Upper GI Surgery Flashcards
Definition of Upper GI Bleed
Bleeding proximal to the ligament of Tretz
Etiology of Upper GI Bleed
Investigations in Upper GI bleeding
Upper GI Bleed Emergency Treatment
- Wide-bore (18-22G) IV cannula in each antecubital fossa
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Definition of a Massive Hemorage?
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
Lethal Triad of Hemorage?
- Acidosis
- Coagulopathy
- Hypothermia
3 Principles of Massive Transfusion Protocol (MTP)
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
Intraluminal Causes of Dysphagia? (2)
Intramural Causes of Dysphagia? (5+3)
Also:
- Esophageal Rupture
- Mallory-Weis Tears
- Esophageal Ulceration
Extraluminal Causes of Dysphagia? (3)
Upper GI investigations? (7)
Pathophysiology of Hiatus Hernia
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.
Types of Hiatal Hernias and Predominating Symptoms
- Type 1: GERD Symptoms Predominate
- Type 2-4: Obstructive Symptoms predominate (Emergency surgery needed 1% => 5% Mortality)
Clinical Features of Hiatal Hernia?
Associated Triad?
- Type 1: GERD Symptoms Predominate
- Type 2-4: Obstructive Symptoms predominate (Emergency surgery needed 1% => 5% Mortality)
Complications of Hiatal Hernia?
Risk Factors of Hiatal Hernia?
Investigations for a Hiatal Hernia?
- CXR
- Contrast Swallow
- CT TAP
- High-Resolution Manometry
Treatment of Hiatal Hernia
Pathophysiology of GORD?
Combination of:
- Transient increase in abdominal pressure (Cough/strain)
- Loss of Anti-Reflux Mechanisms:
History and Presentation of GORD?
- Typical
- Atytpyical
- Extra-Esophageal
Typical: Heartburn, regurgitation, abdominal pain
Atypical: Bloating, intermittent dysphagia.
Extra-oesophageal: Cough, laryngitis, asthma, dental erosions
Risk factors for GORD?
GORD Investigations?
Sequelae of GORD?
- Oesophagitis and ulceration
- Schatzki ring: Ring of tissue near stomach => Narrowing
- Barrett’s Oesophagus
- Adenocarcinoma
Treatment of GORD (Conservative/Surgical)
Post Fundoplication Complications?
- Gas Bloat Syndrome (Inability to burp/vomit)
- Stricture
- Dysphagia
- Splenic Injury
- Esophageal Perferation
- Phenomthroax
Types of Fundoplications
Toupet - posterior partial fundoplication, often used for patients with oesophageal dysmotility.
Nissen (360) reserved for cases of severe reflux
Pathophysiology of peptic ulcer disease
- Aggressive Factors?
- Protective Factors?
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
H. Pylori
- Proportion of Duodenal/Gastric Ulcers?
- Pathophysiology?
- Associations?
Gastric vs. Duodenal Ulcers?
Sequalae of Peptic Ulcers?
Investigations for Peptic Ulcer Disease?
Treatment of Peptic Ulcer Disease
Definition/Complications of Barret’s Esophagus
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.
Classification of Barrett’s Esophagus?
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).
Treatment of Barrett’s Esophgus
Indications for Barrett’s endoscopic SCREENING?
Barrett’s Esophagus Surveilance Interval
Pathophysiology of Achalasia
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
Presentaiton of Achalasia?
Complications of Achalasia?
Investigations for Achalasia
Classification System?
Classification System for Achalasia?
Treatment of Achalasia
Investigations/Treatment of Diffuse Esophageal Spasm
Adenocarcinoma vs. Squamous Cell Carcinoma?
- Definition
- Epidemiology
- Pathophysiology
- Location
- Risk Factors
Presentation of Oesophageal Cancers?
Investigations for Diagnosis and TNM staging of Esophogeal Cancers?
Classification/Treatment of Esophogeal Junction Cancer
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
Complications of Oesophagectomy?
Types of Gastric Cancer? (3)
Types of Gastric Neuroendocrine Tumors?
Progression to Malignancy of Gastric Adenocarcinoma
Presentation of Gastric Malignancy
Risk Factors for Gastric Malignancy
Investigations for Gastric Malignancy
- When is OGD Urgent?
Signs of Advanced Gastric Malignancy?
Complications of Gastrectomy?
Types of Gastric Bypass Operations?
Indications/Contraindications for Gastric Bypass?
Roux-en-Y Gastric Bypass (RYGB)
- Procedure
- Why it is effective for weight loss
- Expected Weight Loss
Sleeve Gastrectomy
- Procedure
- Why it is effective for weight loss
- Expected Weight Loss
Gastric Band
- Procedure
- Why it is effective for weight loss
- Expected Weight Loss
Biliopancreatic Diversion w/ Duodenal Switch
- Procedure
- Why it is effective for weight loss
- Expected Weight Loss
Outcomes of Bariatric Surgery?
Complications of Bariatric Surgery (Early/Late)
