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Clinical Surgery > Upper GI Surgery > Flashcards

Upper GI Surgery Flashcards

1
Q

Definition of Upper GI Bleed

A

Bleeding proximal to the ligament of Tretz

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2
Q

Etiology of Upper GI Bleed

A
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3
Q

Investigations in Upper GI bleeding

A
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4
Q

Upper GI Bleed Emergency Treatment

A
  • Wide-bore (18-22G) IV cannula in each antecubital fossa

+

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5
Q

Definition of a Massive Hemorage?

A

Definition of massive haemorrhage:

  • > 10U RCC in 24hrs
  • > 4U RCC in less than 1 hour
  • Replacement of 50% or more of total circulating volume within 3 hours
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6
Q

Lethal Triad of Hemorage?

A
  • Acidosis
  • Coagulopathy
  • Hypothermia
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7
Q

3 Principles of Massive Transfusion Protocol (MTP)

A

Principle 1: Blood products are transfused in 1:1:1 ratio (RCC:FFP:Platelets).

Principle 2: Target a low-normal blood pressure (e.g. MAP of 60mmHG), especially in variceal bleeding where over-resuscitation may disrupt formed clot and propagate bleeding (termed permissive hypotension).

Principle 3: Avoid fluid resuscitation with crystalloids to prevent volume overload

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8
Q

Intraluminal Causes of Dysphagia? (2)

A
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9
Q

Intramural Causes of Dysphagia? (5+3)

A

Also:

  • Esophageal Rupture
  • Mallory-Weis Tears
  • Esophageal Ulceration
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10
Q

Extraluminal Causes of Dysphagia? (3)

A
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11
Q

Upper GI investigations? (7)

A
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12
Q

Pathophysiology of Hiatus Hernia

A

Displacement of part or all of the stomach through the oesophageal hiatus due to widening of the diaphragmatic crura at the oesophageal hiatus and stretching the phrenoesophageal membrane.

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13
Q

Types of Hiatal Hernias and Predominating Symptoms

A
  • Type 1: GERD Symptoms Predominate
  • Type 2-4: Obstructive Symptoms predominate (Emergency surgery needed 1% => 5% Mortality)
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14
Q

Clinical Features of Hiatal Hernia?

Associated Triad?

A
  • Type 1: GERD Symptoms Predominate
  • Type 2-4: Obstructive Symptoms predominate (Emergency surgery needed 1% => 5% Mortality)
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15
Q

Complications of Hiatal Hernia?

A
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16
Q

Risk Factors of Hiatal Hernia?

A
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17
Q

Investigations for a Hiatal Hernia?

A
  • CXR
  • Contrast Swallow
  • CT TAP
  • High-Resolution Manometry
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18
Q

Treatment of Hiatal Hernia

A
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19
Q

Pathophysiology of GORD?

A

Combination of:

  • Transient increase in abdominal pressure (Cough/strain)
  • Loss of Anti-Reflux Mechanisms:
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20
Q

History and Presentation of GORD?

  • Typical
  • Atytpyical
  • Extra-Esophageal
A

Typical: Heartburn, regurgitation, abdominal pain

Atypical: Bloating, intermittent dysphagia.

Extra-oesophageal: Cough, laryngitis, asthma, dental erosions

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21
Q

Risk factors for GORD?

A
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22
Q

GORD Investigations?

A
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23
Q

Sequelae of GORD?

A
  • Oesophagitis and ulceration
  • Schatzki ring: Ring of tissue near stomach => Narrowing
  • Barrett’s Oesophagus
  • Adenocarcinoma
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24
Q

Treatment of GORD (Conservative/Surgical)

A
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25
Q

Post Fundoplication Complications?

A
  • Gas Bloat Syndrome (Inability to burp/vomit)
  • Stricture
  • Dysphagia
  • Splenic Injury
  • Esophageal Perferation
  • Phenomthroax
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26
Q

Types of Fundoplications

A

Toupet - posterior partial fundoplication, often used for patients with oesophageal dysmotility.

Nissen (360) reserved for cases of severe reflux

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27
Q

Pathophysiology of peptic ulcer disease

  • Aggressive Factors?
  • Protective Factors?
A

Aggressive factors:

  • H. pylori infection
  • NSAIDs
  • hydrochloric acid secretion
  • ethanol ingestion
  • smoking
  • bile reflux
  • ischemia
  • cocaine
  • hypoxia

Protective factors:

  • Mucosal bicarbonate/mucus production
  • blood flow
  • growth factors
  • cell renewal
  • endogenous prostaglandins
28
Q

H. Pylori

  • Proportion of Duodenal/Gastric Ulcers?
  • Pathophysiology?
  • Associations?
A
29
Q

Gastric vs. Duodenal Ulcers?

A
30
Q

Sequalae of Peptic Ulcers?

A
31
Q

Investigations for Peptic Ulcer Disease?

A
32
Q

Treatment of Peptic Ulcer Disease

A
33
Q

Definition/Complications of Barret’s Esophagus

A

Metaplasia of the distal esophagus with replacement of stratified squamous by columnar epithelium

  • Progression to oesophageal adenocarcinoma (0.33% of those with Intestinal metaplasia)
  • Men with Barrett’s Oesophagus develop cancer at twice the rate of women.
34
Q

Classification of Barrett’s Esophagus?

A

The Prague classification is used to standardize the extent of Barrett’s oesophagus. C is the proximal (highest) circumferential margin, M is the proximal Barrett’s tongue, both are measured in cm (e.g. C3M5).

35
Q

Treatment of Barrett’s Esophgus

A
36
Q

Indications for Barrett’s endoscopic SCREENING?

A
37
Q

Barrett’s Esophagus Surveilance Interval

A
38
Q

Pathophysiology of Achalasia

A

Most common primary motility disorder of the esophagus

The lower oesophageal sphincter (LOS) fails to relax in response to a peristaltic wave => progressive neuronal loss in the myenteric plexus

39
Q

Presentaiton of Achalasia?

A
40
Q

Complications of Achalasia?

A
41
Q

Investigations for Achalasia

Classification System?

A
42
Q

Classification System for Achalasia?

A
43
Q

Treatment of Achalasia

A
44
Q

Investigations/Treatment of Diffuse Esophageal Spasm

A
45
Q

Adenocarcinoma vs. Squamous Cell Carcinoma?

  • Definition
  • Epidemiology
  • Pathophysiology
  • Location
  • Risk Factors
A
46
Q

Presentation of Oesophageal Cancers?

A
47
Q

Investigations for Diagnosis and TNM staging of Esophogeal Cancers?

A
48
Q

Classification/Treatment of Esophogeal Junction Cancer

A

Siewert Classification:

  • Type 1 (distal oesophagus): 5cm Oesophagectomy and Proximal Gastrectomy
  • Type 2 (cardia): Transhiatal/transthoracic oesophagectomy or extended total gastrectomy
  • Type 3 (proximal stomach): Transhiatal extended total gastrectomy
49
Q

Complications of Oesophagectomy?

A
50
Q

Types of Gastric Cancer? (3)

A
51
Q

Types of Gastric Neuroendocrine Tumors?

A
52
Q

Progression to Malignancy of Gastric Adenocarcinoma

A
53
Q

Presentation of Gastric Malignancy

A
54
Q

Risk Factors for Gastric Malignancy

A
55
Q

Investigations for Gastric Malignancy

  • When is OGD Urgent?
A
56
Q

Signs of Advanced Gastric Malignancy?

A
57
Q

Complications of Gastrectomy?

A
58
Q

Types of Gastric Bypass Operations?

A
59
Q

Indications/Contraindications for Gastric Bypass?

A
60
Q

Roux-en-Y Gastric Bypass (RYGB)

  • Procedure
  • Why it is effective for weight loss
  • Expected Weight Loss
A
61
Q

Sleeve Gastrectomy

  • Procedure
  • Why it is effective for weight loss
  • Expected Weight Loss
A
62
Q

Gastric Band

  • Procedure
  • Why it is effective for weight loss
  • Expected Weight Loss
A
63
Q

Biliopancreatic Diversion w/ Duodenal Switch

  • Procedure
  • Why it is effective for weight loss
  • Expected Weight Loss
A
64
Q

Outcomes of Bariatric Surgery?

A
65
Q

Complications of Bariatric Surgery (Early/Late)

A

Clinical Surgery (20 decks)

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