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Bariatric Surgery
Clinical Medicine II
| Question | Answer |
|---|---|
| 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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