Upper GI Surgery Flashcards
What is the two different cell types for oesophageal cancer
Adenocarcinoma
Squamous cell carcinoma
What cell type of oesophageal cancer affecting the distal oesophagus going to be
Adenocarcinoma
What cell type of oesophageal cancer affecting the proximal and middle third of the oesophagus going to be
Squamous cell carcinoma
What is the patholopgy of gastro-oseophagus reflux
Causes metaplasia to the epithelium
What is the two pathologies ofgastro-oseophagus reflux
Barrets metaplasia
Dysplasia leading to carcinoma
What is the aetiology of squamous cell carcinoma in oesophageal cancer
Smoking
Alcohol
(low social-economic status)
What is the symptoms of oesophageal cancer
Progressive dysphagia - difficulty swallowing
Anorexia and weight loss
Odynophagia - pain when swalloing
Chest pain/heartburn
Haematemesis- vomit in the blood
What is the investigations for oesophageal cancer
Endoscopy
CT contrast
What is the benefit of an endoscopy in oesophageal cancer
Can follow up with a biopsy
Endoscopic ultrasound investigates T/N staging
What is the benefit of CT
Allows staging to occur:
Metastatic staging - PET CT
What happens if oesophageal cancer metastases
Patient deemed unfit
No more staging required
Receives Palliative are
What is the treatment options if oesophageal metastases
Stenting
Palliative radiotherapy
Palliative chemotherapy
What is the treatment options if a patient is deemed fit in oesophageal cancer and metastases hasn’t occurred
Oesophagectomy
+ Chemotherapy
What is the treatment options if you have concerns about resection or patient fitness in oesophageal cancer and metastases hasn’t occurred
Chemo/Radiotherapy
What are the three approaches to Esophagectomy
Ivor Lewis
(esophageal tumor is removed through an abdominal incision and a right thoracotomy)
Trans-hiatal
(dissection from a cervical incision from above and transhiatal approach through an abdominal incision)
Left thoraco-abdominal
What are two conduits in Esophagectomy
Stomach
Colon
How does the procedure of Esophagectomy work
Takes 2 hours,
Removal of oesophagus
stomach/colon is pulled up into the chest and reattached
Why do patients need to be fit to undergo Esophagectomy
As during surgery only lies on one lung for ventilation
What is the symptoms experienced after Esophagectomy
Reflux
Need to eat a small amount go food but often
receive feeding tube
What is gastric cancer usually associated with
H.Pylori
What is the presentation of Gastric cancer
Dyspepsia
Alarm symptoms: Dysphagia GI blood loss weight loss Vomiting Upper abdominal mass
What is the investigations used for Gastric Cancer
Endoscopy
Contrast meal
CT Chest/abdomen
(allows staging)
What is the four kinds of gastric cancer surgerys
Sub total gastrectomy - preserves some of the stomach
Total Gastrectomy and roux en Yreconstruction
Laparoscopic distal gastrorectomy
Open gastrorectomy
What therapy do you receive before gastric surgery in gastric cancer
Chemotherapy
When does a
Total Gastrectomy and roux reconstruction occur
In proximal tumours of gastric cancer
What occurs inTotal Gastrectomy and roux reconstruction
Stomach is fully resected
The oesophagus is reconstructed to join with the jejunum
and duodenal is reconstructed also to join to a later part of the jejunum
What is the symptoms of Gastro-Oesophageal Reflux Disease
Heartburn
Water brash
Cough
What is the risk factors ofGastro-Oesophageal Reflux Disease
Obesity
Smoking
Alcohol
What is the management of Gastro-Oesophageal Reflux Disease
Lifestyle modification
PPI therapy (omeprazole)
Surgery
What is potential aetiology of Gastro-Oesophageal Reflux Disease
A Hiatus hernia
(sliding or paraeoesophageal)
Failed lower oesophageal spinchter
What are the additional symptoms of Gastro-Oesophageal Reflux Disease if caused by a hiatus hernia
Pain
Vomiting
Terrible reflux
What is the investigations for Gastro-Oesophageal Reflux Disease
Endoscopy
Oesophageal pH studies and manometry (pressure evaluation)
What is the surgery undertaken inGastro-Oesophageal Reflux Disease
laparoscopic hiatus hernia repair and (fundoplication)
What is the side effects of fundoplication
In the repair of GORD
Dysphagia
Difficulty to belch and vomit
Gas Bloating
Excess flatulence
Diarrhoea
How does he procedure oflaparoscopic hiatus hernia repair and (fundoplication) work in the repair of hernia and relfux
Tightening the opening in your diaphragm with stitches to keep your stomach from bulging upward through the opening in the muscle wall (fixes hiatus hernia)
Wrap the fundus around the end of your esophagus with stitches to create pressure and prevent reflux
What is Bariatric surgery used to tackle
Obesity
BMI >35
What is the affect of decreasing obesity
Reduces mortaility
and decreases the risk of co-morbidities
What are the three bariattric surgery options
Restrictive
Malabsorption
Combination
How do restrictive bariatric surgeries work in tackling obesity
Decrease the size of the stomach leading to satiety with smaller volumes of food that eventually leads to food intolerance and weight loss
How do malabsorbtive bariatric surgeries work in talking obesity
Bypassing segments of bowel, thereby causing malabsorption of nutrients
How does a combination bariatric surgery work in tackling obesity
Combination of restrictive and malabsoptive
= Roux-en-Y gastric bypass,
What is taken into account with bariatric surgeries
Patients BMI Co-morbidites Diet Safety Personal experience
What is taken into account with Bariatris surgeries
Patients BMI Co-morbidites Diet Safety Personal experience
How does laparoscopic adjustable gastric banding occur
Hollow silicon band is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the larger remainder of the stomach.
The band is then inflated with isotonic fluids.
It can be tightened or loosened over time to change the size of the passage by increasing or decreasing the amount of fluid
What is the advantage of a gastric band
Relatively minor surgery
Reversible and adjustable
Low operative complication rate
Mortality 0.1%
What is the disadvantage of gastric banding
Requires an implanted medical device
Easier to ‘cheat’
Risk of prolapse or slippage
15% will require revisional surgery
How does the procedure of laparscopoc gastric bypass occur
A small stomach pouch is created to restrict food intake.
A Y-shaped section of the small intestine is then attached to the pouch to allow food to bypass the lower stomach, the duodenum and the first portion of the jejunum
- reduces absorbtion of nutrients
What is the advantages to laparoscopic gastric bypass
Quick and dramatic weight loss
reduces calories intake
What is the disadvantages to laparoscopic gastric bypass
More invasive surgery
Malabsorptive component requires lifelong supplements
More complex if requires revision
Mortality 0.5%
Dumping syndrome - evacuate bowels quick
What happens in the procedure of laparoscopic sleeve gastrectomy,
Removal or part of the stomach
decrease in the stomach size inhibits distentson of the stomach
becomes full sooner, thereby increasing the patient’s sensation of fullness and decreasing their appetite
How doeslaparoscopic sleeve gastrectomy reduce obesity
decrease in the stomach size inhibits distentson of the stomach
becomes full sooner, thereby increasing the patient’s sensation of fullness and decreasing their appetite
as well removal decreases the release of ghrelin hormone which decreases the size of your appetite
What is the advantages of laparoscopic sleeve gastrectomy
Good medium term outcomes
No ‘dumping’ syndrome
No small bowel manipulation
No foreign body
What is the disadvantages of laparoscopic sleeve gastrectomy
More invasive surgery
Long staple line (bleeding/leak)
Mortality 0.4%
What is the overall complications of bariatric surgery
Anastomotic leak
DVT/PE
Infection
Malnutrition
Vitamin and mineral deficiencies
Hair loss
Excess Skin
