3_5ObesityBariatricSurgery Flashcards
What comorbid conditions show increased risk with increasing BMI (obesity)?
1) CV disease, 2) diabetes, 3) musculoskeletal disorders, 4) breast/colon/endometrial cancer, 5) sleep apnea
How does obesity cost the patient?
1) increased hospital stay lengths, 2) decreased QoL, 3) lower income, 4) social stigma, 5) decreased life expectancy
What is an example of an endoscopic procedure to induce weight loss?
intragastric balloon
What are the risks to sleeve gastrectomy?
1) infection, 2) leaking, 3) clots, 4) evidence relatively lacking
Sleeve gastrectomy is otherwise known as?
stapling
What are the risks to gastric banding?
1) slippage, 2) infection
How does gastric banding work?
inflatable (saline) band squeezes stomach into upper and lower pouch to cause slower emptying of the upper pouch
How much food is a gastric banding patient allowed per meal?
1/2 to 1 cup of soft/well-chewed food
What are 2 types of gastric bands?
LAPBAND and REALIZE
What causes dumpting syndrome?
eating refined sugar
What are the symptoms of dumping syndrome?
1) TACHYCARDIA, 2) nausea, diarrhea, 3) tremor
For which weight-loss surgery is dumping syndrome a risk?
RYGB
What are the risks in RYGB?
1) leaks, 2) N/V, 3) hernia, 4) obstruction, 5) deficiency
How does an RYGB work?
restrictive and malabsorptive technique bypasses most of stomach (15-50mL) and jejunum
How is RYGB performed?
laparoscopically or open
How is a BPD performed?
laparoscopically or open
What patients can get a BPD?
only if BMI > 60
What are the risks of BPD?
1) malnutrition, 2) steatorrhea, 3) intermittent diarrhea
Describe the length of stay and success rate associated with a BPD?
2-7 days in the hospital, 80% success with 10% morbidity
What surgical weight loss technique is most risky?
BPD
Which surgical weight-loss techniques are solely restrictive?
1) banding, 2) sleeve
Which surgical weight-loss techniques are solely malabsorptive?
BPD
Which surgical weight-loss techniques are both malabsorptive and restrictive?
RYGB
Why has surgical weight-loss increased exponentially since the 90’s?
1) more obesity = treatment failures, 2) laparoscopic, 3) celebrities, 4) CMS REIMBURSEMENT
What are the general risks of surgical weight-loss procedures?
1) bleeding/leakage, 2) infection, 3) embolism, 4) stricture, 5) ulcers, 6) bowel obstruction, 7) malnutrition, 8) 20% HAVE CHOLELITHIASIS IN 3 YEARS - pharm
Who are candidates for surgical weight-loss?
1) BMI > 40 or >35 with comorbidities, 2) failure of non-surgical, 3) psych stable, 4) motivated, 5) no EtOH/substance abuse
Who are candidates for the lap-band?
> 30 with a comorbidity
What are the recommended supplements post weight-loss surgery?
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)
How much Vit D should be supplemented every day post surgery?
400 - 2000 IU D3 qday
If a patient is vitamin d deficient, what is the recommended supplementation?
50,000 IU po q week x 4-6 weeks then prn
What patients have bone mineral density issues?
1) malabsorptive surgery, 2) BMI > 50
What drug forms should be used 2 months post-op?
liquid, crushed, or capsule
What drugs/substances should be avoided post-surgery?
1) EtOH, 2) GI irritants, 3) oral contraceptives, 4) food-requiring drugs, 5) gallstone-causing drugs
What changes occur in post-op patients regarding drug solubility?
1) pH, 2) blood flow, 3) enzyme production, 4) absorption
What are the mechanisms of action for weight-loss in surgeries?
1) restrict intake, 2) malabsorption, 3) alter food taste, 4) decrease appetite, 5) increase energy expenditure, 6) aversion effect (dumping, steatorrhea, vomiting)
