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Surgery Lectures > Upper GI surgery > Flashcards

Upper GI surgery Flashcards

1
Q

what are the conditions of Upper GI surgery ?

A

Gastroesophageal Reflux Disease (GORD)
* Barret Oesophagus
* Oesophageal Cancer
* Gastric Cancer
* Gallstone Disease
* Symptomatic cholelithiasis
* Acute cholecystitis
* Choledocholithiasis
* Acute cholangitis

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2
Q

Definition of GORD?

A

It is a Chronic condition characterized by r**eflux of gastric contents **
(particularly acid, bile, and pepsin)
back into the oesophagus

prevelance increase with age and most commonly in women overall

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3
Q

What is the pathophysiology of GORD?

A

Mechanical disorder of the LES allowing
reflux of gastric contents
* Poor oesophageal motility decreases clearance
of acidic material.
* A dysfunctional LES allows reflux of large
amounts of gastric juice.
* Delayed gastric emptying can increase gastric
volume & pressure coupled with a defective
valve mechanism GOR

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4
Q

What is the Risk factors of Gord?

A

Obesity, alcohol consumption, smoking, certain
foods & pregnancy

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5
Q

What are the clinical presentation of Gord ?

A

Heartburn
Retrosternal burning sensation
Can occur after eating or when
lying supine or bending over.

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6
Q

what are the other symptoms of GORD?

A

Bloating,
nausea & vomiting
Atypical symptoms include difficulty in swallowing, hoarseness, sore throat & cough

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7
Q

What is the investigation of GORD?

A

Endoscopy
* Can help confirm the
diagnosis of reflux
* Can identify complications
like esophagitis, strictures,
Barrett oesophagus)
* Can help in evaluating the
anatomy (eg, hiatal hernia,
masses, strictures).

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8
Q

What are the red flags of GORD ?

A

** Dysphagia
* Hoarse voice
* Recurring or persistent cough
* Upper or lower GI tract bleeding
* Weight loss
* Lymphadenopathy
* Epigastric or supraclavicular
mass
* Requires urgent referral and
investigation**

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9
Q

What is the management for GORD?

A

Lifestyle modifications
* Medications
* Proton-pump inhibitors
* H2-receptor antagonist therapy if
inadequate response to PPI

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10
Q

What is the surgery for GORD?

A

Laparoscopic fundoplication
* Gastric fundus is sutured around the
LES to reinforce & lessen any acid
reflux

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11
Q

What is Barret Oesophagus ?

A

When healthy oesophgeal
epithelium is replaced with
metaplastic columnar cells due to prolonged exposure of
to the acid reflux from GORD.

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12
Q

What is the risk in barret oesophagus?

A

Risk of progression from barret oesophagus to adenocarcinoma

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13
Q

What is the pathophysiology of Barret Oesophagus?

A

barret oesophagus eventually lead to pre cancerous changes (low grade dysplasia & high grade dysplasia) and that lead to cancer

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14
Q

What is the clinical presentation of Barret oesophagus?

A

Pts often present with a chronic history of gastroesophageal reflux
and complain of heartburn
acid regurgitation occasionally, dysphagia

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15
Q

What investigation would you carry out for Barret Oesophagus?

A

Oesophagogastroduodenoscopy (OGDS) is the procedure of choice for the diagnosis of Barrett oesophagus.

DIagnosis require biopsy confirmation of specialized intestinal metaplasia in
the oesophagus

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16
Q

What is the management for Barret oesophagus?

A
  • Close monitoring- yearly surveillance endoscopy
  • Pharmacologic- prescribe medications to control/stop acid reflux
  • Radiofrequency ablation- destroys the involved area of the
    oesophagus
  • Mucosal resection through an endoscope
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17
Q

What surgery do you carry out for barret oesophagu?

A

tightens the junction between the GE junction to prevent
acid reflux

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18
Q

What is Oesophageal cancer?

A

Cancerous cells are present in the oesophagus

19
Q

What is the pathophysiology of oesophageal cancer?

A
  • Majority of malignancies are
  • adenocarcinomas (60-70%)
  • Previously were squamous cell
    carcinomas (still predominant in
    parts of Asia)
  • Cancer cells may fungate into the
    lumen of the or often infiltrate
    diffusely along & around the
    wall go through & invade
    adjoining mediastinal structures
20
Q

What is the etiology of the oesophageal cancer?

A
  • Squamous cell CA- smoking,
    alcohol consumption, long
    standing achalasia, lye strictures
  • Starts as epithelial dysplasia,
    which progresses in sequence to
    carcinoma in situ, and finally to
    invasive carcinoma
  • Adenocarcinoma- Barret’s
    esophagus, gastroesophageal
    reflux
21
Q

What is the clinical presentation of Oesophageal carcinoma?

A

Dysphagia develops insidiously and is the classic symptom (initial to solids
then even to liquids); considered as a late feature

22
Q

What are the other symptoms of oesophageal cancer?

A

Loss of appetite
weight loss & fatigue
* Abdominal pain, chest or back
* Locally advanced tumours may involve the
laryngeal nerve hoarseness or with
tracheoesophageal fistula

23
Q

What do you find in physical examination of the oesophageal cancer?

A

Enlarged cervical & supraclavicular

24
Q

What is the investigation of Oesophageal cancer?

A

Barium swallow-assess outline
oesophageal lumen
* Endoscopy- provides direct
visualization inside the lumen
* Biopsy provides a histologic
diagnosis
* Once confirmed staging is
done to guide therapy and
predict prognosis.

25
Q

List the stages of oesophageal cancer?

A

Primary Tumour (T) invades
Regional LNs (N)
Metastases (M)

26
Q

What is the first staging in oesophageal cancer?

A

Primary Tumour (T) invades
T1 lamina propria/submucosa
T2 muscularis propria
T3 adventitia
T4 adjacent structures

27
Q

What is the second stage in oesophageal cancer?

A

Regional LNs (N)
N1 1/2 nearby nodes
N2 3-6 nearby nodes
N3 >7 nearby nodes

28
Q

What is the last stage in oesophageal cancer?

A

Metastases (M)
M1 distant spread

29
Q

What is the management of Oesophagela cancer?

A

Treatment is based on patient’s status
& stage of the carcinoma

30
Q

What is the primary treatment of oesophageal carcinoma?

A

Primary treatment is by removing the
malignancy through surgery
* Selection of curative vs. palliative
operation is based on the following:
* Location of the tumor
* Patient’s age and health
* Extent of the disease
* Preoperative staging

31
Q

What is the curative management of the oesophagal cancer?

A
  • Surgery
  • Chemo/radiotherapy

Two-thirds of patients are already
incurable at the time of diagnosi

32
Q

What is the palliative management of oesophageal cancer?

A
  • Chemotherapy
  • Radiotherapy
  • Placement of stents
33
Q

What is Gastric cancer?

A

Presence of malignant cells in the lining of the
stomach
* Marked variations in the incidence worldwide:
* UK- approximately 15 per 100,000 per year
* USA- 10 per 100,000 per year
* Japan- 70 per 100,000 per year
* 4,200 stomach cancer deaths in the UK every year
(about 12 every day) (2017-2019).
* Prognosis tends to be poor, with cure rates little
better than 5–10%, although better results are
obtained in Japan, where the disease is common

34
Q

What is the RF of gastric cancer?

A

Dietary habits
* Pickled, salted, or smoked food (fresh fruits and
vegetables are protective)

Helicobacter pylori
* Strongest established risk factor worldwide
** * Epstein-Barr Virus**
* About 10% of gastric adenoCA carry the EBV virus
*** Genetic Factors **
* Most common genetic abnormalities in sporadic
gastric cancer affect the p53 and COX-2 genes.
* **Premalignant conditions of the stomach
**

35
Q

What is the clinical condition of Gastric cancer?

A

Vague abdominal pain, unexplained weight loss,
early satiety, dysphagia, iron deficiency anaemia,
cachexia
* PE findings are often nonspecific or absent
* Patients present in a delayed fashion due to
vague and nonspecific symptoms
* If patient does have significant findings have
advanced, incurable disease.
* palpable epigastric mass
* palpable left supraclavicular LNs (Virchow’s node)
* periumbilical lymphadenopathy (Sister Mary Joseph
node

36
Q

What is the red flags for gastric cancer?

A

Important in the diagnosis of cancer is that these “benign” symptoms fail
to resolve after 6 weeks of antacid therapy or the presence of dyspepsia
in combination with so called “ALARM” symptoms

  • Anaemia (iron deficiency)
  • Loss of weight
  • Anorexia
  • Recent onset of progressive symptoms
  • Melena/hematemesis
  • Dysphagia
  • Dyspepsia and age >55 years
37
Q

What is the investigation of gastric cancer?

A

Endoscopy plus biopsy to confirm
diagnosis
* allows direct visualization of the
gastric mucosa
* localization of the tumour for
operative planning
* ability to biopsy suspicious lesions
*adenocarcinoma most common

38
Q

What are the staging investigation for gastric cancer?

A

CT scan (chest, abdomen, pelvis)
* PET scan
* Endoscopic ultrasound

39
Q

What are the management of gastric cancer?

A

depends on how advanced the cancer is

40
Q

What is the surgical intervention of gastric cancer?

A

gastrectomy
and others include chemotherapy
and radiotherapy

41
Q

What are the Gallstone disease?

A
  • Symptomatic cholelithiasis
  • Acute cholecystitis
  • Choledocholithiasis
  • Acute cholangitis
42
Q

What is the definition of choleothesis?

A

stones in the gallbladder

43
Q

What are the symptoms of cholelithiasis ?

A

condition where gallstones cause symptoms,
most commonly biliary colic.

Surgery Lectures (12 decks)

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