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Alimentary System > Upper GI Surgery > Flashcards

Upper GI Surgery Flashcards

1
Q

What are the histological types of oesophageal cancer?

A

Adenocarcinoma

Squamous cell carcinomas

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2
Q

What histological type of oesophageal cancer affects the distal oesophagus?

A

Adenocarcinoma

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3
Q

What histological type of oesophageal cancer affects the proximal and middle third of the oesophagus?

A

Squamous cell carcinoma

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4
Q

What histological type of oesophageal cancer is related to obesity and consequent Barrett’s oesophagus?

A

Adenocarcinoma

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5
Q

What histological type of cancer is related to smoking, high alcohol intake and low socio-economic status?

A

Squamous cell carcinoma

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6
Q

What is the typical presentation of oesophageal cancer?

A 
Progressive dysphagia 
Weight loss and anorexia 
Odynophagia 
Chest pain/heartburn 
Haematemesis
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7
Q

What is the first line investigation in a patient presenting with dysphagia?

A

Endoscopy - will show cause of dysphagia and gives opportunity for biopsy and diagnosis

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8
Q

What imaging investigations might be used to determine whether an oesophageal cancer is resectable/whether the patient is fit for surgery?

A

CT chest/abdomen
EUS
PET CT

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9
Q

If a patient with oesophageal cancer has metastatic disease or is unfit for surgery, what would you use to treat them?

A

Palliative stenting

Palliative chemo/radiotherapy

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10
Q

What would be the treatment for a resectable oesophageal cancer?

A

Oesophagectomy and chemotherapy

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11
Q

How long would it take for the quality of life of the patient to return to pre-operative quality after an oesophagectomy?

A

10 months

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12
Q

What additional measure would be taken with a patient following an oesophagectomy to aid recovery?

A

Feeding tube into the small bowel for a couple of months until patient adapts to eating

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13
Q

What is the typical presentation of gastric cancer?

A

Non specific presentation with dyspepsia

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14
Q

What are the ‘alarm features’ of a presentation of gastric cancer, suggesting severe disease?

A 
Dysphagia
Evidence of GI blood loss 
Weight loss
Vomiting 
Upper abdominal mass
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15
Q

What two investigations would be done first if suspecting gastric cancer?

A

Endoscopy

Contrast meal

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16
Q

How would you ensure that a tumour was mobile and resectable, and determine surgical viability?

A

Laparoscopic investigation

17
Q

What are the benefits of a subtotal gastrectomy?

A

Some of the stomach is preserved which gives a better surgical outcome and better quality of life

18
Q

What are the symptoms of gastro-oesophageal reflux disease?

A

Heartburn
Water brash
Cough

19
Q

How would a hiatus hernia causing gastro-oesophageal reflux disease typically present?

A

Chest pain and vomiting

20
Q

What are the risk factors for gastro-oesophageal reflux disease?

A

Obesity
Smoking
Alcohol excess

21
Q

What are the treatments for gastro-oesophageal reflux disease?

A

Lifestyle changes
PPI therapy
Surgery

22
Q

What side effects might occur after surgery to treat gastro-oesophageal reflux disease?

A 
Dysphagia 
Difficulty belching/vomiting 
Gas bloating 
Excess flatulence 
Diarrhoea
23
Q

What investigations would be done in gastro-oesophageal reflux disease?

A

Endoscopy
Oesophageal pH studies
Manometry

24
Q

Why is the incidence of bariatric surgery increasing?

A

Due to increasing obesity

25
Q

Why might bariatric surgery be the best option for obese people?

A

Co-morbidities associated with obesity may be more severe than the risks associated with surgery

26
Q

What are the options for bariatric surgery?

A

Restrictive
Malabsorptive
Combination of both

27
Q

What are the advantages of laparoscopic adjustable gastric banding?

A

Relatively minor surgery
Reversible and adjustable
Low operative complication rate
Low mortality rates

28
Q

What are the disadvantages of laparoscopic adjustable gastric banding?

A

Requires implanted medical device
Risk of prolapse or slippage
15% require revision surgery
Easier for the patient to ‘cheat’

29
Q

What are the bariatric surgeries commonly used to aid weight loss?

A

Laparoscopic adjustable gastric banding
Laparoscopic gastric bypass
Laparoscopic sleeve gastrectomy

30
Q

What are the disadvantages of a laparoscopic gastric bypass?

A

Invasive surgery
Malabsorptive component requires lifelong supplements
More complex if it requires revision

31
Q

What are the advantages of a laparoscopic sleeve gastrectomy?

A

Good medium-term outcomes
No dumping syndrome
No small bowel manipulation
No foreign body put into body

32
Q

What are the possible complications of bariatric surgery?

A 
Anastomotic leak 
DVT/PE 
Infection 
Malnutrition 
Vitamin and mineral deficiencies 
Hair loss 
Excess skin

Alimentary System (29 decks)

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