14. Bariatric surgery - selection and preoperative work-up Flashcards
what do you need to evaluate at the pre-operative workup?
medical, nutritional, mental and functional health status
special attention should be given to the care of which patients who are considering bariatric surgery?
type 2 diabetes - minimize complications from uncontrolled diabetes
what is mandatory and should be maintained lifelong prior to bariatric surgery?
smoking cessation!
risks of post-operative complications associated with tobacco use
in patients living with severe obesity, which combination is more effective option for long-term weight loss and control of chronic conditions?
surgery + behavioural interventions
what should be done in candidates for bariatric surgery?
comprehensive medical and nutritional evaluation;
nutrient deficiencies corrected
what to screen for and treat in people seeking bariatric surgery?
sleep apnea
before surgery, what should be performed or investigated to ensure you are ready and safe for surgery?
blood work, cardiac or pulmonary testing
if you are at high risk for obstructive sleep apnea, you may be asked to undergo what to determine if you have significant sleep apnea?
sleep study
what do you need to do to shrink your liver size and make your surgery easier?
low-calorie diet 2-3 weeks before surgery
if you are diabetes, what do you need to do before surgery?
follow blood sugars very closely and obtain instructions on how to adjust diabetes medications while on the low-calorie diet prior to surgery
what are medical evaluations may include before surgery?
cardiac, respiratory, metabolic, GI and sleep apnea testing
what is the indication for bariatric surgery?
> 18 years old,
BM35 kg/m2,
at least 1 major obesity-related complications including type 2 diabetes, hypertension, hyperlipidemia, pseudotumor cerebri, obesity hypoventilation syndrome or Pickwickian syndrome, debilitating arthritis, non-alcoholic fatty liver disease, or non-alcoholic steatohepatitis, coronary artery disease, severe reflux or obstructive sleep apnea.
for BMI between 30-34.9, who can be considered for surgery?
wh ohave been refractory to non-surgical attempts at weight loss with obesity-related complications, especially T2DM.
adolescent candidates who have BMI 35 and over may be considered for surgery if?
additional significant complications, including T2DM, significant obstructive sleep apnea with an apnea-hypopnea index measured at 15 or higher, pseudotumor cerebri or severe non-alcoholic steatohepatitis (NASH)
if adolescent with BMI 40 and over with other complication, such as hypertension, insulin resistance or glucose intolerance, significant impairment with their quality of life or activities of daily living, hyperlipidemia or obstructive sleep apnea, are they a candidate for surgery?
yes
who can be considered inappropriate candidates for surgery?
patients with unstable psychiatric illness,
malignancy or other diseases associated with decreased life expectancy, substance abuse or an inability to adhere to long-term follow-up
is advanced patient age an absolute contraindication to surgery?
no - outcomes and complication rates >60 years appear to be comparable to those of a younger population, regardless of the surgical procedure performed
what is non-alcoholic steatohepatitis NASH?
what is Child-Pugh Class A liver cirrhosis?
General considerations for bariatric surgery candidates
P2, paragraph 4
