Bariatric Surgery Flashcards
Surgical procedure performed on the stomach
or intestines to induce weight loss
bariatric surgery
Qualifications for surgery
BMI greater than ____ OR
BMI greater than ____ with a _______ such as diabetes, sleep apnea, hypertension, hyperlipidemia
Bariatric Coverage depending on ______
40
35
co-morbidity
insurance
gastric bypass description (GBP)
restrictive and malabsorptive
sleeve gastrectomy
restrictive
adjustable gastric Band
restrictive and adjustable
Long term average loss of ______% excess weight with bypass
Long term average loss of ____% excess weight with sleeve
Resolution or improvement of ________:
– Diabetes
– Hypertension
– GERD
– Reduction in medications
– Quality of life
60-80
50
comorbidities
advantages of gastric bypass
gold standard of wt loss surgery
restrictive and malabsorptive
usual weight loss is 60-80% excess body weight in the first 2 yrs
disadvantages of gastric bypass
Gastrointestinal rerouting
Portion of digestive tract is bypassed, which may result in
nutritional deficiencies
“Dumping syndrome” can occur
Difficult to reverse
More cuts = more changes of leaks
Roux-en-Y Gastric Bypass (RNY)
jejune attaches to small gastric pouch
duodenum attached to lower in jejunum for pancreas juices to be available
mix in jejunem
Gastric Bypass Complications
Dumping Syndrome
Leaks
Blood clots
Bleeding
Ulcers
Wound infections
Bowel obstruction
Internal hernias
Organ failure
Sepsis
Death
Sleeve Gastrectomy Advantages
- Restrictive
- Continuity of gastrointestinal tract
- No rerouting
- Decrease in hunger by removing fundus and therefore ghrelin
production - Usually achieve loss of 50% excess body weight at 2 years
Sleeve Gastrectomy Disadvantages
Pouch can stretch
Complications:
- Reflux / Leaks / Sepsis / Nausea and Vomiting
- Bleeding / Blood Clots / Vitamin Deficiencies / Death
which surgery to choose…
Very High BMI?
Type 2 Diabetic on Insulin?
GERD? Ulcers? Barrett’s?
Smoker?
NSAID use?
Prior Hernia Repairs?
Bypass
Bypass
Bypass
Sleeve
Sleeve
Sleeve
All contraindications are individualized
– Previous ___________
– Previous_______ surgery
– ________: varying degrees
* ________: NO
– _____ didn’t clear them
– Very complicated medical history & any surgery is too high risk
Nissen Fundoplication
stomach
Cirrhosis
Portal Hypertension
Psych
Most Common Nutritional Concerns Post Op
Intolerance to certain foods from _________
____________
____________
Inadequate ______ intake
Weight _____
“_____ Mentality”
nausea and vomiting
Dumping syndrome
Nutritional deficiencies
protein
regain
Diet
Dietary Guidelines in Preparation for Surgery
Eat _______ per day based on _______ and ___ and or ______
– Starch: _____ per meal, eaten ____ on the plate
3 meals
lean protein
fruit
vegetable
1 serving
last
Dietary Guidelines in Preparation for Surgery
Aim for______ of non-caloric/non-carbonated fluids
Begin _____
Physical activity (_______)
Begin mindful eating habits
64 oz
MVI (not gummy’s)
water or weights
Pre-Op Diet: Liquids
_____ days prior to surgery patients are to begin liquid pre-op diet
____ days is a full liquid diet which consists of:
– Protein shakes
– Clear Liquids:
* Sugarfree:Jell-O,popsicles,broths,CrystalLite,Mio,G2 Gatorade, coffee/tea, milk
* Limit caffeine to _____ per day
Last day of pre-op, ______ only!
– Protein shakes and milk are eliminated
NPO _____ prior to surgery
7
6
16oz
clear liquids
6 hours
Post Op Diet: Phase I Liquids
♦ Phase 1 begins the day they leave the hospital
♦ Similar to pre-op liquid diet
♦ Goals: ________
♦ Minimum ______ protein per day
♦ Sipping fluids all day long
♦ Acceptable Liquids:
– All _____ free: Water, sports drinks, broths, Jell-O, popsicles, coffee/tea, milk, protein shakes, condensed strained soups with milk
– Low blood sugar symptoms: treat with small amount of ______
♦ No ___________
Protein & Hydration
30-40g
sugar
real sugar (fruit juice, Gatorade)
straws, gum, big gulps
Post Op Diet: Phase II Soft Foods - about _____ weeks
- need soft food because _____?
♦ _______ a day
♦ _______ first
♦ _____ protein per day is goal
♦ ______ meal, slowly grows to _____ total
– Small bites, chew thoroughly, put fork down in between bites to ensure eating slowly
♦ No drinking __________ after meals
♦ Begin _______ regimen
♦ Acceptable foods:
– Cottage cheese, yogurt, eggs, crock pot meat, fish that flakes, thinly sliced lunch meat, lean ground beef, soups, soft cooked/mushy vegetables, applesauce, diced peaches
4-6 weeks
stepping stone to slowly increase fiber content
3 meals
Protein
1-2oz
4oz
during or 30 minutes
vitamin
Post Op Diet: Phase III
Building upon ______ to get back to regular diet
– Crock pot chicken → Baked chicken breast with chicken stock→
Grilled chicken breast
Focus on nutritionally balanced meals with______ as
most important macronutrient
- _________ to keep track of protein consumed per day
Every recovery and progression back to normal foods is
individualized
textures
protein
Food logging
supplements required for gastric bypass
multivitamin with minerals (2 servings) (hard chewable)
calcium
vitamin D
B12
thiamin
ferrous sulfate (around 3 month mark)
supplements required gastric sleeve
multivitamin with minerals (1 servings) (hard chewable)
calcium (citrate only)
vitamin D
B12
thiamin
ferrous sulfate (only if bloodwork indicates)
How We See a Patient: Start to Finish
- Initial
– Qualify for surgery and have bariatric coverage
– Smoking cessation
– Lab work
– Cardiac clearance
– Psych clearance
– EKG
– Pulmonary clearance & sleep study
– RD visits - _______ visits
- ____ pre-op
- Surgery
- Post op ______
Monthly
Final
follow up
