Upper GI surgery Flashcards
What are the main differences between the types of oesophageal cancer?
Adenocarcinomas:
- Distal oesophagus
- Related to obesity more strongly
- Can be caused by Gastro-oesophageal reflux (barrett’s metaplasia)
Squamous cell carcinomas:
- Proximal & middle third of oesophagus
- Smoking, alcohol are more strongly associated
- Low socioeconomic status
What are the symptoms of oeophageal cancer?
Progressive Dysphagia
Dyspepsia / acid reflux
Frequent hiccups/burping/belching
Weight loss
Pain between shoulder blades
How is oesophageal cancer investigated?
Upper GI endoscopy
Can also do barium contrast swallow study
How is oesophageal cancer staged?
CT chest/abdomen
(if unfit for surgery then discontinue. If fit then do:)
EUS (T/N staging)
PET CT (M staging)
How are patients with oesophageal cancer who are unfit for surgery treated?
Stenting
Palliative radiotherapy
Palliative chemotherapy
If a patient with oesophageal cancer is fit for surgery, how are they treated?
Oesophagectomy + Chemotherapy
- 5 year survival 45%
If a patient has oesophageal cancer which hasnt spread, but there are concerns over their fitness/suitability for surgery; how are they treated?
Chemotherapy + radiotherapy
- 5 year survival ~30%
What are the different approaches to oesophagectomy?
Ivor Lewis
Trans-hiatal
Left thoraco-abdominal
How does an oesophagectomy work?
Cancerous section of oeophagus removed
Stomach pulled up into the chest and then reattached
(Either the stomach or colon can be used as a conduit)
What are the modifiable risk factors for stomach cancer?
H.pylori infection
Smoking
Alcohol
Excess of Salted fish, pickled vegetables and cured meat
What are the ALARMS symptoms for stomach cancer?
Anaemia
Loss of weight
Anorexia
Recent onset of progressive symptoms
Masses & Melaena/Haemotemesis
Swallowing difficulty (dysphagia)
Dyspepsia is the most common symptom
ALARMS or >55 = Upper GI endoscopy
How is gastric cancer investigated and staged?
Upper GI endoscopy
Contrast meal
Staging:
CT chest/abdo and Laparoscopy
What are the types of gastric surgery?
Subtotal gastrectomy
Total Gastrectomy and Roux en Y reconstruction
Is a gastrectomy done as an open procedure or laparoscopically?
Can be both
What is a typical presentation for GORD?
- Reflux obviously
- Heartburn
- Dysphagia / swallowing pain (especially with hot/alcoholic drink)
- Relieved by antacids
What anatomical problem causes GORD?
Hiatus hernia of stomach
What two types of hernias can cause GORD?
Sliding hiatus hernia
Paraoesophageal hiatus hernia
How is GORD investigated?
Endoscopy
Oesophageal ph Studies & Manometry
It is worth noting that the Clinical diagnosis of GORD can be made without investigation (unless there are alarm signs)
What is meant by ‘oesophageal pH studies and Manometry’?
Manometry - measurement of strength of muscle contractions in oesophagus
pH studies - measures acidity of whats coming up
Why is endoscopy used to investigate GORD?
- Can identify hernia
- Assess any oesophagitis
- Can identify Barrett’s oesophagus/metaplasia etc
How is GORD treated?
50% of patients are treated only in primary care (drugs & advice) and dont get surgery
Surgical treatment:
- Laproscopic hiatus hernia repair & fundoplication
What happens in Fundoplication?
- Herniated section of stomach pulled back through the hiatus
- This flappy ass bit of stomach is then wrapped round the oesophagus like a coat
- Flappy bit of stomach is attached to other part of stomach once round the oespohagus
What are side effects of laparoscopic hiatus hernia repair and fundoplication (GORD surgery)?
- Dysphagia
- Difficulty to belch and vomit
- Gas bloating
- Excess flatulence
- Diarrhoea
What are the Overweight groups on the BMI scale?
Overweight: 25.0-29.9
Obesity I: 30.0-34.9
Obesity II: 35.0-39.9
Obesity III: 40.0+ (morbidly obese)
What BMI groups is bariatric surgery indicated for?
Obesity groups II & III
BMI of 35+
50% of patients with GORD dont get surgery, how are they treated?
Antacids
Weight loss
Sleep more upright (extra pillows)
