Bariatric Surgery Flashcards
Who is a candidate for bariatric surgery
BMI>40 for whom other methods failed
BMI>35 with comorbidities (HTN, T2DM, Sleep apnea)
consider BMI>30-35 with diabetes or metabolic syndrome
Outcomes of bariatric surgery
23% reduction in BMI in 1-2yr
16% reduction after 10 years
post-op complications: leaks, bleeding, infection, PE
decreases risk of stroke, MI, CVD, T2DM, and cancer
Strategies
Bypass
Band, stapling
sleeve gastrectomy - laparoscopy
Implantable devices - electrical stim, gastric baloon
Post Op issues - protein
emphasize intake of branched chain AAs deficiency depends on procedure loss of lean muscle mass hair loss and edema intake should be 60-80gm/day
Post Op issues - calcium
malabsorption and lactose intolerance
citrate better absorbed than carbonate
consider vit D; alendronate if bone loss
Post Op issues - Mg
PPI can lead to low Mg
Mg citrate better bioavail
diarrhea frequently accompanies oral replacement
Post Op issues - B vitamins
B1 deficiency: muscle weakness, cardiac, neuro
B12: anemia, weakness, tingling in finges and toes
maintenance supplements necessary lifelong
Iron deficiency \
anemia is a common long term complication
from - decr surface area, decr acid secretion, incr inflammation, frequent intolerance of red meat
treat deficiency with parenteral iron
Changes in drug use
decreased surface area for abs
decr biavail for drugs with long abs time
changes in Vd as fat is lost
decr cholesterol and diabetes meds
NO CHANGE in antidepressant use
DO NOT use NSAIDs, high risk of ulceration
Short term medication use post op
crushed or liquid meds for 2wk
risk of gall stones high with rapid weight loss –> ursodiol 300mg bid for 6mo
use PPI or H2RA for at least 2mo post op
Contraception post op
recommend against pregnancy for 12-18mo abs of OC are reduced flaccid skin makes admin difficult diaphragms, female condoms, vaginal rings difficult to insert in obese patients IUD standard of care
