Upper GI Surgery Flashcards
What are the types of oesophageal cancer and their key differences?
Adenocarcinoma
- Distal
- Related to obesity
- Can be caused by Gi reflux -> Barrett’s metaplsia -> Dysplasia -> Cancer
Squamous cell:
- Proximal/middle
- Related to smoking & alcohol
- And a low socio-economic status
How does oesophageal cancer present?
PROGRESSIVE DYSPHAGIA Anorexia/weight loss Odynophagia Chest pain/heartburn Haematemesis
How do we investigate suspected oesophageal cancer?
Upper GI Endoscopy
Can also do a barium swallow
Whats worse about a barium swallow?
Doesnt ive you an opportunity to biopsy or identify what is causing the stricture, just see where it is/that it exists
Investigations used to stage esophageal cancers
Chest & abdo CT
If unfit for surgery stop staging as theres no point
If resectable you can continue with EUS & PET CT
How do we treat oesophageal cancer?
If its metastatic or they’re unfit for surgery:
- Stenting
- Palliative radiotherapy/chemo
If its resectable:
- Oesophagectomy & chemo
- Chemo adjuvantly & neo-adjuvantly
How does an oesophactomy work?
Cut out part or all of the oesophagus and pull the stomach into the chest then reattach.
You can also use part of the colon as a transplant.
What are the effects of an oesophagectomy on the patient?
Very radical so:
- Mortality is up to 10%
- Takes up to 10 months to return to pre-op QOL
- Often have to adjust to eating small amounts often to prevent reflux
- Must have a feeding jejunostomy for the first few months
What is gastric cancer most associated with?
Heliobacter Pylori infection?
How does gastric cancer present?
Mostly non-specific symptoms:
- Dyspepsia most common
Alarm features:
- Dysphagia
- Evidence of GI blood loss (melaena etc)
- Weight loss
- Vomiting
- Upper abdominal mass
How do investigate/stage a suspected gastric cancer ?
Endoscopy
Contrast meal
Stage with a chest/abdo CT and laparoscopy
How do we treat gastric cancer ?
Subtotal or total gastrectomy (if total use a roux en Y reconstruction)
Can be laparascopic or open
What is roux en Y reconstruction?
Cut gastropeosophageal junction and duodenum/jejunum junction.
Anastomose the oesophagus to jejunum and duodenum to jejunum.
This way food bypasses stomach and duodenum but bile/gastric juice still gets in
How does GORD present?
Heartburn
Waterbrash
Cough
What are the risk factors for GORD?
Obesity
Alcohol
Smoking