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Final Lec01
Final Lec01
SURG NOTES
Clinically:
- Vague symptoms.
•Epigastric pain
“D.D : Gastritis: pain is not severe as lymphomas”
•Early satiety leading to loss of weight •Fatigue
•Bleeding is uncommon. [but anemia is present in 50% of patients
“Not constant sign” —> alarm sign]
-Old age (6th & 7th decades) , Male > Female (2:1).
- Antrum of stomach is the commonest site.
Pathology:
-Has multiple classification systems thus has No ideal tttج.
-Diffuse B-cell lymphomas is the most common type —> 55%
“usually primary”
-MALT —> 40%, H. Pylori associated “if lymphoma was only
mucosal, it will regress after ttt of H. pylori”
- Burkett lymphoma —> younger age, at body of stomach & EBV
associated.
- Mantel cell
GASTRIC LYMPHOMA
Management:
- PET scan is investigation of choice for staging.
A. Early stage : Multimodality:
According to extensions
(Metastasis)
Surgery Chemotherapy
NB: low immunity leads to Ex: cyclophosphamide
↑↑↑ mortality. NB: 5% risk of perforation (lesion melt)
leads to ↑↑↑ mortality
B. Late stage :
- Not amenable to sx/chemo.
- Low grade MALT: H. pylori ttt eradicated by 75% “repeated
endoscopy after 2 months to detect recurrence or reinfection”
GASTRIC SARCOMA
-3% 0f gastric cancers.
-Arises from Mesenchymal cells.
-GIST is the most common (stomach 60-70%).
- Age : After 4th decade. “But also seen in younger”
Adjuvant treatment:
•Radiation has NO benefit “radio-resistance”
•Glivic Gleevec (imatinib) : "tyrosin kinase antagonist"
(54% to 90%) —> partial response
but it is the best treatment used for now.
Target the CD117+ CD34 cells cause regression of the
tumor “used for 3-5 years; according to size of tumor”
OBESITY SURGERY
- Effect of obesity on the body is worse than smoking.
- Obesity is a chronic disease.
- It causes early morbidity, mortality & social
disadvantages.
-70% of obese patients make social changes after losing
weight.
- Prevalence in Mediterranean : Males 16% , Females
30%.
OBESITY SURGERY
Defining weight loss:
Excess weight loss = (weight loss / excess weight) x
100%
-EWL% is 60-70% at 1st year after surgery
-Excess weight = current weight – normal weight (BMI<
25)
Causes :
1.Hereditary
2.Altered metabolism (1% hormonal effect)
3.Prescript medication
4.Obesogenic environment : Overeating & lack of exercise
(number 1 cause)
Consequences of obesity :
- Direct : “related to treatments” for associated
diseases (DM , HTN , ...etc)
- Indirect : “related to society” loss of productivity
- Mortality risk: higher after BMI > 30
Health effects of obesity :
- Diabetes type 2 (70-80%)
- Hyper-estrogenemia “predisposing factor for cancer”
- Arthritis (irreversible damage)
- Hypertension
-Social dysfunction
OBESITY SURGERY
Treatment:
A.Non-surgical treatment:
“Little chance in morbid obesity (5%) ”
- Drugs :
1- Merida: decrease appetite
3- FDA .. Orlistat:
Inhibit absorption of fat from intestine
(30%).
Complications: diarrhea , fecal
incontinence (soil underwear).
OBESITY SURGERY
Treatment:
B. Surgical treatment:
Indication of surgery:
1. BMI > 40 (class 3)
2. BMI > 35 (class 2) when medical
therapy has failed and comorbid
condition exist.
- Reduction intake :
•Intra-gastric balloon
•VBG “Vertical Banded Gastroplasty /
stomach stapling”
•LABG “Laparoscopic adjustable gastric
banding” .. Not done d.t its complications
(out of practice).
OBESITY SURGERY
Treatment:
B. Surgical treatment:
- Reduction absorption:
•GBP “Gastric bypass surgery”
•BPD “Bilio-pancreatic Diversion”
•JIBP .. “ Historical” —> complications: liver
cirrhosis, not done any more
- Sleeve gastrectomy :
Removal of greater curvature, it interferes
with gastric hormones “Not absorption”
especially Hunger hormone: Ghrelin