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Bariatric Surgery

Clinical Medicine II

Define morbid obesity because of obesiety, can get serious health conditions
What classifies morbid obesity 200% ideal body wt, 100lbs overweight, BMI of 40 or more
Severe RF’s of of medical conditions d/t obesity DM, gall bladder, HTN, dyslipid, insulin resistence, breathlessness, sleep abneal
Mod RFs for med conditions CHD, OA, hyperuricemia and gout
What are classifications for results of medical therapy in wt loss 95-98% failure of sustained wt loss at 5 yrs, 100% failrure
What are options for medical therapy diet, exerdcise, behavior modifcifation, anti-obesity drugs
How often does diet and exercise work 1 in 20 people
What is A1C goal for DM patients <6
What is the best wt loss strategy in morbitly obese pt’s w/ DM more invasive, better the results: biliopancreatic > gastric bypass/gastric sleeve >lab band
Who are the best canidates for surgical tx of DM Duration <10 years, Insulin resitance (prediabetic), B-cell fxn remaining, BMI overweight/obese
Who are actual surgical candidates BMI >40, BMI >35 with co-morbities such as DM II, OSA,HTN, Hyperlipids, CVD, and must be dedicated to life-style changes and F/U care
What must we check of the surgical candidate check for endocrine, operative risk, absence drug/alcohol prob, non-smoker, psych conditions controlled
3 types of surgical options malabsorbtion: bioliopancreatic, restruction: adjustable gastric banding and sleeve, malabsorptive and restrictive: roux-en-y gastric bypass
Gold standard and most frequent surgery roux-enY gastric bypass surgery
When in wt loss the greatest with Roux-en-Y greatest in the 1st year
How does the restriction cause wt loss small pouch, receptors stretched w/ small amounts of food, ↓ wt
Risks of gastric bypass major abd surg,cutting and stapling, rapid wt loss, malabsorption
Risks with major abd surg DVT, death, major bleeding, hernia, wound infex, obstruction
What are complications w/ rapid wt loss cholelithiasis, Prevented by cholecystectomy at time of surgery or Actigall
Complications w/ cutting and stapling leak, stenosis, dumpin syndrome, gastric/duodenal ulcers, N/V/dehydration
Signs of a leak in the intestines tachy, pain (jumps from 2-8?), peritoneal signs
Signs of stenosis of the bowel N/V, inability to keep solids down
What is dumping syndrome w/ ↑ surgars and complex carbs, the jujunum can’t take that causings a rush of fluids to rush to the intestine, makes the pt feel awful, N/V, diarrhea, diaphoresis, flushing
How do we avoid gastric/duodenal ulcers avoid NSAIDS in abusers or smokes, use tramadol instead
4 of the most common vitamin deficiencies w/ this surgery Iron, Vit B12, Calcium, Vit D
What other two are potentials for vit def thiamine, folate
How do we get these vitamins to be absorbed make the
What is the restrictive type of surgery stomach stapleing (sleeve gastrectomy), limits the amount of food you can eat and hunger is ↓
Which surgery is better biliogastric is better w/ wt loss, but sleeve gastrectomy is better tolerated d/t no dumping syndrome
Sleeve size post surgery banana or thin hotdog
What are major complications of sleeve gastrectomy leak, bleed, death
Minor complications of sleeve worsening GERD/barretts, N/V, structure, Vit. Def (lower)
2 restrictive surgeries sleeve gastrectomy, laprascoopic gastric band
How do we control the band w/ port connected to the band, saline is inserted to adjust the balloon size of the band and adjust for sxs
How does band work makes a 3 oz puch created, patient full faster and stays full longer
Order of surgical effective ness gastric bypass, sleeve, band
Complications of gastric band surgery: dvt, PE, bleeding, Slippage, band erosion, port problems, foreign object, death (LOW), wt loss problsems: gallstones and GERD
Do we remove band once ideal wt loss has been achieved commonly not, d/t ↑ chance to regain wt
How often do we f/u for band adjustments ~12x/yr, 1 a month until BMI <30
What is the optimal zone of tightness for the band early and prolonged satiety, eat 1 cup and full, and lost 1-2 lbs/week
What are signs of too lose hungry, big meals (>1cup), not loosing wt
s/s of a band that is too tight difficulty swallowing,
what does the diet consist of post surgery initial 2-4 tbsps of food/meal, goal: 1 c, take 30mins to eat, high protein meals are best, no liquid during meals
why don’t we want to drink liquids during meals increase the passage of food
common sxs post surgery telogen effluvium, excess skin: exercise and plastic surgery: 2 years out, intertrigo (d/t excess skin), cold
tx for intertrigo nystatin and triamcinolone cream prn, cornstarch for excess skin areas
4 personal challenges faced post op Fatigue, clothing issue, social issue, mental health
Vitamin replacements for post op Calcium + Vit D 3x daily w/ meals, MVI w/ iron, Vit D: 2000 UR daily, B12
How do we give B12, when and y daily SL or monthly injection w/ bypass and sleeve
How often do we f/u 6m 1yr, yearly after that
What is the lab work that should be done at F/U CBC, vit B12, iron studies, Vit D, PTH (d/t calcium)
What must we check with excessive vomiting thyamine levels (takes a week), usually automatically give it
Complications w/ thiamine def neurpathy, wernikes encephalopathy
How do we check calcium absorption do a yearly DEXA scan for osteoporosis,
F/U apt every 3 m for 1st year, yearly later, F/U 1 wk with DM, 6m for ↑cholesterol,
What must females do 18m post op 2 forms of Birth control, d/t so many changes in the body
What do we need to check post surgery followhealth condition, bloodsugars, 1wk, check cholesterol 6m, TSH, adjust meds,dc meds?
What are signs during follow up we need to take note swallow/GERD?, dehydration first3m, neurologials signs: B12, cross addiction (used to be addicted to food, now something else) and depression/anxiety
Rules for bariatric surgery 3sm meals, no snacking, no drinking w/ meals, eat slowly, focus on nutrient dense foods, avoid calorie liquids, exercise 30m/day, be active
What are some acceptable weight loss terms excess wt, wt, overwt, bmi
What are some biased terms w/ wt loss unhealthy size, lg size, excess fat, wt problem, obesity, fatness, heavy
Name supplements post surgery Iron, B12, Calcium, Vit D
when do we need b 12 supplements Post bypass and sleeve
two surgeries that are restrictive gastric sleeve and lap band
which surgery is most effective in wt loss gastric by roux-en-Y surgery
Created by: becker15
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