
Nutrition, dietician, physical (5k), psychological,

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11
Q

What is Ivor Lewis op?

A

Abdomen incision, mobalise stomach, tube ready for chest

Then open up chest, move things around, chop out and attach stomach (gastro-oesophageal anastomisis)

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12
Q

Why is prehab imorirant for osophageal cancer surgery?

A

Help with recovery. Big big op

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13
Q

Gastric Cancer causes/modifiable factors

A

Helicobacter pylori infection,
Alcohol
Smoking/vaping
Excessive consumption of salted fish, pickled veg and cured meat
gastroesophageal reflux disease
Epstein Barr virus
Gastritis
Obesity

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14
Q

Weight loss surgery criteria (Bariatric)

A

Over 40 BMI
35-40 with comorbidity

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15
Q

What happens in a laparoscopic sleeve gastrectomy

A

Sleeve - cut out part of the stomach -
Gastric bypass - around stomach and straight to duodenum

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16
Q

What happens in a laparoscopic sleeve gastrectomy

A

Sleeve - cut out part of the stomach -
Gastric bypass - around stomach and straight to duodenum

17
Q

Where are adenocarcinomas in oesophageal cancers usually found? What are they related to?

A

Found in the distal oesophagus

Related to obesity, gastro-oesophageal reflux (Barrett’s metaplasia, dysplasia -> carcinoma)

18
Q

What is BArrett’s metaplasia?

A

metaplasia of the stratified squamous cells in the distal oesophagus to simple columnar and goblet cells)

19
Q

where are Squamous cell carcinomas found and what are they related to?

A

Proximal and middle 1/3 oesophagus.

Related to:
-Smoking
-Alcohol
-Low socio-economic status

20
Q

What are the warning signs of oesophageal cnacer?

A

Frequent and Persistant hiccups
Constant belchiung, coughing, burping
Difficulty swallowing
Acid indigstion /heartburn/reflux
Weight Loss
Pain inbetween the shoulder blades

21
Q

What are the ALARM Symptoms of Stomach cancer?

A

A - naemia
L - oss of weight
A - norexia
R - ecent onset of progressive symptoms
M-asses and Melaena/haematemesis
S - wallowing difficulty

22
Q

nvestigations for stomach cancer

A

Endoscopy, contrast meal

23
Q

What are the 2 options for gastric cancer surgery?

A

Subtotal Gastrectomy (just less than the whole stomach, more if cancer at bottom of the stomach)
Total gastrectomy and Roux en Y reconstruction (More for if cancer towards the top of the stomach, whole stomach comes out, jejenum connected to oesophagus and duodenum feeds in bile etc)

24
Q

WHat does laproscopic mean?

A

Keyhole/ smaller incisions (not opening up the whole stomach)

25
Q

What type of hiatus hernia would you definitly want to oparate on?

A

Paraesophageal Hiatus Hernia
(Stomach startes to poke through another hole in the diphragm, can lead to suffocation)

Sliding Hiatus Hernia (Stomach starts to poke through the osophageal hiatus) - surgery is considered but not definate.

26
Q

How is acid reflux investigated?

A

Endoscopy/Oesophageal pH Studies and Manometry (pH in end of oesophagus monitored, can see if symptoms occur at the same time (patient presses a button)

27
Q

Side effects of laparoscopic hiatus hernia repair and fundoplication

A

Dysphagia
Difficulty to belch and vomit
Gas Bloating
Excess flatulence
Diarrhoea

Ailimentary 2 (9 decks)

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