Upper GI Surgery

Question 1

What is the prevalence of oesophageal cancer?

Answer 1

-M:F 5:2

Question 2

Where do adenocarcinomas occur in the oesophagus?

Answer 2

Distal oesophagus

Question 3

What risk factors are linked to adenocarcinomas in the oesophagus?

Answer 3

• Obesity
• Gastro-oesophageal reflux
• Barrett’s metaplasia
• Dysplasia

Question 4

Where do squamous cell carcinomas occur in the oesophagus?

Answer 4

Proximal and middle third oesophagus

Question 5

What risk factors are linked to squamous cell carcinomas in the oesophagus?

Answer 5

• Smoking
• Alcohol
• Low socio-economic status

Question 6

How does oesophageal cancer present?

Answer 6

• Progressive dysphagia
• Anorexia and weight loss
• Odynophagia
• Chest pain/heartburn
• Haematemesis

Question 7

What investigations are carried out for oesophageal cancer?

Answer 7

• Endoscopy and biopsy
• Contrast swallow
• CT chest and abdomen

Question 8

What is the staging algorithm for those deemed metastatic or unfit in oesophageal cancer?

Answer 8

• No further staffing required

- Palliative/supportive therapy

Question 9

What is the staging algorithm for those deemed resectable/ fit in oesophageal cancer?

Answer 9

• EUS for T/N staging

- PET CT for M staging

Question 10

What are the treatment options for those deemed metastatic or unfit in oesophageal cancer?

Answer 10

• Stenting
• Palliative radiotherapy
• Palliative chemotherapy

Question 11

What are the treatment options for those deemed resectable/fit in oesophageal cancer?

Answer 11

• Oesophagectomy and chemotherapy

- Chemotherapy and radiotherapy

Question 12

What approaches are there for oeosophagectomy?

Answer 12

• Ivor Lewis
• Trans-hiatal
• Left thoraco-abdominal

Question 13

What can be used as a conduit in an oesophagectomy?

Answer 13

• Stomach

- Colon

Question 14

What takes place in the abdomen during an oesophagectomy?

Answer 14

Gastric mobilisation

Question 15

What takes place in the chest during an oesophagectomy?

Answer 15

-Oesophageal resection and gastro-oesophageal anastomosis

Question 16

What is the prevalence of gastric cancer?

Answer 16

M:F 9:5

Question 17

Where in the world is there a high prevalence of gastric cancer?

Answer 17

East Asia

Question 18

What bacterium is gastric cancer associated with?

Answer 18

Helicobacter Pylori

Question 19

How can gastric cancer present?

Answer 19

• Nonspecific
• Dyspepsia
• Alarm features

Question 20

What are the alarm features of gastric cancer?

Answer 20

• Dysphagia
• Weight loss
• Vomiting
• Upper abdominal mass

Question 21

What should be done if there are alarm features of gastric cancer present?

Answer 21

• Endoscopy

- Contrast meal

Question 22

What investigation is used to stage gastric cancer?

Answer 22

CT chest/abdomen

Question 23

What surgery is there available for gastric cancer?

Answer 23

• Subtotal gastrectomy

- Total gastrectomy and Roux en Y reconstruction

Question 24

GORD

Answer 24

Gastro-oesophageal reflux disease

Question 25

What are the symptoms of GORD?

Answer 25

- Heartburn - Water brush - Cough

Question 26

What are the risk factors for GORD?

Answer 26

- Obesity - Smoking - Alcohol excess

Question 27

How is GORD managed?

Answer 27

- Lifestyle modification - PPI therapy - Surgery

Question 28

What structural abnormality can cause GORD?

Answer 28

Hiatus hernia

Question 29

Give 2 examples of hiatus hernias.

Answer 29

- Sliding hiatus hernia | - Para oesophageal hiatus hernia

Question 30

What investigations should be carried out for GORD?

Answer 30

- Endoscopy | - Oesophageal pH studies and manometry

Question 31

What side effects can occur with laparoscopic hiatus hernia repair and fundoplication?

Answer 31

- Dysphagia - Difficulty to belch and vomit - Gas bloating - Excess flatulence - Diarrhoea

Question 32

When is conventional treatment offered to lower BMI?

Answer 32

BMI 30.0-34.9

Question 33

When should surgery be considered for lowering BMI?

Answer 33

-BMI 35->40

Question 34

Give examples of conditions can obesity put you at risk of developing.

Answer 34

- Idiopathic intracranial hypertension - Stroke - Cataracts - Pulmonary disease - Coronary heart disease - NAFLD - Diabetes - Dyslipidaemia - Hypertension - Severe pancreatitis - Cancer - Phlebitis - Gout - Osteoarthritis - Gynaecological abnormalities - Gall bladder disease

Question 35

Bariatric surgery

Answer 35

Surgical procedures utilised to achieve reduction of excess weight

Question 36

What are the 3 types of bariatric surgeries available?

Answer 36

- Restrictive - Malabsorptive - Combination

Question 37

Restrictive bariatric surgery

Answer 37

Decreases the size of the stomach leading to satiety with smaller volumes of food that eventually leads to food intolerance and weight loss

Question 38

Malabsorptive bariatric surgery

Answer 38

Operations consisting of bypassing bowel which thereby cause malabsorption of nutrients

Question 39

Combination bariatric surgery

Answer 39

Involves aspects of restriction and malabsorption

Question 40

What may influence the patient in bariatric surgery choice?

Answer 40

- Peers - Celebrities - Safety

Question 41

What may influence the surgeon in bariatric surgery decisions?

Answer 41

- Personal/units experience | - Patients BMI/ co-morbidities/ diet

Question 42

What are the advantages of laparoscopic adjustable gastric banding?

Answer 42

- Relatively minor surgery - Reversible and adjustable - Low operative complication rate - Mortality 0.1%

Question 43

What are the disadvantages of laparoscopic adjustable gastric banding?

Answer 43

- Requires an implants medical device - Easier to cheat - Risk of prolapse or slippage - 15% will require revisional surgery

Question 44

What are the advantages of gastric bypass?

Answer 44

- Quick and dramatic weight loss - Pedigree - Dumping syndrome

Question 45

What are the disadvantages of laparoscopic gastric bypass?

Answer 45

- More invasive surgery - Malabsorptive component requires lifelong supplements - More complex if requires revision - Mortality 0.5%

Question 46

What are the advantages of laparoscopic sleeve gastrectomy?

Answer 46

- Good medium term outcomes - No dumping syndrome - No small bowel manipulation - No foreign body

Question 47

What are the disadvantages of laparoscopic sleeve gastrectomy?

Answer 47

- More invasive surgery - Long staple line (bleeding/leak) - Short pedigree - Mortality 0.4%

Question 48

What are the possible complications of bariatric surgery?

Answer 48

- Anastomotic leak - DVT/PE - Infection - Malnutrition - Vitamin and mineral deficiencies - Hair loss - Excess skin