Upper GI Surgery Flashcards
What are the histological types of oesophageal cancer?
Adenocarcinoma
Squamous cell carcinomas
What histological type of oesophageal cancer affects the distal oesophagus?
Adenocarcinoma
What histological type of oesophageal cancer affects the proximal and middle third of the oesophagus?
Squamous cell carcinoma
What histological type of oesophageal cancer is related to obesity and consequent Barrett’s oesophagus?
Adenocarcinoma
What histological type of cancer is related to smoking, high alcohol intake and low socio-economic status?
Squamous cell carcinoma
What is the typical presentation of oesophageal cancer?
Progressive dysphagia Weight loss and anorexia Odynophagia Chest pain/heartburn Haematemesis
What is the first line investigation in a patient presenting with dysphagia?
Endoscopy - will show cause of dysphagia and gives opportunity for biopsy and diagnosis
What imaging investigations might be used to determine whether an oesophageal cancer is resectable/whether the patient is fit for surgery?
CT chest/abdomen
EUS
PET CT
If a patient with oesophageal cancer has metastatic disease or is unfit for surgery, what would you use to treat them?
Palliative stenting
Palliative chemo/radiotherapy
What would be the treatment for a resectable oesophageal cancer?
Oesophagectomy and chemotherapy
How long would it take for the quality of life of the patient to return to pre-operative quality after an oesophagectomy?
10 months
What additional measure would be taken with a patient following an oesophagectomy to aid recovery?
Feeding tube into the small bowel for a couple of months until patient adapts to eating
What is the typical presentation of gastric cancer?
Non specific presentation with dyspepsia
What are the ‘alarm features’ of a presentation of gastric cancer, suggesting severe disease?
Dysphagia Evidence of GI blood loss Weight loss Vomiting Upper abdominal mass
What two investigations would be done first if suspecting gastric cancer?
Endoscopy
Contrast meal
How would you ensure that a tumour was mobile and resectable, and determine surgical viability?
Laparoscopic investigation
What are the benefits of a subtotal gastrectomy?
Some of the stomach is preserved which gives a better surgical outcome and better quality of life
What are the symptoms of gastro-oesophageal reflux disease?
Heartburn
Water brash
Cough
How would a hiatus hernia causing gastro-oesophageal reflux disease typically present?
Chest pain and vomiting
What are the risk factors for gastro-oesophageal reflux disease?
Obesity
Smoking
Alcohol excess
What are the treatments for gastro-oesophageal reflux disease?
Lifestyle changes
PPI therapy
Surgery
What side effects might occur after surgery to treat gastro-oesophageal reflux disease?
Dysphagia Difficulty belching/vomiting Gas bloating Excess flatulence Diarrhoea
What investigations would be done in gastro-oesophageal reflux disease?
Endoscopy
Oesophageal pH studies
Manometry
Why is the incidence of bariatric surgery increasing?
Due to increasing obesity
Why might bariatric surgery be the best option for obese people?
Co-morbidities associated with obesity may be more severe than the risks associated with surgery
What are the options for bariatric surgery?
Restrictive
Malabsorptive
Combination of both
What are the advantages of laparoscopic adjustable gastric banding?
Relatively minor surgery
Reversible and adjustable
Low operative complication rate
Low mortality rates
What are the disadvantages of laparoscopic adjustable gastric banding?
Requires implanted medical device
Risk of prolapse or slippage
15% require revision surgery
Easier for the patient to ‘cheat’
What are the bariatric surgeries commonly used to aid weight loss?
Laparoscopic adjustable gastric banding
Laparoscopic gastric bypass
Laparoscopic sleeve gastrectomy
What are the disadvantages of a laparoscopic gastric bypass?
Invasive surgery
Malabsorptive component requires lifelong supplements
More complex if it requires revision
What are the advantages of a laparoscopic sleeve gastrectomy?
Good medium-term outcomes
No dumping syndrome
No small bowel manipulation
No foreign body put into body
What are the possible complications of bariatric surgery?
Anastomotic leak DVT/PE Infection Malnutrition Vitamin and mineral deficiencies Hair loss Excess skin
