Upper GI Surgery Flashcards
What conditions are treated with upper GI surgery?
Oesophageal cancer
Gastric cancer
Anti-reflux
Bariatric surgery
Is oesophageal cancer more common in m or F?
M
What is the median age for oesophageal cancer?
65
In Oesophageal cancer where are adenocarcinomas more likely to occur?
Distally
What are the main risk factors for squamous cell carcinoma in the oesophagus?
Smoking
Alcohol
Low socio-economic status
What are the symptoms for oesophageal cancer?
Progressive dysphagia Anorexia and weight loss Odynophagia chest pain/heart bur n Haematemesis
What investigations can diagnose oesophageal cancer?
Endoscopy
Contrast swallowing
What investigations need to be done t stage oesophageal cancer?
CT of Chest and Abdomen
What classification is used to stage oesophageal cancer?
TNM
If metastases are found is any further staging required?
No
What is the treatment for metastasised oesophageal cancer?
Palliative and supportive therapy
What treatment can be given to relieve symptoms present in oesophageal cancer?
Stenting
When is a patient suitable for resection in oesophageal cancer?
If no metastases are found and the cancer is primary
What is the treatment for primary oesophageal cancer?
Oesophagectomy and chemo
What is an oesophagectomy?
Removal of part of the oesophagus
What is inserted after a patient undergoes a oesophagectomy?
feeding tube
Anatomically where does an oesophacetomy require access to?
Above and below the diaphragm
Is gastric cancer more common in M or F?
M
Which bacteria is gastric cancer often associated with?
H.pylori
What is the 5yr survival rate of gastric cancer?
15-20%
What are the symptoms of gastric cancer?
Non-specific often Dyspepsia Dysphagia Evidence of GI blood loss Weight loss Vomiting Upper abdominal mass on examination
What investigations are used to diagnose gastric cancer?
Endoscopy
Contrast meal
What investigations are used to stage gastric cancer?
CT chest and abdo
What treatment is given before gastric cancer surgery is attempted/
Chemotherapy
Why is chemotherapy given before gastric cancer surgery?
To shrink the tumour and catch any micrometastases
What is a subtotal gastrectomy?
Removal of part of the stomach
What is a total gastrectomy?
Removal of the entire stomach
What are the two methods for gastrectomy surgery?
Laparoscopically
Or open surgery
Describe the scar in gastric surgery?
Downwards V
Why is the scar V shaped with gastric surgery?
To stop and overload of pressure of the abdomen wall
What is GORD?
Gastro-oesophageal Reflux Disease
What are the symptoms of GORD?
Heartburn
Water brash
Cough
What are the risk factors for GORD?
Obesity
Smoking
Alcohol
Describe oesophageal pH studies as an investigation
pH of the stomach is recorded
Along with the patient keeping a diary of their daily symptoms
Assessing to see if there is any correlation between the two
What are the classifications of obesity?
Overweight
Obesity I
Obesity II
Obesity III
What is the BMI of someone overweight?
25.0-29.9
What is the BMI of someone with Obesity I?
30.0-34.9
What is the BMI of someone with Obesity II?
35.0-39.9
What is the BMI of someone with Obesity III?
> 40.0
Give examples of conditions that obesity is a risk factor for?
Pulmonary disease Hypertension Cancer Pancreatitis Gout Osteoarthritis Fatty liver disease CHD Stroke Cataracts
What is restrictive bariatric surgery?
When the size of the stomach is decreased
What is malabsorptive bariatric surgery?
When segments of the bowel are bypassed
What is combination bariatric surgery?
A mixture of restrictive and malabsorptive bariatric surgery
What needs to be taken into consideration with bariatric surgery?
Patients choice Safety Surgeons choice Personal Patients BMI and co-morbidities
What are the Pros of restrictive bariatric surgery?
Relatively minor surgery
Reversible and adjustable
Low operative complication rate
Low mortaility
What are the cons of restrictive bariatric surgery?
Required an implanted device
Easier to cheat
Risk of prolapse of slippage of the band
What are the pros of malabsorptive bariatric surgery?
Quick and dramatic weight loss
Pedigree
Dumping syndrome
What are the cons of malabsorptive bariatric surgery?
More invasive
Require lifelong supplements
More complex if require revision
Slight mortality rate
What are the pros of combination bariatric surgery?
Good medium of surgery
No dumping syndrome
No small bowel manipulation
No foreigns body is implanted
What are the cons of combination bariatric surgery?
More invasive
Long staple line
Short pedigree
Small mortality rate
What are the complications of any bariatric surgery?
Anastomotic leak DVT/PE Infection Malnutrition Vitamin and mineral deficiencies Hair loss Excess skin