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Finals > Upper GI surgery > Flashcards

Upper GI surgery Flashcards

1
Q

What is the presentation of gallstones?

A

*RUQ/epigastric pain
*Postprandial pain - typically one hour after eating
*RUQ tenderness

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2
Q

What investigations should you carry out in suspected gallstones?

A

*Abdominal USS
*LFTS: in uncomplicated should be normal, if in bile duct then rise in ALP and bilirubin
*FBC: normal if uncomplicated
*Check lipase or amylase if epigastric pain

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3
Q

What is the management of gallstones?

A

*Symptomatic: NSAID (diclofenac), consider anti-emetic (hyoscine), elective laparoscopic cholecystectomy
*Asymptomatic: observation, consider a lap chole if >3cm or at high risk of complications

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4
Q

What are the complications of gallstones?

A

*Gallstone ileus: stone erodes the wall creating a cholecystoenteric fistula leading to obstruction of the bowel
*Acute cholecystitis
*Acute cholangitis
*Acute biliary pancreatitis

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5
Q

What is the presentation of chronic pancreatitis?

A

*Epigastric pain, radiates to the back, worse 30 mins post prandially
*Steatorrhoea (Increased fat in stool)|
*Weight loss/malnutrition (due to fear of pain or malabsorption or diabetes)
*Diabetes mellitus/glucose intolerance
*Nausea and vomiting

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6
Q

What investigations should be carried out in suspected chronic pancreatitis?

A

*CT/MRI: pancreatic calcification, enlargement, ductal dilation
*Endoscopic ultrasonography if diagnosis is not confirmed after CT/MRI

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7
Q

What is the management of chronic pancreatitis?

A

*Alcohol and smoking cessation
* Analgesia
*Replacement pancreatic enzymes
*Treat diabetes and complications

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8
Q

What are the complications of chronic pancreatitis?

A

*Pancreatic exocrine insufficiency
*Diabetes mellitus
*Pancreatic calcifications/duct obstruction/pseudocysts
*Low trauma fracture due to decreased bone mineral density, malnutrition, inflammation

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9
Q

What is the most common pancreatic carcinoma?

A

Primary pancreatic ductal adenocarcinoma, most occur in the head of the pancreas

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10
Q

What is the presentation of pancreatic adenocarcinoma?

A

*Painless obstructive jaundice
*Upper abdominal pain/discomfort, back pain
*Weight loss and anorexia
*New onset diabetes or worsening of type 2 diabetes
*Nausea, vomiting, change of bowel habit

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11
Q

What investigations should be carried out in suspected pancreatic carcinoma?

A

*CT
*Abdominal USS
*LFTs, FBC
*Cancer antigen 19-9 biomarker (CA19-9)
*MRCP to assess biliary obstruction, ERCP to relieve it and obtain a biopsy
*Biopsy

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12
Q

What is the management of pancreatic adenocarcinoma?

A

*Surgery: total or distal pancreatectomy; whipples
*Pancreatic enzyme replacement
*If there are cholangitis symtpoms: biliary stenting
*Chemotherapy/radiotherapy
*Analgesia

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13
Q

What is whipples procedure?

A

Removal of the head of the pancreas, pylorus of the stomach, duodenum, bile duct, relevant lymph nodes and the gallbladder

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14
Q

What is the difference between whipple’s and modified whipple’s procedure?

A

Modified does not remove the pylorus of the stomach

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15
Q

What is a hiatus hernia?

A

Protrusion of intra-abdominal contnets in to the thoracic cavity through an enlarged oesophageal hiatus of the diaphragm

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16
Q

What are the 4 types of hiatus hernia?

A

1: Sliding
2: Rolling
3: combination
4: large opening with additional organs entering into the thorax

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17
Q

What is a sliding hiatus hernia?

A

Gastro-oesophageal junction protrudes thorugh the oesophageal hiatus, followed by the body of the stomach

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18
Q

What is a rolling hiatus hernia?

A

The fundus/body of the stomach enters in to the thorax and the gastro-oesophageal junction remains below the diaphragm

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19
Q

What are the risk factors for a hiatus hernia?

A

*Obesity
*Previous GORD
*Elevated intra abdominal pressure
*Increasing age
*Pregnancy

20
Q

What is the presentation of a hiatus hernia?

A

*Bowel sounds in the abdomen
*Heartburn: type 1 will have gord and the rest may
*Regurgitation, especially when lying flat
*Bloating
*burping and halitosis

21
Q

What investigations should be carried out in suspected hiatus hernia?

A

*Chest Xray
*Barium oesophagus
*Endoscopy
*CT or MRI

22
Q

What is the conservative management of a hiatus hernia?

A

*PPI for GORD symptoms
*Lifestyle changes: avoid nicotine, chocolate, peppermint, caffeine, fatty foods
*Avoid nitrates, CCB and beta blockers

23
Q

What is the surgical repair of a hiatus hernia?

A

Laparoscopic fundoplication

24
Q

What are the complications of a hiatus hernia?

A

*Gastric volvulus
*Obstruction
*Oesophagitis -> GI bleeding
*Barrett’s oesophagus

25
Q

What are the surgical complications of hiatus hernia repair?

A

*Bloating - usually resolves itself
*Recurrent hernia
*Dysphagia
*Post operative haemorrhage

26
Q

What are the two main types of oesophageal carcinoma and which is the most common?

A

Adenocarcinoma and squamous cell, adenocarcinoma is more common in the developed world

27
Q

What is the presentation of oesophageal caricnoma?

A

*Dysphagia
*Odynophagia
*Weight loss

28
Q

What are the risk factors for oesophageal adenocarcinoma?

A

*Male
*Age
*Smoking
*GORD
*Barretts
*Hiatus hernia

29
Q

What are the risk factors for oesophageal squamous cell carcinoma?

A

*Male
*Age
*Smoking
*Excessive alcohol
*Family history
* High temperature food and beverages

30
Q

What investigations should be carried out in suspected oesophageal carcinoma?

A

*Oesophagogastroduodenoscopy with biopsy
*CT ches/abdomen
*FDG-PET scan
*Metabolic profile

31
Q

What is the treatment of oesophageal carcinoma?

A

*Surgery: oesophagectomy
*Chemotherapy
*Trastuzumab if HER2 positive metastatic disease

32
Q

What is the most common type of gastric carcinoma?

A

Adenocarcinoma

33
Q

What are the risk factors of gastric adenocarcinoma?

A

*Pernicious anaemia
*H.pylori
*Male
*Smoker

34
Q

What are the investigations for suspected gastric carcinoma?

A

*Upper GI endoscopy with biopsy: ulcer/mass/mucosal changes
*FBC
*UEs, LFTs
*CT chest/abdo/pelvis to look for metastases

35
Q

What is the presentation of GORD?

A

*Heartburn
*Retrosternal/epigastric pain
*Bloating
*Nocturnal cough
*Hoarse voice

36
Q

What is the management of GORD?

A

*Lifestyle advice: avoid caffeine and alcohol, lose weight, quit smoking, smaller and lighter meals, stay upright after meals
*Gaviscon/rennies, PPI (omeprazole or rantidine)
*Surgery: laparoscopic fundoplicaiton

37
Q

What is the eradication therapy for H.pylori?

A

Triple therapy with PPI and 2 antibiotics (amoxicillin and clarithromycin) for 7 days

38
Q

What are the complications of GORD?

A

*Barrett’s oesophagus
*Oesophagitis
*Anaemia
*ulcers
*Oesophageal carcinoma
*Benign strictures

39
Q

What are the causes of gastritis?

A

-Helicobacter pylori inflection
-NSAIDs
-Alcohol
-Stress secondary to mucosal ischaemia
-Autoimmune

40
Q

What are the symptoms of gastritis?

A

-Nausea and vomiting
-Severe emesis
-Acute abdominal pain - epigastric area
- Fever

41
Q

Which type of ulcer is worse on eating?

A

Gastric

42
Q

What is the severity scoring system for pancreatitis?

A

Glasgow scale of pancreatitis severity

43
Q

Explain the glasgow scale of pancreatitis severity

A
  • PaO2<7.9kPa
  • Age>55
  • Neutrophils WCC>15
  • Calcium <2
  • Renal function: urea >16mmol/L
  • Enzymes LDH >600
  • Albumin <32g/L
  • Sugar: blood glucose >10
44
Q

What can be used as a marker of the pancreas’ exocrine function?

A

Faecal elastase

45
Q

What is the most common cause of cholangitis?

A

E.coli

46
Q

What tumour marker is used for cholangiocarcinoma?

A

Ca19-9

Finals (37 decks)

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