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Advanced MNT 1 > Bariatric Surgery > Flashcards

Bariatric Surgery Flashcards

1
Q

Surgical procedure performed on the stomach
or intestines to induce weight loss

A

bariatric surgery

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2
Q

Qualifications for surgery

BMI greater than ____ OR
BMI greater than ____ with a _______ such as diabetes, sleep apnea, hypertension, hyperlipidemia

Bariatric Coverage depending on ______

A

40
35
co-morbidity
insurance

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3
Q

gastric bypass description (GBP)

A

restrictive and malabsorptive

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4
Q

sleeve gastrectomy

A

restrictive

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5
Q

adjustable gastric Band

A

restrictive and adjustable

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6
Q

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

A

60-80
50

comorbidities

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7
Q

advantages of gastric bypass

A

gold standard of wt loss surgery
restrictive and malabsorptive
usual weight loss is 60-80% excess body weight in the first 2 yrs

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8
Q

disadvantages of gastric bypass

A

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

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9
Q

Roux-en-Y Gastric Bypass (RNY)

A

jejune attaches to small gastric pouch
duodenum attached to lower in jejunum for pancreas juices to be available
mix in jejunem

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10
Q

Gastric Bypass Complications

A

Dumping Syndrome
Leaks
Blood clots
Bleeding
Ulcers
Wound infections
Bowel obstruction
Internal hernias
Organ failure
Sepsis
Death

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11
Q

Sleeve Gastrectomy Advantages

A
  • 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
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12
Q

Sleeve Gastrectomy Disadvantages

A

Pouch can stretch

Complications:
- Reflux / Leaks / Sepsis / Nausea and Vomiting
- Bleeding / Blood Clots / Vitamin Deficiencies / Death

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13
Q

which surgery to choose…

Very High BMI?
Type 2 Diabetic on Insulin?
GERD? Ulcers? Barrett’s?
Smoker?
NSAID use?
Prior Hernia Repairs?

A

Bypass
Bypass
Bypass
Sleeve
Sleeve
Sleeve

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14
Q

All contraindications are individualized
– Previous ___________
– Previous_______ surgery
– ________: varying degrees
* ________: NO
– _____ didn’t clear them
– Very complicated medical history & any surgery is too high risk

A

Nissen Fundoplication
stomach
Cirrhosis
Portal Hypertension
Psych

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15
Q

Most Common Nutritional Concerns Post Op

Intolerance to certain foods from _________
____________
____________
Inadequate ______ intake
Weight _____
“_____ Mentality”

A

nausea and vomiting
Dumping syndrome
Nutritional deficiencies
protein
regain
Diet

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16
Q

Dietary Guidelines in Preparation for Surgery

Eat _______ per day based on _______ and ___ and or ______
– Starch: _____ per meal, eaten ____ on the plate

A

3 meals
lean protein
fruit
vegetable
1 serving
last

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17
Q

Dietary Guidelines in Preparation for Surgery

Aim for______ of non-caloric/non-carbonated fluids
Begin _____
Physical activity (_______)
Begin mindful eating habits

A

64 oz
MVI (not gummy’s)
water or weights

18
Q

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

A

7

6
16oz
clear liquids
6 hours

19
Q

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 ___________

A

Protein & Hydration
30-40g
sugar
real sugar (fruit juice, Gatorade)
straws, gum, big gulps

20
Q

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

A

4-6 weeks
stepping stone to slowly increase fiber content

3 meals
Protein
1-2oz
4oz
during or 30 minutes
vitamin

21
Q

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

A

textures
protein
Food logging

22
Q

supplements required for gastric bypass

A

multivitamin with minerals (2 servings) (hard chewable)
calcium
vitamin D
B12
thiamin
ferrous sulfate (around 3 month mark)

23
Q

supplements required gastric sleeve

A

multivitamin with minerals (1 servings) (hard chewable)
calcium (citrate only)
vitamin D
B12
thiamin
ferrous sulfate (only if bloodwork indicates)

24
Q

How We See a Patient: Start to Finish

  1. Initial
    – Qualify for surgery and have bariatric coverage
    – Smoking cessation
    – Lab work
    – Cardiac clearance
    – Psych clearance
    – EKG
    – Pulmonary clearance & sleep study
    – RD visits
  2. _______ visits
  3. ____ pre-op
  4. Surgery
  5. Post op ______
A

Monthly
Final
follow up

25
Q

Motivational Interviewing
♦ Eliciting _________ is one of the biggest parts of this job
♦ Limited amount of _______ with patients
♦ Eliminating __________
♦ Lifestyle changes
♦ __________ monthly

A

behavior change
time
diet mentality
Support groups

26
Q

Medical Management of Obesity
♦ Non-invasive weight loss approach working with PCP & PA

♦ 6 weight loss drugs approved by FDA:
____________________

♦ RD involvement: lifestyle modification and exercise
♦ Education is individualized

A

Orlistat (Xenical or Alli)
Phentermine(Adipex)
Belviq (Lorcaserin)
Contrave (Naltrexone and Bupropion)
Qsymia (Phentermine and Topiramate)
Saxenda (Victoza)

27
Q

bariatric vitamins do not contain what

A

the calcium and iron bc they compete

28
Q

Should not get pregnant for ______ after bariatric surgery

A

12-18 months

29
Q

most common surgery as of recently

A

sleeve

30
Q

structure of Biliopancreatic Diversion (BPD)

A

stomach cut smaller and stomach attached to ileum
less length where they connect for mixing (more risk)

31
Q

AKA Roux-en-Y Gastric Bypass

Small gastric pouch (____oz) created by _____ partition

______ is attached to the gastric pouch via a narrow __________ (~ _____)

Food bypasses the ____________

Weight loss is caused by restricted intake, decreased hunger & malabsorption

A

~1
staple

Jejunum
anastomosis
2 cm (why they need soft foods)

distal stomach, duodenum, & proximal jejunum

32
Q

Nutritional Concerns of Bariatric Surgery

N/V
_________ (more common in _____)
Dehydration
Protein malnutrition
Micronutrient deficiencies
Weight loss failure or regain

A

Dumping Syndrome (RYGB)

bypass bc smaller stomach, loss of pyloric sphincter, no slow down mechanism

33
Q

Common Food Intolerances
* Tough _____
* _____ vegetables
* ____ fruits, skins
* __________ (snacks)
* ______ beverages
* _____ (gastric bypass)

A

meat
Raw
Dried
Seeds, nuts, popcorn
Carbonated
Sweets

34
Q

Most common nutrient deficiencies

A

B12
Iron
calcium
folate
thiamin
fat soluble

35
Q

Vitamin B12 deficiency due to decreased _____ intake
decreased ________ levels, and decreased ________

A

meat
HCl & pepsin
intrinsic factor

36
Q

Iron deficiency from…
Decreased intake of _____
Decreased _____
Bypassed ___________

A

heme iron
HCl
duodenum (RYGB)

37
Q

Calcium deficiency from…

Decreased _______
Bypassed ________
__________ deficiency
_________

A

intake
duodenum
Vitamin D
Steatorrhea

38
Q

Folate deficiency from…

Decreased_______
__________ deficiency

A

intake
Vitamin B12

39
Q

Thiamin deficiency from
________
Excessive _______
Deficiency can cause __________ syndrome

A

N/V
alcohol use
Wernicke-Korsakoff

40
Q

Fat-soluble vitamin deficiency from ___________

A

Biliopancreatic diversion

41
Q

B12 only absorbed in _______

A

ileum

Advanced MNT 1 (20 decks)

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