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Upper GI surgery Flashcards

1
Q

what are the two different types of oesophageal cancer

A

adenocarcinoma

squamous cell carcinoma

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2
Q

what part of the oesophagus does adenocarcinoma usually occur in

A

distal oesophagus

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3
Q

what can are risk factors for adenocarcinoma

A

obesity

gastro-oesophageal reflux

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4
Q

what can cause gastro-oesophageal reflux

A

barrets metaplasia

  • change of squamous epithelia to columnar
  • can be precursor to caner
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5
Q

what part of the oesophagus does SCC usually occur in

A

proximal and middle third of the oesophagus

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6
Q

what are risk factors for SCC

A

smoking
alcohol
low socio-economic status

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7
Q

how does oesophageal cancer present

A 
Progressive dysphagia
Anorexia and weight loss
Odynophagia
Chest pain/heartburn
Haematemesis
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8
Q

what investigations can be done for oesophageal cancer

A

endoscopy

contrast swallow

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9
Q

what investigation can be used to stage oesophageal cancer

A

CT chest/abdomen for TNM staging

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10
Q

what happens if metastases are found on initial investigations

A

no further staging

unfit for surgery so palliative/supportive therapy only

  • palliative chemotherapy
  • palliative radiotherapy

?stenting

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11
Q

what happens if no metastases are found on initial investigations and it is found to be resectable

A

further staging required:
endoscopic US - T/N stage
PET CT - M stage

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12
Q

what are the treatment options if there is a resectable non-met oesophageal cancer

A

Oesophagectomy + Chemotherapy
5 year survival approx 30%

*Concerns about resection/fitness and no metastatic disease =
Chemo/Radiotherapy
5 year survival approx 20%

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13
Q

how does an oesophagectomy work

A

part of oesophagus that includes cancer (as well as good margins on either side) removed

stomach pulled up into the chest and reattached to what is left of the oesophagus

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14
Q

what are complications of oesphagectomy

A

chest infections, arrhythmias, leakage from anastomoses

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15
Q

how does gastric cancer present

A

non-specific
dyspepsis

alarm features

  • dysphagia
  • evidence of GI blood loss
  • weight loss
  • vomiting
  • upper abdominal mass
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16
Q

what investigations can be done for gastric cancer

A

endoscopy

contrast meal

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17
Q

what investigations can be done to stye gastric cancer

A

CT chest/abdomen

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18
Q

what are the 2 main surgeries for gastric cancer

A

subtotal gastrectomy

total gastrectomy and Roux en Y reconstruction

19
Q

what 2 way can gastric cancer surgeries be performed

A

laparoscopic distally

open gastrectomy

20
Q

when would anti-reflux surgery be needed

A

severe GORD - gastro-oesophgeal reflux disease

21
Q

what are the symptoms of GORD

A

heartburn, water brash, cough

5-10% adults experience daily GORD symptoms

22
Q

what are risk factors for GORD

A

obesity
smoking
alcohol excess

23
Q

how can GORD be managed

A

lifestyle modifications

PPI therapy (proton-pump inhibitors)

surgery

24
Q

what anatomical change can lead to GORD

A

hiatus hernia

  • sliding
  • paraoesophageal
25
Q

what investigations can be done for GORD

A

endoscopy

oesophageal pH studies and manometry

26
Q

what is the surgery for GORD

A

laparoscopuc hiatus hernia repair

fundoplication

27
Q

what are the side effects of GORD surgeries

A 
Dysphagia
Difficulty to belch and vomit
Gas Bloating
Excess flatulence
Diarrhoea
28
Q

what is bariatric surgery

A

weight loss surgery - include a number of different procedures - performed on people who are obese and in critical condition because of it

29
Q

what are the three types of bariatric surgery

A

restrictive
malabsorptive
combination

30
Q

what do restrictive surgeries involve

A

decrease the size of the stomach either by:

  • a synthetic gastric band
  • stapling
  • size reduction by “sleeve gastrectomy”

leads to satiety with smaller volumes of food - eventually leads to food intolerance and weight loss

31
Q

what do malabsorptive surgeries involve

A

consist of bypassing segments of bowel - cause malabsorption of nutrients

e.g. the biliopancreatic diversion with or without duodenal switch and ileal interposition

32
Q

what do combination surgeries involve

A

involve both aspects of restriction and malabsorption such as the Roux-en-Y gastric bypass, which is considered as the “gold standard” bariatric operation

33
Q

what needs to be taken into account before bariatric surgery

A

patients choice

  • peers
  • ?celebrities
  • safety

surgeons choice

  • personal/units experience
  • patients - BMI/co-morbidity/diet
34
Q

what is laparoscopic adjustable gastric binding

A

a hollow silicon band is placed around the stomach near its upper end
- creates 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

35
Q

what are the advantages of LAGB

A

Relatively minor surgery

Reversible and adjustable

Low operative complication rate

Mortality 0.1%

36
Q

what are the disadvantages of LAGB

A

Requires an implanted medical device

Easier to ‘cheat’

Risk of prolapse or slippage

15% will require revisional surgery

37
Q

what is a laparoscopic gastric bypass

A

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 (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine)

This bypass reduces the absorption of nutrients and thereby reduces calorie intake

38
Q

what are the advantages of laparoscopic gastric bypass

A

Quick and dramatic weight loss

Pedigree

Dumping syndrome

39
Q

what are the disadvantages of laparoscopic gastric bypass

A

More invasive surgery

Malabsorptive component requires lifelong supplements

More complex if requires revision

Mortality 0.5%

40
Q

what is laparoscopic sleeve gastrectomy

A

a partial gastrectomy that results in removal of most of the stomach, with the remainder resembling a “banana” or “half moon.”

The mechanism of action of this procedure is that the resulting decrease in the stomach size inhibits distentson of the stomach so that it becomes full sooner, thereby increasing the patient’s sensation of fullness and decreasing their appetite

41
Q

what are the advantages of laparoscopic sleeve gastrectomy

A

Good medium term outcomes

No ‘dumping’ syndrome

No small bowel manipulation

No foreign body

42
Q

what are the disadvantages of laparoscopic sleeve gastrectomy

A

More invasive surgery

Long staple line (bleeding/leak)

Short pedigree

Mortality 0.4%

43
Q

what are the complications of bariatric surgery

A

Anastomotic leak
DVT/PE
Infection

Malnutrition
Vitamin and mineral deficiencies

Hair loss
Excess Skin

GI (25 decks)

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