Upper GI surgery

Question 1

Incidence, age and gender of oesophageal cancer

Answer 1

12/100,000
50-70
M:F 5:1

Question 2

Risk factors for oesophageal cancer

Answer 2

Alcohol + smoking
Achalasia
GORD –> Barrett’s
Plummer-vinson

Question 3

Pathophys of oesophageal cancer

Answer 3

65% adenocarcinoma in lower 3rd
-GORD –> Barrett’s –> dysplasia/cancer
35% SCC - upper and mid 3rd

Question 4

Ix in oesophageal cancer

Answer 4

Diagnose - upper GI endoscopy + biopsy

TNM staging - CT/EUS/laparoscopy

Question 5

Mx oesophageal cancer

Answer 5

Only 25% have resectable tumours

Question 6

Incidence, age, sex of gastric cancer

Answer 6

23/100,000
50s
M:F 2:1

Question 7

Risk factors for gastric cancer

Answer 7

Atrophic gastritis: pernicious anaemia, H. pylpori 
Diet: raised nitrates, smoked
Smoking, low SEC
Blood group A
Adenomatous polyps

Question 8

Pathology of gastric cancer

Answer 8

Mainly adenocarcinoma

Question 9

Signs of gastric cancer

Answer 9

Anaemia, epigastric mass, jaundice, ascites
Hepatomegaly
Acanthosis nigricans
Virchow’s node - Troisier’s sign

Question 10

Ix gastric cancer

Answer 10

Bloods - FBC+LFTS
Imaging - CXR, USS, Ba meal, gastroscopy
Biopsy - Signet ring cells

Question 11

Gastric lymphoma cause

Answer 11

MALT lymphoma due to H. pylori

Question 12

Bariatric surgery options

Answer 12

Laparoscopic gastric banding

Roux-en-Y gastric bypass

Question 13

Types of bile stones and cause

Answer 13

Cholesterol - fat, female, fertile, forty
Pigmented stones - unconjugated bilirubin, black, due to haemolytic anaemia
Mixed - 75% of stones

Question 14

Cholesterol stone formation

Answer 14

Admirand’s triangle - low bile, low lecithin, high cholesterol

Question 15

Complications of gallstones in gallbladder

Answer 15

Biliary colic 
Acute/chronic cholecystitis
Mucocele
Carcinoma 
Mirizzi's syndrome

Question 16

Complications of gallstones in bile duct and gut

Answer 16

Obstructive jaundice, pancreatitis, cholangitis

Gallstone ileus

Question 17

Biliary colic patho and present

Answer 17

Impacted stone

RUQ pain radiate to back, may be precipitated by fatty food

Question 18

Ix biliary colic

Answer 18

Urine, blood, US

Question 19

Rx biliary colic

Answer 19

Conservative - rehydrate, NBM, analgesia

Surgical - laparoscopic cholecystectomy

Question 20

Acute cholecystitis patho + present

Answer 20

Impacted stone and bacterial inflammation

RUQ pain, fever, vomiting

Question 21

Signs in acute cholecystitis

Answer 21

Murphy sign - 2 fingers over GB and pain on inspiration, negative on LUQ

Question 22

Ix acute cholecystitis

Answer 22

Urine, blood (raised WCC compared to biliary colic), US

MRCP - if dilated ducts seen on US

Question 23

Rx acute cholecystitis

Answer 23

Conservative - NMB, fluid, analgesia, cef+met

Surgical - lap chole

Question 24

Chronic cholecystitis symptoms

Answer 24

Flatulent dyspepsia:

upper abdo pain, bloated, nausea, flatulence, burping

Question 25

Rx chronic cholecystitis

Answer 25

Medical - bile salts

Surgical - cholecystectomy

Question 26

Mirizzi’s syndrome

Answer 26

Large stone in GB presses on common hepatic duct –> obstructive jaundice

Question 27

Gallstone ileus

Answer 27

Distal ileum obstruction
Rigler’s triad - pneumobilia, small bowel obstruction, gallstone in RLQ
Rx - stone removal

Question 28

Ascending cholangitis

Answer 28

Charcot’s triad - fever/rigor, RUQ pain, jaundice

Rx: cef+met, 1. ERCP 2. open/lap stone removal