3_5ObesityBariatricSurgery

Question 1

What comorbid conditions show increased risk with increasing BMI (obesity)?

Answer 1

1) CV disease, 2) diabetes, 3) musculoskeletal disorders, 4) breast/colon/endometrial cancer, 5) sleep apnea

Question 2

How does obesity cost the patient?

Answer 2

1) increased hospital stay lengths, 2) decreased QoL, 3) lower income, 4) social stigma, 5) decreased life expectancy

Question 3

What is an example of an endoscopic procedure to induce weight loss?

Answer 3

intragastric balloon

Question 4

What are the risks to sleeve gastrectomy?

Answer 4

1) infection, 2) leaking, 3) clots, 4) evidence relatively lacking

Question 5

Sleeve gastrectomy is otherwise known as?

Answer 5

stapling

Question 6

What are the risks to gastric banding?

Answer 6

1) slippage, 2) infection

Question 7

How does gastric banding work?

Answer 7

inflatable (saline) band squeezes stomach into upper and lower pouch to cause slower emptying of the upper pouch

Question 8

How much food is a gastric banding patient allowed per meal?

Answer 8

1/2 to 1 cup of soft/well-chewed food

Question 9

What are 2 types of gastric bands?

Answer 9

LAPBAND and REALIZE

Question 10

What causes dumpting syndrome?

Answer 10

eating refined sugar

Question 11

What are the symptoms of dumping syndrome?

Answer 11

1) TACHYCARDIA, 2) nausea, diarrhea, 3) tremor

Question 12

For which weight-loss surgery is dumping syndrome a risk?

Answer 12

RYGB

Question 13

What are the risks in RYGB?

Answer 13

1) leaks, 2) N/V, 3) hernia, 4) obstruction, 5) deficiency

Question 14

How does an RYGB work?

Answer 14

restrictive and malabsorptive technique bypasses most of stomach (15-50mL) and jejunum

Question 15

How is RYGB performed?

Answer 15

laparoscopically or open

Question 16

How is a BPD performed?

Answer 16

laparoscopically or open

Question 17

What patients can get a BPD?

Answer 17

only if BMI > 60

Question 18

What are the risks of BPD?

Answer 18

1) malnutrition, 2) steatorrhea, 3) intermittent diarrhea

Question 19

Describe the length of stay and success rate associated with a BPD?

Answer 19

2-7 days in the hospital, 80% success with 10% morbidity

Question 20

What surgical weight loss technique is most risky?

Answer 20

BPD

Question 21

Which surgical weight-loss techniques are solely restrictive?

Answer 21

1) banding, 2) sleeve

Question 22

Which surgical weight-loss techniques are solely malabsorptive?

Answer 22

BPD

Question 23

Which surgical weight-loss techniques are both malabsorptive and restrictive?

Answer 23

RYGB

Question 24

Why has surgical weight-loss increased exponentially since the 90’s?

Answer 24

1) more obesity = treatment failures, 2) laparoscopic, 3) celebrities, 4) CMS REIMBURSEMENT

Question 25

What are the general risks of surgical weight-loss procedures?

Answer 25

1) bleeding/leakage, 2) infection, 3) embolism, 4) stricture, 5) ulcers, 6) bowel obstruction, 7) malnutrition, 8) 20% HAVE CHOLELITHIASIS IN 3 YEARS - pharm

Question 26

Who are candidates for surgical weight-loss?

Answer 26

1) BMI > 40 or >35 with comorbidities, 2) failure of non-surgical, 3) psych stable, 4) motivated, 5) no EtOH/substance abuse

Question 27

Who are candidates for the lap-band?

Answer 27

> 30 with a comorbidity

Question 28

What are the recommended supplements post weight-loss surgery?

Answer 28

1) MVI with fat-soluble vitamins and Fe 325mg 1-3x qday 2) Ca citrate 2000 mg/day; 3) 1-2 mg folate/day; 4) B12 IM or oral supplements (<1000 mcg)

Question 29

How much Vit D should be supplemented every day post surgery?

Answer 29

400 - 2000 IU D3 qday

Question 30

If a patient is vitamin d deficient, what is the recommended supplementation?

Answer 30

50,000 IU po q week x 4-6 weeks then prn

Question 31

What patients have bone mineral density issues?

Answer 31

1) malabsorptive surgery, 2) BMI > 50

Question 32

What drug forms should be used 2 months post-op?

Answer 32

liquid, crushed, or capsule

Question 33

What drugs/substances should be avoided post-surgery?

Answer 33

1) EtOH, 2) GI irritants, 3) oral contraceptives, 4) food-requiring drugs, 5) gallstone-causing drugs

Question 34

What changes occur in post-op patients regarding drug solubility?

Answer 34

1) pH, 2) blood flow, 3) enzyme production, 4) absorption

Question 35

What are the mechanisms of action for weight-loss in surgeries?

Answer 35

1) restrict intake, 2) malabsorption, 3) alter food taste, 4) decrease appetite, 5) increase energy expenditure, 6) aversion effect (dumping, steatorrhea, vomiting)