Upper GI surgery Flashcards
Incidence, age and gender of oesophageal cancer
12/100,000
50-70
M:F 5:1
Risk factors for oesophageal cancer
Alcohol + smoking
Achalasia
GORD –> Barrett’s
Plummer-vinson
Pathophys of oesophageal cancer
65% adenocarcinoma in lower 3rd
-GORD –> Barrett’s –> dysplasia/cancer
35% SCC - upper and mid 3rd
Ix in oesophageal cancer
Diagnose - upper GI endoscopy + biopsy
TNM staging - CT/EUS/laparoscopy
Mx oesophageal cancer
Only 25% have resectable tumours
Incidence, age, sex of gastric cancer
23/100,000
50s
M:F 2:1
Risk factors for gastric cancer
Atrophic gastritis: pernicious anaemia, H. pylpori Diet: raised nitrates, smoked Smoking, low SEC Blood group A Adenomatous polyps
Pathology of gastric cancer
Mainly adenocarcinoma
Signs of gastric cancer
Anaemia, epigastric mass, jaundice, ascites
Hepatomegaly
Acanthosis nigricans
Virchow’s node - Troisier’s sign
Ix gastric cancer
Bloods - FBC+LFTS
Imaging - CXR, USS, Ba meal, gastroscopy
Biopsy - Signet ring cells
Gastric lymphoma cause
MALT lymphoma due to H. pylori
Bariatric surgery options
Laparoscopic gastric banding
Roux-en-Y gastric bypass
Types of bile stones and cause
Cholesterol - fat, female, fertile, forty
Pigmented stones - unconjugated bilirubin, black, due to haemolytic anaemia
Mixed - 75% of stones
Cholesterol stone formation
Admirand’s triangle - low bile, low lecithin, high cholesterol
Complications of gallstones in gallbladder
Biliary colic Acute/chronic cholecystitis Mucocele Carcinoma Mirizzi's syndrome
Complications of gallstones in bile duct and gut
Obstructive jaundice, pancreatitis, cholangitis
Gallstone ileus
Biliary colic patho and present
Impacted stone
RUQ pain radiate to back, may be precipitated by fatty food
Ix biliary colic
Urine, blood, US
Rx biliary colic
Conservative - rehydrate, NBM, analgesia
Surgical - laparoscopic cholecystectomy
Acute cholecystitis patho + present
Impacted stone and bacterial inflammation
RUQ pain, fever, vomiting
Signs in acute cholecystitis
Murphy sign - 2 fingers over GB and pain on inspiration, negative on LUQ
Ix acute cholecystitis
Urine, blood (raised WCC compared to biliary colic), US
MRCP - if dilated ducts seen on US
Rx acute cholecystitis
Conservative - NMB, fluid, analgesia, cef+met
Surgical - lap chole
Chronic cholecystitis symptoms
Flatulent dyspepsia:
upper abdo pain, bloated, nausea, flatulence, burping
Rx chronic cholecystitis
Medical - bile salts
Surgical - cholecystectomy
Mirizzi’s syndrome
Large stone in GB presses on common hepatic duct –> obstructive jaundice
Gallstone ileus
Distal ileum obstruction
Rigler’s triad - pneumobilia, small bowel obstruction, gallstone in RLQ
Rx - stone removal
Ascending cholangitis
Charcot’s triad - fever/rigor, RUQ pain, jaundice
Rx: cef+met, 1. ERCP 2. open/lap stone removal
