MEDI CAL ST UDENT UPPE R GI
S URG ERY
KNOWLEDGE FOR FINALS
,Final Year Surgery
Upper GI Surgery
Symptoms of GI disease
Distension: Causes are the 5 F’s
1. Fat
2. Flatus
3. Faeces
4. Foetus
5. Fluid
Ascites: causes include
1. Malignancy
2. Pancreatitis
3. infections (TB)
4. CCF
5. cirrhosis with portal hypertension
6. Budd-chiari syndrome (hepatic venous outflow obstruction causing abdominal
pain, hepatomegaly and ascites as a classic triad)
Splenomegaly: The normal working spleen breaks down old blood cells and stores
platelets and white blood cells. Also stored monocytes and lymphocytes and a
reserve of blood in case of hypovolemia etc.
Boerhaave’s syndrome
Oesophageal rupture, often due to iatrogenic causes post-op or forceful vomiting.
The classic presentation is retching and vomiting followed by severe retrosternal
chest pain, odynophagia, dyspnoea, cyanosis, fever and shock. Subcutaneous
emphysema and pleural effusion can also be present
Rupture of an organ (spleen, aorta, ectopic pregnancy)
The rupture of an organ can cause peritonitis due to peritoneal irritation. This is
because perforation of an organ releases fluid from within that organ, that is often
irritant to the peritoneum.
Symptoms:
Prostration (not wanting to move), percussion tenderness and rebound tenderness,
guarding and rigidity, positive cough response.
, Final Year Surgery
This is different from the symptoms of colic, which is a waxing and waning pain due
to intermittent contraction of a hollow viscus i.e. in cholecystitis. In this situation, the
patient will be restless and constantly wanting to move.
Beware of hidden diagnoses: mesenteric ischemia, ruptured AAA and acute
pancreatitis (may have mild signs but severe symptoms so make sure to think of
them)
Carcinoma of the oesophagus and dysphagia
Usually Squamous cell carcinoma or adenocarcinoma
Risk factors: low SEC, smoking, alcohol, hot drink consumption, chronic
GORD, Barrett’s and obesity
Superior third of the oesophagus is striated muscle
Middle third of the oesophagus is striated muscle and smooth muscle
Lower third of the oesophagus is smooth muscle only
Presentation
Dysphagia and odynophagia
Weight loss
Chest pain
Hoarseness
Cough
Survival is poor with or without treatment
Investigations
Oesophagastroduodenoscopy (OGD)
Comprehensive metabolic profile
CT thorax and abdomen
Treatment
Endoscopic resection and surveillance
Oesophagectomy
S URG ERY
KNOWLEDGE FOR FINALS
,Final Year Surgery
Upper GI Surgery
Symptoms of GI disease
Distension: Causes are the 5 F’s
1. Fat
2. Flatus
3. Faeces
4. Foetus
5. Fluid
Ascites: causes include
1. Malignancy
2. Pancreatitis
3. infections (TB)
4. CCF
5. cirrhosis with portal hypertension
6. Budd-chiari syndrome (hepatic venous outflow obstruction causing abdominal
pain, hepatomegaly and ascites as a classic triad)
Splenomegaly: The normal working spleen breaks down old blood cells and stores
platelets and white blood cells. Also stored monocytes and lymphocytes and a
reserve of blood in case of hypovolemia etc.
Boerhaave’s syndrome
Oesophageal rupture, often due to iatrogenic causes post-op or forceful vomiting.
The classic presentation is retching and vomiting followed by severe retrosternal
chest pain, odynophagia, dyspnoea, cyanosis, fever and shock. Subcutaneous
emphysema and pleural effusion can also be present
Rupture of an organ (spleen, aorta, ectopic pregnancy)
The rupture of an organ can cause peritonitis due to peritoneal irritation. This is
because perforation of an organ releases fluid from within that organ, that is often
irritant to the peritoneum.
Symptoms:
Prostration (not wanting to move), percussion tenderness and rebound tenderness,
guarding and rigidity, positive cough response.
, Final Year Surgery
This is different from the symptoms of colic, which is a waxing and waning pain due
to intermittent contraction of a hollow viscus i.e. in cholecystitis. In this situation, the
patient will be restless and constantly wanting to move.
Beware of hidden diagnoses: mesenteric ischemia, ruptured AAA and acute
pancreatitis (may have mild signs but severe symptoms so make sure to think of
them)
Carcinoma of the oesophagus and dysphagia
Usually Squamous cell carcinoma or adenocarcinoma
Risk factors: low SEC, smoking, alcohol, hot drink consumption, chronic
GORD, Barrett’s and obesity
Superior third of the oesophagus is striated muscle
Middle third of the oesophagus is striated muscle and smooth muscle
Lower third of the oesophagus is smooth muscle only
Presentation
Dysphagia and odynophagia
Weight loss
Chest pain
Hoarseness
Cough
Survival is poor with or without treatment
Investigations
Oesophagastroduodenoscopy (OGD)
Comprehensive metabolic profile
CT thorax and abdomen
Treatment
Endoscopic resection and surveillance
Oesophagectomy
