Upper GI surgery

Question 1

Upper GI surgery can be in order to treat which 4 main things?

Answer 1

oesophageal cancer
gastric cancer
anti-reflux
bariatric surgery

Question 2

oesophageal cancer is more common in people who do what?

Answer 2

smoke
eat little fruit and veg
are overweight
drink alcohol

Question 3

which part of the oesophagus do you tend to find adenocarcinomas

Answer 3

distal part of the oesophagus

Question 4

adenocarcinomas of the oesophagus tend to be linked with what

Answer 4

obesity and gastro-oesophageal reflux

strong link with Barrett’s metaplasia. Dysplasia becomes carcinoma

Question 5

what part of the oesophagus do sqaumous cell carcinomas tend to affect

Answer 5

proximal and middle third

Question 6

what are squamous cell carcinomas often linked with?

Answer 6

smoking
alcohol
low socio-economic status

Question 7

signs/ symptoms of oesophageal cancer (6)

Answer 7

frequent/persistent hiccups

acid indigestion, reflux, heartburn

difficulty when swallowing food

constant burping, belching, coughing

pain between the shoulder blades

weight loss

Question 8

what investigations can be done for oesophageal cancer? (4)

Answer 8

endoscopy
contrast swallow
staging (TNM)
CT Chest / Abdomen

Question 9

if M stage then what are the treatment options?

Answer 9

palliative radiotherapy
palliative chemotherapy
stenting

Question 10

what are the treatment options for someone with a respectable staging of oesophageal cancer?

Answer 10

Oesophagectomy + Chemotherapy

If concerns about fitness but no metastatic disease then Chemo/Radiotherapy

Question 11

what is an oesophagectomy? and what are the 3 main approaches called

Answer 11

removal of part or all of your oesophagus

Ivor Lewis
Trans-hiatal
Left thoraco-abdominal

Question 12

what is the Ivor Lewis approach to oesophagectomy

Answer 12

removal through an abdominal incision and a right thoracotomy

Question 13

what is the Trans-hiatal approach to oesophagectomy

Answer 13

minimally invasive and removes the esophageal tumor through abdominal incision, without thoracotomy, and a left neck incision

Question 14

Left thoraco-abdominal approach to oesophagectomy

Answer 14

used more often for removal or repair of the lower or middle part of the oesophagus

Question 15

what is the morbidity/mortality rate roughly for oesophagectomy

Answer 15

morbidity 20-30%

Mortality 5%

Question 16

ALARMS anogram for stomach cancer presentation

Answer 16

Anemia 
Loss of weight
Anorexia
Recent onset of progressive symptoms
Masses 
Swallowing difficulty

Question 17

Investigations for stomach cancer

Answer 17

endoscopy
contrast meal
staging TNM CT chest / abdomen
staging laparoscopy

Question 18

Gastric cancer surgery options

Answer 18

Subtotal Gastrectomy

total gastrectomy and Roux en Y reconstruction

Question 19

what is Roux en Y reconstruction?

Answer 19

a repair method after a gastrectomy

type of gastric bypass procedure - simple

Question 20

what is a hiatus hernia?

Answer 20

your stomach protudes into your chest

it may prevent the valve at the bottom of the oesophagus from working properly

Question 21

investigations for hiatus hernia

Answer 21

endoscopy

oesophageal pH studies and manometry

Question 22

Side effects of laparoscopic hiatus hernia repair and fundoplication (surgery done if your stomach herniates through the diaphragm and into your chest) (5)

Answer 22

Dysphagia
Difficulty to belch and vomit
Gas Bloating
Excess flatulence
Diarrhoea

Question 23

What is Fundoplication?

Answer 23

An operation to treat gastro-oesophageal reflux disease (GORD). It involves wrapping the top part of your stomach around your lower oesophagus. It helps strengthen the lower esophageal sphincter, to prevent food and acid from going back up.