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Gastrointestinal Pathology > Upper GI Surgery > Flashcards

Upper GI Surgery Flashcards

1
Q

5 year survival of Oesophageal cancer

A

10%

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2
Q

Two types of oesophageal cancer

A

Adenocarcinoma

Squamous cell carcinoma

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3
Q

Where does adenocarcinomas affect on the oesophagus?

A

Distal

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4
Q

Risk factors for adenocarcinoma of oesophagus

A

Obesity
GORD
- barretts

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5
Q

Where does SCC of oesophagus affect it?

A

Proximal and middle 1/3rds

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6
Q

Risk factors for SCC of oesophagus

A

Smoking
Alcohol
Low socio economic status

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7
Q

Presentation of oesophageal cancer

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

Investigations for oesophageal cancer

A

Endoscopy

Contrast swallow

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9
Q

Treatment for unfit patients with oesophageal cancer

A

Stenting
Palliative radiotherapy
Palliative chemotherapy

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10
Q

Treatment for oesophageal cancer

A

Surgery

Chemoradiotherapy

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11
Q

5 year survival rate after Oesophagectomy and chemotherapy

A

30%

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12
Q

Morbidity of Oesophagectomy

A

40%

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13
Q

Complications of Oesophagectomy

A

Chest infections
Wound infections
Arrythmias
Anastomotic leaks

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14
Q

Approaches for oesophagectomy

A

Ivor lewis
Trans hiatal
Left thoraco abdominal

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15
Q

What can be used for conduits in Oesophagectomy?

A

Stomach

Colon

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16
Q

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

A

Jejenostomy

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

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17
Q

5 year survival rate of gastric cancer

A

15 - 20%

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18
Q

Where is there a high prevalence of gastric cancer?

A

East asia (Japan)

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19
Q

What is the big association of gastric cancer?

A

H pylori

20
Q

Presentation of gastric cancer

A 
Non specific
Dyspepsia 
Dysphagia
Evidence of GI blood loss 
Weight loss
Vomiting
Upper abdominal mass
21
Q

Investigations for gastric cancer

A

Endoscopy

Contrast meal

22
Q

Types of gastric cancer surgery

A

Subtotal gastrectomy

Total gastrectomy and Roux en Y construction

23
Q

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

A

Chemotherapy

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

24
Q

What is the only curative option for gastric cancer?

A

Surgery

25
Q

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

A

Proximal cancers - have to take out whole stomach

Distal cancers - may be able to preserve some of the stomach

26
Q

Symptoms of GORD

A

Heartburn
Water brash
Cough

27
Q

Risk factors for GORD

A

Obesity
Smoking
Alcohol excess
Pregnancy

28
Q

What % of adults experience daily GORD symptoms?

A

5 - 10%

29
Q

Treatment of GORD

A

Lifestyle modification
PPI therapy
Surgery

30
Q

What anatomical condition can cause GORD?

A

Hiatus hernia

31
Q

Investigations for GORD

A

Endoscopy

Oesophageal pH studies and manometry

32
Q

Side effects of laparascopic hiatus hernia repair and fundoplication

A 
Dysphagia 
Difficulty to belch and vomit
Gas bloating
Excess flatulence
Diarrhoea
33
Q

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

A

> 35

34
Q

Types of bariatric surgery

A

Restrictive
Malabsorption
Combination

35
Q

How does restrictive bariatric surgery work?

A

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

36
Q

How does malabsorptive bariatric surgery work?

A

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

37
Q

How does combination bariatric surgery work?

A

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

38
Q

What is considered as the gold standard bariatric operation?

A

Combination

39
Q

Definition of bariatric surgery

A

All surgical procedures utilised to achieve reduction of excess weight

40
Q

Features of laparoscopic adjustable gastric banding

A 
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
41
Q

Features of laparoscopic gastric bypass

A

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

42
Q

How does laparoscopic gastric bypass work?

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 and the first portion of the jejunum
This bypass reduces the absorption of nutrients and thereby reduces calorie intake

43
Q

Features of a laparoscopic sleeve gastrectomy

A 
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%
44
Q

How does a sleeve gastrectomy work?

A

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

45
Q

Complications of Bariatric surgery

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

Gastrointestinal Pathology (26 decks)

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