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Bariatric Knowledge Statments for Testing Flashcards

0
Q

What is Morbid (Severe) Obesity?

A
  • Patients who weigh 100% over ideal weight.
  • Patients with a BMI > 35
  • Patients who develop disease states as a result of obesity
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1
Q

What is the history of the Prevalence of Obesity in US Adults… Chronologically?

A

1991 - Highest percentage was 15-20%
2007 - 25-29% primarily in the midwest states
- > 30 in southern states
2010 - 12 US states at >30%
- 11 US states at 20-24%
- 22 US states at 25-29%
Obese children are 30% heavier than in 1990

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2
Q

What is are the causes of Obesity?

A
  • Energy Imbalance
  • Overeating
  • Genetic Factors
  • Inability to feel full
  • Cultural factors
  • Environmental factors
  • Calories intake increased
  • Increased Sugar consumption - Cane and Beet sugar, Corn sweeteners
  • Increased expenditures for food, due to increased consumption
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3
Q

Why treat Morbid Obesity?

A
  • There is proven weight-associated mortality
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4
Q

What are the areas in the body affected by morbid obesity?

A
  • Starts at the head
    • Stroke, Pseudotumor, Diabetic Retinopathy
  • Goes to the toes
    • Diabetic Neuropathy, Infection; Venous Stasis
  • Gets to every organ in-between
    • Lungs, heart liver, spleen, esophagus, gall bladder, colon, kidneys, uterus, breasts, bladder, prostate, pancreas
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5
Q

What are the medical complications of Obesity?

A
  • Pulmonary Diseases
    • Abnormal function
    • OSA
    • Hypoventilation Syndrome
  • Idiopathic intracranial hypertension
    • Stroke
    • Cataracts
  • Nonalcoholic Fatty liver disease
    • Steatosis
    • Steatohepatitis
    • Cirrhosis
  • Gallbladder disease
  • Gynecologic abnormalities
    • Abnormal Menses
    • Infertility
    • polycystic ovarian syndrome
  • Coronary heart disease
  • Diabetes
  • Dyslipidemia
  • Hypertension
  • Severe pancreatitis
  • Cancer
    • Breast, uterus, cervix, colon, esophagus, pancreas, kidney, prostate
  • Osteoarthritis
  • Skin
  • Gout
  • Phlebitis
    • Venous Stasis
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6
Q

BPD - 1993

A
  • Pylorus is preserved
  • The first part of the duodenum is included in the enteric limb
  • Decreased size of the stomach by 60% (sleeve)
  • Increases the length of the common channel
  • Decreases dumping syndrome, B12 deficiencies and stomal ulcers
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7
Q

Sleeve Gastrectomy

A
  • Tubular stomach
  • 2/3 of stomach is removed
  • Stomach capacity ~ 100ml
  • Based upon Magnestrasse and ill Procedure
  • Initially used in 2 stage procedure for super morbidly obese
  • Weight loss proved promising with some patients electing not to proceed with the second portion of the procedure
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8
Q

Advantages of Gastric Sleeve

A
  • Preserves the Pylorus
    • prevents dumping syndrome
  • No malabsorption
  • No foreign object - no adjustments
  • Weight loss is comparable to Gastric Bypass
  • Feasibility of a 2nd procedure if needed
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9
Q

Disadvantages of Gastric Sleeve

A
  • Lack of long-term data for durability of procedure compared to GBP and LAGB
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10
Q

Vertical Gastric Sleeve Anatomy and Physiology

A
  • Removal of the greater curvature of the stomach
    • approximately 75-80% removed
    • Hormonal effect
    • Reduction in ghrelin by resection of the fundus
    • Positive impact on sensation of satiety
  • Creates a long gastric tube or sleeve
    • sized by a bougie (32-40 French may be used)
    • Pouch is between 50ml and 180 ml
    • Restrictive component
    • Less distensibility than normal stomach
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11
Q

Efficacy of Vertical Gastric Sleeve

A
  • 33 - 85% (average 60%) EWL at 5 years
  • Resolution of co morbidities comparable to those seen with other restrictive procedures:
    • T2DM - 66%
    • HTN - 54%
    • OSA - 62%
    • GERD - 69%
  • Postoperative 30-day mortality rate - 0.1%
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12
Q

Complications of Gastric Sleeve

A
  • Similar to gastric bypass
    • Gastric leak
    • Bleeding
    • Stricture and Obstruction
    • Pulmonary embolism/DVT
    • Pneumonia
    • Infection
    • Dehydration
    • Nausea and Vomiting
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13
Q

Gastric Leak

A
  • Incidence: 0-2.2%
    • Proximal staple line leaks - 1.3%
    • Distal staple line leaks - 0.5%
  • Causes
    • Staple line dehiscence
    • related to higher intraluminal pressures Postop
    • at criss-cross of stapling (staples over staples)
    • patient induced
    • Ischemic - due to electrocautery or vessel sealing systems
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14
Q

Gastric Leak Complications

A
  • Abdominal pain (epigastric or left flank)
  • Tachycardia (sustained 120 BPM for 4 hours)
  • Tachypnea
  • Fever
  • Hypotension
  • Low urine output
  • Leukocytosis
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15
Q

Gastric Leak Diagnosis

A
  • UGI
  • Abdominal CT Scan
  • surgical exploration
16
Q

Gastric Leak Treatment

A
  • Medical management
  • Percutaneous drainage, parenteral/enteral nutrition, antibiotics
  • Stents, endoscopic injection of fibrin glue
  • Surgical management
17
Q

Gastric Sleeve - Bleeding

A

Incidence - 2 %
Endoluminnal and or extraluninal
- Causes
- Increased risk due to long suture line
- Stomach has thick wall with 3 layers of very well vascularized muscle

18
Q

Gastric Sleeve - Bleed - Diagnosis

A
  • Melena
  • Hematemesis
  • Hypotension
  • Tachycardia
  • Decreased Hgb/Hct
  • Drain output
19
Q

Gastric Sleeve - Bleed - Treatment

A
  • Blood transfusion

- Reoperation

20
Q

Gastric Sleeve - Gastric Stricture and Obstruction

A

Incidence - 0-0.63%
Causes:
- latrogenic - size of bougie
- “Floppy” sleeve

21
Q

Gastric Sleeve - Stricture/Obstruction symptoms

A
  • nausea and vomiting
22
Q

Gastric sleeve - Stricture and obstruction

A

Treatment -

  • Endoscopic dilatation
  • Hydration
23
Q

Pulmonary Embolism - DVT

A

Incidence - ~1% without high risk attributes

- Responsible for nearly 1/3 of deaths in bariatric surgery patients

24
Q

PE/DVT Risk Factors

A
  • Male gender
  • Age
  • High BMI
  • Smoking
  • Estrogen/HRT
  • Decreased mobility status
  • Surgery
25
Q

PE/DVT Prevention

A
  • VTE Prophylaxis preop and postop
  • Low dose unfractionated Heparin (LDUH)
  • Low molecular weight heparin (LMWH)
  • Early ambulation
  • Graded compression stockings
  • Intermittent pneumatic compression devices
  • Prophylactic IVC filter
  • Combination of above
26
Q

Gastric Sleeve - Nausea and vomiting

A
  • Usually occurs during the first 24-36 hours postop
  • Causes:
  • Diameter of the sleeve
  • Manipulation/inflammation of stomach tissue
  • Gastric stricture
  • Gastric ulcers
  • Patient issues
  • Measuremet of food, speed of drinking and eating
27
Q

Gastric Sleeve - Treatment of N/V

A
  • Nutrition assessment and or counseling
  • Hydration
  • Antiemetic
  • Thiamine replacement
  • Endoscopic Evaluation

Knowledge Statements (1 decks)

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