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Flashcards in Bariatric Surgery Deck (73)
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1

Indications for Bariatric Surgery

BMI > 40 without comorbidities
BMI 35-39.9 with comorbities
BMI 30-34.9 with uncontrolled type 2 DM or metabolic syndrome

2

Comorbidities with a BMI 35-39.9 for Bariatric Surgery

DM2
OSA
HTN
Hyperlipidemia
Obesity-hypoventilation syndrome (OHS)
Pickwickian syndrome (OSA+OHS)
Nonalcoholic steatohepatitis (NASH)
Pseudotumor cerebri
GERD
Venous stasis disease
Severe urinary incontinence
Debilitating arthritis
Impaired QOL

3

Contraindications for Bariatric Surgery

Hx of bulimia
Age >65 or

4

Preoperative Assessment for Bariatric Surgery

Psychological
Medical anesthetic risk

5

Preoperative Assessment for Bariatric Surgery

Nutritionist
Medical bariatric specialist
Psychologist/Psychiatrist
Clinical nurse specialist
Surgeon

6

Components of the Psychological Assessment

Behavioral
Cognitive/emotional
Current life situation
Expectations

7

Mechanisms of Weight Loss with Surgery

Restriction
Malabsorption
Both

8

Define Restrictive Surgery

Limit caloric intake by reducing the stomach's capacity via resection, bypass, or creation of a proximal gastric outlet

9

Examples of Restrictive Surgeries

Vertical banded gastroplasty
Laparoscopic adjustable gastric banding
Sleeve gastrectomy

10

Examples of Malabsorptive Surgeries

Jejunoileal bypass
Duodenal switch operation

11

Define Malabsorption Surgeries

Decrease the effectiveness of nutrient absorption by shortening the length of the functional small intestine by bypassing of the small bowel absorptive surface area or diversion of the biliopancreatic secretions that facilitate absorption

12

Examples of Combination Surgeries

Roux-en-Y gastric bypass
Biliopancreatic diversion
Biliopancreatic diversion with duodenal switch

13

Top 3 Bariatric Surgeries

Roux-en-Y
Sleeve gastretomy
Laparoscopic adjustable gastric band

14

Roux-en-Y Surgery

Gastric pouch

15

Roux-en-Y Weight Loss Mechanism

Pouch restrictive
Malabsorption of "removed" small bowel
Gastrojejunostomy can result in dumping syndrome
Ghrelin inhibition
GLP-1 & CCK increased post bypass

16

Symptoms of Dumping Syndrome

Lightheadedness
Nausea
Diaphoresis
Abdominal pain
Diarrhea

17

What does insulin do?

Stimulates insulin synthesis
Suppresses appetite

18

What does CCK do?

Gallbladder contraction
Stimulates gastric emptying
Suppresses appetite

19

Expected Weight Loss with RYGB

Up to 70% in 2 years

20

Sleeve Gastrectomy

Great curvature of stomach is removed
Safer & technically less difficult that RYGM
Resistant to stretching

21

Weight Loss Mechanism of a Sleeve Gastrectomy

Restrictive
Alterations in gastric motility
Decreased gherkin levels
Increased GLP-1 & PYY

22

Expected Weight Loss for a Sleeve Gastrectomy

60% weight lost in 2 years

23

Lap Band

Soft silicone ring connected to infusion port
Ring inflated with saline to vary the restriction

24

Goal of Lap Band Adjustments

Allow a cup of dried food
Satiety for 1.5-2 hours

25

Weight Loss Mechanism for lap Band

Restrictive

26

Expected Weight Loss with Lap Band

50-60% at 2 years

27

What do you need to monitor post bariatric surgery?

Weight
Blood pressure
Glycemic control
Nutrient deficiencies

28

Weight & Blood Pressure Monitoring

Every visit
Watch for hypotension
Check every 4-6 weeks for 6 months
Check at 9 & 12 months
Check annually

29

Macronutrient Needs

Protein
Carbs
Fats
RYGB doesn't cause significant macronutrient deficiencies

30

Micronutrient Deficiency in a Lap Band Procedure

Folate deficiency