Upper GI Surgery Flashcards
Where does adenocarcinoma and squamous cell carcinoma occur in the oesophagus?
Adenocarcinoma: Distal oesophagus
Squamous cell carcinoma: Proximal and middle third oesophagus
What are the aetiologies of adenocarcinoma?
- Obesity
- Gastro-oesophageal reflux
–Barrett’s metaplasia
–Dysplasia -> Carcinoma
What are the aetiologies for squamous cell carcinoma?
- Smoking
- Alcohol
- Low socio-economic status
What is the presentation of oesophageal cancer?
- Progressive dysphagia
- Anorexia and weight loss
- Odynophagia
- Chest pain/heartburn
- Haematemesis
What are the investigations for oesophageal cancer?
Endoscopy and contrast swallow
Where are the common metastatic sites for the oesphagus?
Liver and lung
What imaging technique is used to determine the T/N stage of osophageal cancer?
EUS
What imaging technique is best for oesphagus mets?
PET CT
What palliative options are available for oesophagus options are availavle for metastatic/unfit?
- Stenting
- Palliative radiotherapy
- Palliative chemotherapy
What are the treatment options for resectable oesophageal carcinoma?
•Oesophagectomy + Chemotherapy
–5 year survival approx 30%
•Concerns about resection/fitness and no metastatic disease
–Chemo/Radiotherapy
–5 year survival approx 20%
What are the possible conduits for oesphagectomy?
Stomach and colon
What are the main risks associated with oespohagectomy?
40% morbidity rate (chest infections, wound infections, heart arrhythmias leaks)
Mortality rate is 5-10%
Return to pre-op quality of life is 10 months
What is the presentation for gastric cancer?
- Nonspecific
- Dyspepsia
- Alarm features
–Dysphagia
–Evidence of GI blood loss
–Weight loss
–Vomiting
–Upper abdominal mass
What are the investigations for gastric cancer?
Endoscopy and contrast meal
What is the staging modality for gastric cancer?
CT Chest / abdomen
What are the forms of gastric cancer surgery?
Subtotal gastrectomy and Total Gastrectomy and Roux en Y reconstruction
What are the two forms of performing gastrectomy?
Palarascopic and open
What are risk factors for GORD?
–Obesity, smoking, alcohol excess
What is management for Anti-Reflux surgery?
–Lifestyle modification, PPI therapy
–Surgery
What are the investigations regarding GORD?
Endoscopy and Oesophageal pH Studies and Manometry
Manometry is to get a definitive measure of the severity of the GORD. Patients tolerate GORD differently
What are the side effects of laparoscopic hiatus hernia repair and fundoplication
Fuindoplication: a surgical procedure in which the upper portion of the stomach is wrapped around the lower end of the esophagus and sutured in place as a treatment for the reflux of stomach contents into the esophagus
- Dysphagia
- Difficulty to belch and vomit
- Gas Bloating
- Excess flatulence
- Diarrhoea
What are the health consequences associated with obesity?
Stroke
Hypertension
Cataracts
Coronary heart disease
Diabetes
Severe pancreatitis
Cancer
NAFLD
What does the term bariatric surgery mean?
Refers to all surgical procedures utilised to achieve reduction of excess weight
What is meant by restrictive options for bariatric surgery?
•Restrictive operations decrease the size of the stomach (either by a synthetic gastric band, stapling or size reduction by “sleeve gastrectomy”), leading to satiety with smaller volumes of food that eventually leads to food intolerance and weight loss
What are malabsorptive bariatric surgery options?
Malabsorptive operations consist of bypassing segments of bowel, which thereby cause malabsorption of nutrients (such as the biliopancreatic diversion with or without duodenal switch and ileal interposition)
In a BPD Biliopancreatic diversion procedure, portions of the stomach are removed. The small pouch that remains is connected directly to the final segment of the small intestine, completely bypassing the upper part of the small intestines. A common channel remains in which bile and pancreatic digestive juices mix prior to entering the colon. Weight loss occurs since most of the calories and nutrients are routed into the colon where they are not absorbed.
What are the combinatino bariatric surgery options?
Involves both aspects of restriction and malabsorption such as the roux - en - Y gastric bypass, considered the gold standard
What is laparascopic adjustable gastric banding?
In a BPD procedure, portions of the stomach are removed. The small pouch that remains is connected directly to the final segment of the small intestine, completely bypassing the upper part of the small intestines. A common channel remains in which bile and pancreatic digestive juices mix prior to entering the colon. Weight loss occurs since most of the calories and nutrients are routed into the colon where they are not absorbed.
What are the advantages and disadvantages of laparascopic adjustable gastric banding?
Advantages:
- Relatively minor surgery
- Reversible and adjustable
- Low operative complication rate
- Mortality 0.1%
Disadvantages:
- Requires an implanted medical device
- Easier to ‘cheat’
- Risk of prolapse or slippage
- 15% will require revisional surgery
What is a laparascopic gastric bypass?
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.
Reduces the absorption of nutrients and therefore reduces calorie intake
What are the advantages and disadvantages of laparascopic gastric bypass?
•Advantages:
–Quick and dramatic weight loss
–Pedigree
–Dumping syndrome
•Disadvantages:
–More invasive surgery
–Malabsorptive component requires lifelong supplements
–More complex if requires revision
–Mortality 0.5%
What is laparascopic sleeve gastrectomy?
Sleeve gastrectomy is a partial gastrectomy that results in removal of most of the stomach, with the remainder resembling a “banana” or “half moon.” The other names for this procedure are “partial gastrectomy,“ “sleeve gastrectomy,” “longitudinal gastrectomy“ and “vertical gastrectomy
Decreases stomach size - inhibits distension of the stomach so that it becomes fuller sooner, increasing patients sensation of fullness and decreasing appetite
What are the advantages and disadvantages of laparascopic sleeve gastrectomy?
•Advantages:
–Good medium term outcomes
–No ‘dumping’ syndrome
–No small bowel manipulation
–No foreign body
•Disadvantages:
–More invasive surgery
–Long staple line (bleeding/leak)
–Short pedigree
–Mortality 0.4%
Define dumping syndrome
A group of symptoms, including weakness, abdominal discomfort, and sometimes abnormally rapid bowel evacuation, occurring after meals in some patients who have undergone gastric surgery.
Happens in laparascopic gstric bypass, but not in laparascopic sleeve gastrectomy
What are the complications with bariatric surgery?
- Anastomotic leak
- DVT/PE
- Infection
- Malnutrition
- Vitamin and mineral deficiencies
- Hair loss
- Excess Skin
