Altered Anatomy Flashcards
By what mechanism does a gastric lap band become increased or decreased in diameter?
Injection of saline through the port changes the size of the proximal gastric segment
What common condition of obese patients is reversed rapidly in many cases of biliopancreatic diversion or roux-en-y gastric bypass surgery?
the most effective methods to control diabetes, resulting in persistent normal concentrations of plasma glucose, insulin, and glycosylated haemoglobin in 80-100% of cases. Resolution of diabetes after such treatment typically occurs too fast to be accounted for by weight loss alone.
• The insulin resistance reversion is partially explained by the incretin level changes after biliopancreatic diversion.
• Incretins
– Glucagon-like peptide-1 (GLP-1)
– Gastric inhibitory peptide (glucose-dependent insulinotropic peptide or GIP)
• These GI hormones act to:
– increase insulin release after eating, even before blood glucose levels become elevated
– reduce gastric emptying (slow the rate of absorption of nutrients into the blood stream)
– Inhibit gastric acid secretion
– inhibit glucagon release
What is the classic surgery for hiatal hernia and also for severe GERD caused by open LES? What is the basic outline of the procedure?
the gastric fundus of the stomach is wrapped, or plicated, around the lower end of the esophagus and stitched in place, reinforcing the closing function of the lower esophageal sphincter. The esophageal hiatus is also narrowed down by sutures to prevent or treat concurrent hiatal hernia, in which the fundus slides up through the enlarged esophageal hiatus of the diaphragm.
What is the definition of short bowel syndrome (SBS)? What factor is critical and affects the severity of the symptoms? What is the top (one) etiology in adults and the top (one) etiology for peds?
- Defined as any loss of >50% of viable small intestine or having less than 200 cm of viable small intestine.
- Presence or absence of the ileocecal valve may be a critical factor.
- Adults: Crohn disease, radiation enteritis, mesenteric vascular accidents, trauma, recurrent intestinal obstruction
- Peds: necrotizing enterocolitis, intestinal atresia, intestinal volvulus
What delivery form of medication/supplements should be avoided in SBS and decreased transit time in general?
Avoid delayed release medications/supplements.
What are the six (actually 8) major deficiencies found in SBS?
A, D, E, K, Zinc, B12, Folate, Iron
vitamin A deficiency - night blindness, xerophthalmia
vitamin D deficiency – paresthesias, tetany, accelerated bone loss
vitamin E deficiency – paresthesias, ataxic gait, visual disturbances (retinopathy)
vitamin K deficiency - easy bruising, prolonged bleeding, accelerated bone loss
zinc deficiency – anorexia, Diarrhea
B12 - anemia
Folate - anemia
iron deficiency – anemia
Briefly describe an ileostomy
The small bowel is brought out to the skin surface and drains into a bag
Briefly describe a J pouch (aka Ileoanal anastomosis):
The terminal portion of small bowel is made into a simulated rectum and stool exits the anus
Briefly describe a Colostomy:
After resection of a portion of the colon, the distal end is brought out to the skin surface and drains into a bag (temporary or permanent)
Briefly describe a Roux-en-y:
A small 15-30 ml gastric pouch is connected to the small intestine bypassing the stomach allowing food and digestive juices to be separated for 3-4 feet. Normal small intestine is about 23 feet long. Significantly restricts the volume of food that can be eaten.
Briefly describe a Gastric sleeve:
a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach along the greater curvature. The result is a sleeve or tube like structure.
Briefly describe a Nissen gastric fundoplication:
the gastric fundus of the stomach is wrapped, or plicated, around the lower end of the esophagus and stitched in place, reinforcing the closing function of the lower esophageal sphincter. The esophageal hiatus is also narrowed down by sutures to prevent or treat concurrent hiatal hernia, in which the fundus slides up through the enlarged esophageal hiatus of the diaphragm.
