Bariatric

Question 1

Blind loop syndrome

Answer 1

Occurs after BR II or RnY

Blind loop of bypassed intestines, stagnant, bacterial overgrowth

Bloating, abd pain, vit B12 deficiency (megaloblasgic anemia, hyperhomocysteine, elevated MMA), macrocytic anemia, fat malabsorption, subsequent steatorrhea

Dx: carb breath test (metabolism of carb by bacteria produces hydrogen and methane gas, excreted in breath); normal breath test - elevates in 2-3 hours; abnormal breath test - elevates early

Question 2

Early dumping syndrome

Answer 2

Rapid onset (w/in 15 min) diaphoresis after PO intake of carbs, abd pain, diarrhea

rapid emptying of food from stomach into small bowel. hyperosmolality of food, rapid fluid shifts into bowel, hypotension and sympathetic nervous system response

Question 3

Late dumping syndrome

Answer 3

postprandial hyperinsulinemic hypoglycemia (PHH)

2-3 hours after carb ingestion

dizzy, fatigue, weakness

Question 4

Obesity hypoventilation syndrome (OHS)

Answer 4

Daytime hypoxemia & hypercapnia in obese patient

1) Extreme overweight (BMI 30 kg/m2)
2) Daytime hypoventilation (PaCO2 > 45 mmHg)
3) Absence of other known causes of hypoventilation and sleep-related breathing disorders

Mechanical effects of obesity -> restrictive ventilatory disorder. causes chronic normal A-a gradient hypoxemia due to change in central chemoreceptor set points