Upper GI surgery Flashcards by J Murray

what are the two different types of oesophageal cancer

adenocarcinoma

squamous cell carcinoma

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what part of the oesophagus does adenocarcinoma usually occur in

distal oesophagus

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what can are risk factors for adenocarcinoma

obesity

gastro-oesophageal reflux

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what can cause gastro-oesophageal reflux

barrets metaplasia

change of squamous epithelia to columnar
can be precursor to caner

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what part of the oesophagus does SCC usually occur in

proximal and middle third of the oesophagus

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what are risk factors for SCC

smoking
alcohol
low socio-economic status

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how does oesophageal cancer present

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

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what investigations can be done for oesophageal cancer

endoscopy

contrast swallow

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what investigation can be used to stage oesophageal cancer

CT chest/abdomen for TNM staging

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what happens if metastases are found on initial investigations

no further staging

unfit for surgery so palliative/supportive therapy only

palliative chemotherapy
palliative radiotherapy

?stenting

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

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

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

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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how does an oesophagectomy work

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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what are complications of oesphagectomy

chest infections, arrhythmias, leakage from anastomoses

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how does gastric cancer present

non-specific
dyspepsis

alarm features

dysphagia
evidence of GI blood loss
weight loss
vomiting
upper abdominal mass

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what investigations can be done for gastric cancer

endoscopy

contrast meal

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what investigations can be done to stye gastric cancer

CT chest/abdomen

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what are the 2 main surgeries for gastric cancer

subtotal gastrectomy

total gastrectomy and Roux en Y reconstruction

what 2 way can gastric cancer surgeries be performed

laparoscopic distally

open gastrectomy

when would anti-reflux surgery be needed

severe GORD - gastro-oesophgeal reflux disease

what are the symptoms of GORD

heartburn, water brash, cough

5-10% adults experience daily GORD symptoms

what are risk factors for GORD

obesity
smoking
alcohol excess

how can GORD be managed

lifestyle modifications

PPI therapy (proton-pump inhibitors)

surgery

what anatomical change can lead to GORD

hiatus hernia

sliding
paraoesophageal

what investigations can be done for GORD

endoscopy | oesophageal pH studies and manometry

what is the surgery for GORD

laparoscopuc hiatus hernia repair fundoplication

what are the side effects of GORD surgeries

``` Dysphagia Difficulty to belch and vomit Gas Bloating Excess flatulence Diarrhoea ```

what is bariatric surgery

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

what are the three types of bariatric surgery

restrictive malabsorptive combination

what do restrictive surgeries involve

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

what do malabsorptive surgeries involve

consist of bypassing segments of bowel - cause malabsorption of nutrients e.g. the biliopancreatic diversion with or without duodenal switch and ileal interposition

what do combination surgeries involve

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

what needs to be taken into account before bariatric surgery

patients choice - peers - ?celebrities - safety surgeons choice - personal/units experience - patients - BMI/co-morbidity/diet

what is laparoscopic adjustable gastric binding

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

what are the advantages of LAGB

Relatively minor surgery Reversible and adjustable Low operative complication rate Mortality 0.1%

what are the disadvantages of LAGB

Requires an implanted medical device Easier to ‘cheat’ Risk of prolapse or slippage 15% will require revisional surgery

what is a laparoscopic gastric bypass

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

what are the advantages of laparoscopic 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 is laparoscopic sleeve gastrectomy

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

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 complications of bariatric surgery

Anastomotic leak DVT/PE Infection Malnutrition Vitamin and mineral deficiencies Hair loss Excess Skin