Upper GI Surgery Flashcards by Sarah Anderson

What is the two different cell types for oesophageal cancer

Adenocarcinoma

Squamous cell carcinoma

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What cell type of oesophageal cancer affecting the distal oesophagus going to be

Adenocarcinoma

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What cell type of oesophageal cancer affecting the proximal and middle third of the oesophagus going to be

Squamous cell carcinoma

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What is the patholopgy of gastro-oseophagus reflux

Causes metaplasia to the epithelium

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What is the two pathologies ofgastro-oseophagus reflux

Barrets metaplasia

Dysplasia leading to carcinoma

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What is the aetiology of squamous cell carcinoma in oesophageal cancer

Smoking
Alcohol
(low social-economic status)

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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

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What is the investigations for oesophageal cancer

Endoscopy

CT contrast

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What is the benefit of an endoscopy in oesophageal cancer

Can follow up with a biopsy

Endoscopic ultrasound investigates T/N staging

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What is the benefit of CT

Allows staging to occur:

Metastatic staging - PET CT

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What happens if oesophageal cancer metastases

Patient deemed unfit

No more staging required

Receives Palliative are

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What is the treatment options if oesophageal metastases

Stenting

Palliative radiotherapy

Palliative chemotherapy

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What is the treatment options if a patient is deemed fit in oesophageal cancer and metastases hasn’t occurred

Oesophagectomy

+ Chemotherapy

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What is the treatment options if you have concerns about resection or patient fitness in oesophageal cancer and metastases hasn’t occurred

Chemo/Radiotherapy

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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

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What are two conduits in Esophagectomy

Stomach

Colon

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How does the procedure of Esophagectomy work

Takes 2 hours,

Removal of oesophagus
stomach/colon is pulled up into the chest and reattached

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Why do patients need to be fit to undergo Esophagectomy

As during surgery only lies on one lung for ventilation

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What is the symptoms experienced after Esophagectomy

Reflux

Need to eat a small amount go food but often
receive feeding tube

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What is gastric cancer usually associated with

H.Pylori

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What is the presentation of Gastric cancer

Dyspepsia

Alarm symptoms:
Dysphagia 
GI blood loss
weight loss 
Vomiting 
Upper abdominal mass

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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