Upper GI surgery Flashcards
Upper GI surgery can be in order to treat which 4 main things?
oesophageal cancer
gastric cancer
anti-reflux
bariatric surgery
oesophageal cancer is more common in people who do what?
smoke
eat little fruit and veg
are overweight
drink alcohol
which part of the oesophagus do you tend to find adenocarcinomas
distal part of the oesophagus
adenocarcinomas of the oesophagus tend to be linked with what
obesity and gastro-oesophageal reflux
strong link with Barrett’s metaplasia. Dysplasia becomes carcinoma
what part of the oesophagus do sqaumous cell carcinomas tend to affect
proximal and middle third
what are squamous cell carcinomas often linked with?
smoking
alcohol
low socio-economic status
signs/ symptoms of oesophageal cancer (6)
frequent/persistent hiccups
acid indigestion, reflux, heartburn
difficulty when swallowing food
constant burping, belching, coughing
pain between the shoulder blades
weight loss
what investigations can be done for oesophageal cancer? (4)
endoscopy
contrast swallow
staging (TNM)
CT Chest / Abdomen
if M stage then what are the treatment options?
palliative radiotherapy
palliative chemotherapy
stenting
what are the treatment options for someone with a respectable staging of oesophageal cancer?
Oesophagectomy + Chemotherapy
If concerns about fitness but no metastatic disease then Chemo/Radiotherapy
what is an oesophagectomy? and what are the 3 main approaches called
removal of part or all of your oesophagus
Ivor Lewis
Trans-hiatal
Left thoraco-abdominal
what is the Ivor Lewis approach to oesophagectomy
removal through an abdominal incision and a right thoracotomy
what is the Trans-hiatal approach to oesophagectomy
minimally invasive and removes the esophageal tumor through abdominal incision, without thoracotomy, and a left neck incision
Left thoraco-abdominal approach to oesophagectomy
used more often for removal or repair of the lower or middle part of the oesophagus
what is the morbidity/mortality rate roughly for oesophagectomy
morbidity 20-30%
Mortality 5%
ALARMS anogram for stomach cancer presentation
Anemia Loss of weight Anorexia Recent onset of progressive symptoms Masses Swallowing difficulty
Investigations for stomach cancer
endoscopy
contrast meal
staging TNM CT chest / abdomen
staging laparoscopy
Gastric cancer surgery options
Subtotal Gastrectomy
total gastrectomy and Roux en Y reconstruction
what is Roux en Y reconstruction?
a repair method after a gastrectomy
type of gastric bypass procedure - simple
what is a hiatus hernia?
your stomach protudes into your chest
it may prevent the valve at the bottom of the oesophagus from working properly
investigations for hiatus hernia
endoscopy
oesophageal pH studies and manometry
Side effects of laparoscopic hiatus hernia repair and fundoplication (surgery done if your stomach herniates through the diaphragm and into your chest) (5)
Dysphagia Difficulty to belch and vomit Gas Bloating Excess flatulence Diarrhoea
What is Fundoplication?
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.
