Upper GI Surgery Flashcards
What is the prevalence of oesophageal cancer?
-M:F 5:2
Where do adenocarcinomas occur in the oesophagus?
Distal oesophagus
What risk factors are linked to adenocarcinomas in the oesophagus?
- Obesity
- Gastro-oesophageal reflux
- Barrett’s metaplasia
- Dysplasia
Where do squamous cell carcinomas occur in the oesophagus?
Proximal and middle third oesophagus
What risk factors are linked to squamous cell carcinomas in the oesophagus?
- Smoking
- Alcohol
- Low socio-economic status
How does oesophageal cancer present?
- Progressive dysphagia
- Anorexia and weight loss
- Odynophagia
- Chest pain/heartburn
- Haematemesis
What investigations are carried out for oesophageal cancer?
- Endoscopy and biopsy
- Contrast swallow
- CT chest and abdomen
What is the staging algorithm for those deemed metastatic or unfit in oesophageal cancer?
- No further staffing required
- Palliative/supportive therapy
What is the staging algorithm for those deemed resectable/ fit in oesophageal cancer?
- EUS for T/N staging
- PET CT for M staging
What are the treatment options for those deemed metastatic or unfit in oesophageal cancer?
- Stenting
- Palliative radiotherapy
- Palliative chemotherapy
What are the treatment options for those deemed resectable/fit in oesophageal cancer?
- Oesophagectomy and chemotherapy
- Chemotherapy and radiotherapy
What approaches are there for oeosophagectomy?
- Ivor Lewis
- Trans-hiatal
- Left thoraco-abdominal
What can be used as a conduit in an oesophagectomy?
- Stomach
- Colon
What takes place in the abdomen during an oesophagectomy?
Gastric mobilisation
What takes place in the chest during an oesophagectomy?
-Oesophageal resection and gastro-oesophageal anastomosis
What is the prevalence of gastric cancer?
M:F 9:5
Where in the world is there a high prevalence of gastric cancer?
East Asia
What bacterium is gastric cancer associated with?
Helicobacter Pylori
How can gastric cancer present?
- Nonspecific
- Dyspepsia
- Alarm features
What are the alarm features of gastric cancer?
- Dysphagia
- Weight loss
- Vomiting
- Upper abdominal mass
What should be done if there are alarm features of gastric cancer present?
- Endoscopy
- Contrast meal
What investigation is used to stage gastric cancer?
CT chest/abdomen
What surgery is there available for gastric cancer?
- Subtotal gastrectomy
- Total gastrectomy and Roux en Y reconstruction
GORD
Gastro-oesophageal reflux disease
What are the symptoms of GORD?
- Heartburn
- Water brush
- Cough
What are the risk factors for GORD?
- Obesity
- Smoking
- Alcohol excess
How is GORD managed?
- Lifestyle modification
- PPI therapy
- Surgery
What structural abnormality can cause GORD?
Hiatus hernia
Give 2 examples of hiatus hernias.
- Sliding hiatus hernia
- Para oesophageal hiatus hernia
What investigations should be carried out for GORD?
- Endoscopy
- Oesophageal pH studies and manometry
What side effects can occur with laparoscopic hiatus hernia repair and fundoplication?
- Dysphagia
- Difficulty to belch and vomit
- Gas bloating
- Excess flatulence
- Diarrhoea
When is conventional treatment offered to lower BMI?
BMI 30.0-34.9
When should surgery be considered for lowering BMI?
-BMI 35->40
Give examples of conditions can obesity put you at risk of developing.
- Idiopathic intracranial hypertension
- Stroke
- Cataracts
- Pulmonary disease
- Coronary heart disease
- NAFLD
- Diabetes
- Dyslipidaemia
- Hypertension
- Severe pancreatitis
- Cancer
- Phlebitis
- Gout
- Osteoarthritis
- Gynaecological abnormalities
- Gall bladder disease
Bariatric surgery
Surgical procedures utilised to achieve reduction of excess weight
What are the 3 types of bariatric surgeries available?
- Restrictive
- Malabsorptive
- Combination
Restrictive bariatric surgery
Decreases the size of the stomach leading to satiety with smaller volumes of food that eventually leads to food intolerance and weight loss
Malabsorptive bariatric surgery
Operations consisting of bypassing bowel which thereby cause malabsorption of nutrients
Combination bariatric surgery
Involves aspects of restriction and malabsorption
What may influence the patient in bariatric surgery choice?
- Peers
- Celebrities
- Safety
What may influence the surgeon in bariatric surgery decisions?
- Personal/units experience
- Patients BMI/ co-morbidities/ diet
What are the advantages of laparoscopic adjustable gastric banding?
- Relatively minor surgery
- Reversible and adjustable
- Low operative complication rate
- Mortality 0.1%
What are the disadvantages of laparoscopic adjustable gastric banding?
- Requires an implants medical device
- Easier to cheat
- Risk of prolapse or slippage
- 15% will require revisional surgery
What are the advantages of gastric bypass?
- Quick and dramatic weight loss
- Pedigree
- Dumping syndrome
What are the disadvantages of laparoscopic gastric bypass?
- More invasive surgery
- Malabsorptive component requires lifelong supplements
- More complex if requires revision
- Mortality 0.5%
What are the advantages of laparoscopic sleeve gastrectomy?
- Good medium term outcomes
- No dumping syndrome
- No small bowel manipulation
- No foreign body
What are the disadvantages of laparoscopic sleeve gastrectomy?
- More invasive surgery
- Long staple line (bleeding/leak)
- Short pedigree
- Mortality 0.4%
What are the possible complications of bariatric surgery?
- Anastomotic leak
- DVT/PE
- Infection
- Malnutrition
- Vitamin and mineral deficiencies
- Hair loss
- Excess skin
