Upper GI Surgery: Base Week 3 material Flashcards
What are benign upper GI surgical conditions? Malignant conditions?
What are ALARM symptoms? (what do they indicate - potential cancer)
Oesophagus: Anatomy:
Important points:
Anatomy of the stomach:
What is gastritis/oesophagitis;
Definintion
Eitology?
NSAIDs
H.pylori
Etoh
Viral causes
Can go on to cause: Reflux:
What is reflux? Definition?
Eitology? Explain
Clinical features?
What can worsen heart burn
Oesophageal symptoms, nonesophageal signs:
What is Barretts oesophagus:
Definition (intestinal metaplasia) - Squamous turnover to intestinal columnar epithelium:
Eitology
Epidemiology? (risk factors)
Pathophysiology:?
Whats the signifcance of barretts oesophagus:
Treatment for barretts?
Picture of example Barretts:
Peptic ulcer disease:
Definition: Explain
Causes? Duodenal vs gastric causes
Peptic ulcer bleed Management pathway management pathway:
Assessment?
Consider what? Meds? Endoscopy
Post endoscopy management:
Peptic ulcer perforation:
How do they present?
What imagings needs to be done? WHat will you see?
Duodenal ulcers tend to bleed posterioly:
What is the operative treatment for peptic ulcer with perforation:
Also need to consider malignancy
Hiatus hernia and reflux:
What are 3 major types:
Most common? MIXED
Hiatus hernia/reflux:
Investigations?
Lifestyle modifications?
Medical treatment?
Image 1: Barium swallow shows hernia
Image 3 big hiatus:
Hiatus hernia:
Mixed hiatus hernia type 3:
Most common indication for surgery
Management of hiatus hernia:
Treatment?
Esophageal perforation:
Borrehave syndrome: Look at CT shows fluid around esophagus and infront of heart
Oesophageal perforation:
Management:
Oesophagogastric cancer: GOJ:
What arethey?
Where are they more prominent?
IMages of eosphageal cancer images:
Bottom images - Gastric tumor
Staging is based on TNM
T Depth
N Number
M Metasis
Gastric cancer:
Epidemiology?
Risk factors? List 4
What are signs of metastatic gastric carcinoma? What is vrichows node?
Lifestyle and envrionmental factors that have contributed to decreases in gastric cancer?
Host related factors for gastric cancer?
Gastric cancer:
Clinical features?
list signs and sympotms?
Ix?
Management:
1) Staging
2) neoadjuvant chemo
3) Surgery
Adjuvant
Rxt
Immunomodulators - on the rise
Surgery for gastric cancer:
Roun en y
Jejunal interposition
Gastric partial sleeve
Oesophageal cancer:
Epidemiology?
Where are is the highest rate of esopohageal cancer? (lower)
Risk factors?
Clinical features? List 6:
Oesophageal cancer:
Investigations????
What metastatic work up needs to be done? what does this include? List
Treatement? SCC (radiosensitive) Adenocarcinoma
GOJ adenocarcinoma: Seiwert classification:
Defines where the cancer is in relation EGJ!
Type 2 very difficult
What is a GIST tumor?
Explain?
GIST
Epidemiology:
Risk factors?
Clinical features?
GIST: Investigations?
Treatment options? Localized? Advanced?
Bariatric and metabolic surgery:
What can it improve?? Quality of life? Improved quality of life? reduced medications?
Indications: Criteria;
Must have failed medical treatment for weight loss
Obesity related co-morbidites (priorites)
What is a sleeve gastrectomy:
What are complications of it? LEAK! (what else) Reflux? Revision surgery?
What is a Roux en Y gastric bypasss:?
What are complications of this procedure?
What is a duodenal switch:?
What are complications? Malnutrition, lifeslong supplementation, frequent bowel motions, highest mortality.
Complications: Rate of risk of complications:
- Leak
- anastomotic stricture
- Dehydration
- Haemorrhage?
- Bowel obstruction
- Dysphagia
NG tube:
Indications?
Contraindications?
INsertion?
Outline steps of NG insertion:
Upper GI emergencies:
What to do for the following:
What is dumping syndrome? Early phase, late phase:
Explain:
Dumping syndrome occurs when food, especially sugar, moves too quickly from the stomach to the duodenum—the first part of the small intestine—in the upper gastrointestinal (GI) tract. This condition is also called rapid gastric emptying.[1] It is mostly associated with conditions following gastric or esophageal surgery, though it can also arise secondary to diabetes or to the use of certain medications; it is caused by an absent or insufficiently functioning pyloric sphincter, the valve between the stomach and the duodenum.[2]
Dumping syndrome has two forms, based on when symptoms occur. Early dumping syndrome occurs 10 to 30 minutes after a meal. It results from rapid movement of fluid into the intestine following a sudden addition of a large amount of food from the stomach.[1] The small intestine expands rapidly due to the presence of hypertonic/hyperosmolar contents from the stomach, especially sweet foods. This causes symptoms due to the shift of fluid into the intestinal lumen, with plasma volume contraction and acute intestinal distention.[3] Osmotic diarrhea, distension of the small bowel leading to crampy abdominal pain, and reduced blood volume can result.
Late dumping syndrome occurs 2 to 3 hours after a meal. It results from excessive movement of sugar into the intestine, which raises the body’s blood glucose level and causes the pancreas to increase its release of the hormone insulin. The increased release of insulin causes a rapid drop in blood glucose levels, a condition known as alimentary hypoglycemia, or low blood sugar
