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Clin Specialties - Surgery > Abdomen 2 and Bariatrics > Flashcards

Abdomen 2 and Bariatrics Flashcards

1
Q

BMI of obesity

A

> 30

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2
Q

_______ is the single most reliable predictor of type 2 DM

A

obesity

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3
Q

About _____ of pts who have HTN also have obesity

A

1/3

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4
Q

Generally, each 1% of body weight loss = a decrease in DBP by ___ and SBP by ___

A

1mmHg DBP

2mmHg SBP

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5
Q

More a _____ people a day die from obesity related health conditions in the US

A

1,000

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6
Q

What is the only effective method for BMI >35 for sustained weight loss?

A

surgery

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7
Q

What is the goal of bariatric surgery?

A

to ASSIST in reducing daily calorie intake

no guarantee, just makes it possible

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8
Q

What is the criteria for bypass surgery?

A

BMI > 40
or
BMI > 35 with co-morbid illness
plus
failed attempt of supervised weight loss programs (documented)
and
no substance abuse, psychoses, or uncontrolled depression

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9
Q

What are types of weight loss surgeries?

A

Malabsorptive
Restrictive
Combined procedures

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10
Q

What is the new and old gold standard for weight loss surgery?

A

Used to be a combined procedure - Roux-en Y Gastric Bypass

NOW is sleeve gastrectomy (restrictive)

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11
Q

Sleeve Gastrectomy

A

Gold standard for weight loss surgery

restrictive and metabolic
part of the stomach is removed thus reducing food intake and decreasing the production of ghrelin

~65% weight loss

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12
Q

What is the least invasive surgical approach for weight loss?

A

gastric band

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13
Q

What are complications of gastric band?

A 
obstruction 
pouch or esophageal dilation 
band slip (displacement) 
erosion 
food intolerance (no bread or rice) 
weight regain 
failure to lose weight

pushes on the diaphragm all the time –risk of hiatal hernia

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14
Q

What are the advantages of gastric bypass?

A

rapid initial weight loss

most effective at GERD resolution

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15
Q

What are the disadvantages of gastric bypass?

A 
intestinal re-routing required 
Dumping syndrome (say you eat something sweet -body tries to poor in a lot of fluid into small intestine --fainting, N/V/D) 
25% need reoperation in their lifetime 
nutritional deficiencies
marginal ulcers
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16
Q

What are the advantages of sleeve gastrectomy?

A 
laparoscopic 
no rerouting of the GI tract 
fairly rapid weight loss 
Elimination of hunger hormone 
Fewer complications than gastric bypass
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17
Q

Where is ghrelin produced?

A

in the fundus of the stomach (also in the brain and pancreas)

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18
Q

What are the disadvantages/complications of sleeve gastrectomy?

A 
not reversible 
long gastric staple line 
GERD
stricture 
staple line leak
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19
Q

What happens when you have faster transit time in the small intestine of sleeve gastrectomy pts?

A

increase insulin sensitivity and satiety

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20
Q

Leptin

A

satiety hormone
produced mainly by adipose tissue
regulates E balance, inhibits hunger, increases activity
increased production in obesity but decreased sensitivity

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21
Q

Ghrelin

A

hunger hormone
produced by fundus
opposes leptin
decrease hunger, doesn’t affect satiety

22
Q

Insulin

A

produced in pancreas
drives glucose into fat cells
blocks leptin at the brain, increasing hunger

23
Q

GLP1 -1

A

increases insulin sensitivity, decreasing E storage (glucose into fat cells) and hunger

24
Q

Peptide YY

A

increases satiety

25
Hernia
a condition where an organ or tissue protrudes through the wall of the compartment that normally contains it
26
Umbilical hernia
most commonly congenital MC in females in infants they typically heal on their own surgery if >2cm or persists at age 3-4 yo
27
Direct inguinal hernia
acquired. medial to inferior epigastric vessel --through Hesselbach's triangle rare in females
28
Indirect inguinal hernia
congenital or acquired later to inferior epigastric vessel peritoneal sac --risk of strangulation Most common inguinal hernia of M/F
29
Processus Vaginalis
congenital out pouching of the peritoneum M > F Right > left indirect inguinal hernia
30
sliding hernia
port of the hernia sac is formed by a viscus
31
Femoral hernia
Femoral canal F > M Below the inguinal ligament often has peritoneal sac --risk of incarceration commonly confused for Cloquet's node
32
What is the dx imaging for hernias?
US or CT for groin or femoral hernias | CT more useful for ventral, incisional, or traumatic hernias (or unusual presentations)
33
PE on a pt with suspected hernia
listen for bowel sounds feel for peristalsis check testes, abdomen, groins because if they have one hernia they could have multiple
34
Can you tell the difference between direct or indirect on PE?
No you could suspect that a younger pt would get indirect and an elder pt with recent surgery has direct
35
Who is more likely to get femoral hernias?
women
36
Cloquet's node
commonly mistaken for femoral hernia associated with penile cancer?
37
What abx would you use for hernia surgery?
clean wound you don't NEED anything +/- cefazolin or clinda
38
What ABX would you use for bariatric surgery?
maybe none (but most use something) clean-contaminated cephazolin or clinda for PCN allergy
39
When do you recommend for hernia surgery?
incarceration, strangulation, pain, increasing size, interference with activity
40
Seroma
the body hates open spaces fills it with fluid if you drain it, it will just refill --and you introduce risk of infection should reabsorb in 2-3 weeks
41
Spigelian hernia
rare interparietal (no huge bulge, just pain) dx - CT can strangulate --lap repair
42
Obturator hernia
rare through obturator foramen through the pelvic floor typically contains small bowel typically in old women
43
Richter Hernia
incarceration of a portion of the antimesenteric bowel wall
44
Littre Hernia
hernia containing a Meckle's diverticulum
45
Amyand Hernia
acute appendicitis in an incarcerated inguinal hernia
46
Lumbar Hernia
M > F 60-70 y/o rare posterior abdominal hernia
47
Diastatsis Recti
wide separation of the rectus muscles in the epigastrium not a hernia no Tx seen best with pt lies supine and raises head
48
Hiatal Hernia Type 1
most common sliding GE junction is above the diaphragm
49
Hiatal Hernia Type 2
GE junction is below the diaphragm with a portion of the fundus above
50
Hiatal Hernia Type 3
Both GE junction and portion of the stomach are above the diaphragm with the fundus extending above the GE junction can have significant portion of stomach above the diaphragm (Cameron's Erosions)
51
Hiatal Hernia Type 4
large diaphragmatic defect with a large portion of the stomach above the diaphragm along with organs other than the stomach ie. colon, spleen

Clin Specialties - Surgery (11 decks)

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