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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
Q

Hernia

A

a condition where an organ or tissue protrudes through the wall of the compartment that normally contains it

26
Q

Umbilical hernia

A

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
Q

Direct inguinal hernia

A

acquired.
medial to inferior epigastric vessel –through Hesselbach’s triangle
rare in females

28
Q

Indirect inguinal hernia

A

congenital or acquired
later to inferior epigastric vessel
peritoneal sac –risk of strangulation
Most common inguinal hernia of M/F

29
Q

Processus Vaginalis

A

congenital out pouching of the peritoneum
M > F
Right > left

indirect inguinal hernia

30
Q

sliding hernia

A

port of the hernia sac is formed by a viscus

31
Q

Femoral hernia

A

Femoral canal
F > M
Below the inguinal ligament
often has peritoneal sac –risk of incarceration

commonly confused for Cloquet’s node

32
Q

What is the dx imaging for hernias?

A

US or CT for groin or femoral hernias

CT more useful for ventral, incisional, or traumatic hernias (or unusual presentations)

33
Q

PE on a pt with suspected hernia

A

listen for bowel sounds
feel for peristalsis
check testes, abdomen, groins because if they have one hernia they could have multiple

34
Q

Can you tell the difference between direct or indirect on PE?

A

No

you could suspect that a younger pt would get indirect and an elder pt with recent surgery has direct

35
Q

Who is more likely to get femoral hernias?

A

women

36
Q

Cloquet’s node

A

commonly mistaken for femoral hernia

associated with penile cancer?

37
Q

What abx would you use for hernia surgery?

A

clean wound
you don’t NEED anything
+/- cefazolin or clinda

38
Q

What ABX would you use for bariatric surgery?

A

maybe none (but most use something)
clean-contaminated
cephazolin or clinda for PCN allergy

39
Q

When do you recommend for hernia surgery?

A

incarceration, strangulation, pain, increasing size, interference with activity

40
Q

Seroma

A

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
Q

Spigelian hernia

A

rare
interparietal (no huge bulge, just pain)
dx - CT
can strangulate –lap repair

42
Q

Obturator hernia

A

rare
through obturator foramen through the pelvic floor
typically contains small bowel
typically in old women

43
Q

Richter Hernia

A

incarceration of a portion of the antimesenteric bowel wall

44
Q

Littre Hernia

A

hernia containing a Meckle’s diverticulum

45
Q

Amyand Hernia

A

acute appendicitis in an incarcerated inguinal hernia

46
Q

Lumbar Hernia

A

M > F
60-70 y/o
rare posterior abdominal hernia

47
Q

Diastatsis Recti

A

wide separation of the rectus muscles in the epigastrium

not a hernia
no Tx

seen best with pt lies supine and raises head

48
Q

Hiatal Hernia Type 1

A

most common
sliding
GE junction is above the diaphragm

49
Q

Hiatal Hernia Type 2

A

GE junction is below the diaphragm with a portion of the fundus above

50
Q

Hiatal Hernia Type 3

A

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
Q

Hiatal Hernia Type 4

A

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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