Bariatric Surgery

Question 1

Duodenal switch procedure

Answer 1

Question 2

Results and complications of the four main bariatric procedures

Answer 2

Question 3

Effects of bariatric surgery on various comorbidities of obesity

Answer 3

Question 4

Prerequisites for bariatric surgery

Answer 4

• BMI requirement:
  
  • >40 kg/m2
  • >35 kg/m2 with comorbidity
• Previous trial and failure of supervised weight loss program of at least 6 months duration (includes diet, exercise, medication)
• Pass psychological evaluation and be willing to comply with post-operative life-style changes and dietary restriction, exercise, follow-up programs
• Good surgical candidate

Question 5

Initial treatment for obesity hypoventilation syndrome

Answer 5

CPAP or BIPAP

Question 6

Diagnosis of obesity hypoventilation syndrome

Answer 6

• Obesity (BMI ≥30)
• + daytime hypercapnia (ABG with pCO2 greater than or equal to 45 mmHg)
• + sleep-disordered breathing,
• without another alternative explanation for hypoventilation

Question 7

Historical factors that should make you suspect obesity hypoventilation syndrome

Answer 7

• Dyspnea with exertion
• Morning headaches (may be secondary to retained CO2)
• Other sleep-disordered breathing questions: Snoring? Poor quality sleep? Mental cloudiness?
• Epworth Sleepiness scale

Question 8

Pathophysiologic trifecta of obesity hypoventilation syndrome

Answer 8

• Leptin resistance (leptin is a powerful ventilatory stimulus)
• Extrathoracic chest wall restriction (central obesity) and associated PFT changes
• Comorbid presence of OSA (~80% overlap between the two)

Question 9

Since gastric sleeve is essentially the first step of ____, you can always finish the ____ procedure at a later date if surgical control of weight is insufficient

Answer 9

Since gastric sleeve is essentially the first step of duodenal switch, you can always finish the duodenal switch procedure at a later date if surgical control of weight is insufficient

Question 10

Most common, most serious postoperative complication of Roux-en-Y gastric bypass / small pouch gastric bypass

Answer 10

Leakage of intestinal contents from the gastrojejunal anastamosis

Characterized by fever, leukocytosis, L shoulder pain on POD#3-5

Question 11

Obesity protects against osteo___, but worsens osteo___.

Answer 11

Obesity protects against osteoporosis, but worsens osteoarthritis.

Question 12

Indications for weight loss medication vs bariatric surgery

Answer 12

• Bariatric surgery:
  
  • BMI > 40 or > 35 + symptoms
  • Prior trial of regimented diet/exercise program x 6 months
  • Medication trial is NOT required
• Weight loss medication:
  
  • BMI > 30 or > 25 + symptoms

Question 13

Weight loss medication optons

Answer 13

• First line:
  
  • Orlistat
  • Liraglutide
• Other possibilities:
  
  • Combination w/ naltrxone - buproprion
  • Combination w/ phentermine - topiramate