Upper GI Surgery Flashcards by Annie Caldwell

5 year survival of Oesophageal cancer

10%

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Two types of oesophageal cancer

Adenocarcinoma

Squamous cell carcinoma

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Where does adenocarcinomas affect on the oesophagus?

Distal

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Risk factors for adenocarcinoma of oesophagus

Obesity
GORD
- barretts

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Where does SCC of oesophagus affect it?

Proximal and middle 1/3rds

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Risk factors for SCC of oesophagus

Smoking
Alcohol
Low socio economic status

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Presentation of oesophageal cancer

Progressive dysphagia
Anorexia and weight loss
Odynophagia
Chest pain 
Heartburn 
Haematemesis

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Investigations for oesophageal cancer

Endoscopy

Contrast swallow

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Treatment for unfit patients with oesophageal cancer

Stenting
Palliative radiotherapy
Palliative chemotherapy

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Treatment for oesophageal cancer

Surgery

Chemoradiotherapy

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5 year survival rate after Oesophagectomy and chemotherapy

30%

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Morbidity of Oesophagectomy

40%

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Complications of Oesophagectomy

Chest infections
Wound infections
Arrythmias
Anastomotic leaks

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Approaches for oesophagectomy

Ivor lewis
Trans hiatal
Left thoraco abdominal

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What can be used for conduits in Oesophagectomy?

Stomach

Colon

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What is usually given after a Oesophagectomy? What does this do?

Jejenostomy

Goes straight into small intestine - plug into it at night and it gives them the nutrition that they need

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5 year survival rate of gastric cancer

15 - 20%

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Where is there a high prevalence of gastric cancer?

East asia (Japan)

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What is the big association of gastric cancer?

H pylori

Presentation of gastric cancer

Non specific
Dyspepsia 
Dysphagia
Evidence of GI blood loss 
Weight loss
Vomiting
Upper abdominal mass

Investigations for gastric cancer

Endoscopy

Contrast meal

Types of gastric cancer surgery

Subtotal gastrectomy

Total gastrectomy and Roux en Y construction

What is usually given before operation for gastric cancer? Why?

Chemotherapy

To get rid of microscopic disease, to shrink the cancer and to improve survival

What is the only curative option for gastric cancer?

Surgery

What would need be done in treatment of distal vs proximal gastric cancers?

Proximal cancers - have to take out whole stomach | Distal cancers - may be able to preserve some of the stomach

Symptoms of GORD

Heartburn Water brash Cough

Risk factors for GORD

Obesity Smoking Alcohol excess Pregnancy

What % of adults experience daily GORD symptoms?

5 - 10%

Treatment of GORD

Lifestyle modification PPI therapy Surgery

What anatomical condition can cause GORD?

Hiatus hernia

Investigations for GORD

Endoscopy | Oesophageal pH studies and manometry

Side effects of laparascopic hiatus hernia repair and fundoplication

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

What BMI do you need to be to be eligible for obesity surgery?

> 35

Types of bariatric surgery

Restrictive Malabsorption Combination

How does restrictive bariatric surgery work?

Decreases the size of the stomach (by gastric band, stapling or sleeve gastrectomy) leading to satiety with smaller volumes of food that eventually leads to food intolerance and weight loss

How does malabsorptive bariatric surgery work?

Operations consist of bypassing segments of the bowel, which therapy cause malabsorption of nutrients

How does combination bariatric surgery work?

Involves both aspects of restriction and malabsorption such as roux en Y gastric bypass

What is considered as the gold standard bariatric operation?

Combination

Definition of bariatric surgery

All surgical procedures utilised to achieve reduction of excess weight

Features of laparoscopic adjustable gastric banding

``` Relatively minor surgery Reversible and adjustable Low op complication rate Requires an implanted medical device Easier to cheat Risk of prolapse or slippage 15% require revisional surgery ```

Features of laparoscopic gastric bypass

Quick and dramatic weight loss Pedigree Dumping syndrome (rapid gastric emptying) More invasive surgery Malabsorptive component requires lifelong supplements Mortality 0.5%

How does laparoscopic gastric bypass work?

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

Features of a laparoscopic sleeve gastrectomy

``` Good medium term outcomes No dumping syndrome No small bowel manipulation No foreign body More invasive surgery Long staple line - bleeding - leak Short pedigree Mortality 0.4% ```

How does a sleeve gastrectomy work?

Partial gastrectomy that results in removal of most of the stomach, with the remainder resembling a banana or half moon Results in a decrease in stomach size and inhibits distention of the stomach so that it becomes full sooner, thereby increasing the patients sensation of fullness and decreasing their apetite

Complications of Bariatric surgery

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