Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NUTR 443 Diabetes and Cardiovascular > Bariatric Surgery > Flashcards

Bariatric Surgery Flashcards

1
Q

Definition of bariatric surgery

A

Surgery on the GI tract for the purpose of inducing weight loss in extremely obese subjects.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Objective of bariatric surgery

A

Reducing caloric intake through modifications of the gastro-intestinal system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Classifications of bariatric surgery

A
  • Restrictive procedures
  • Malabsorptive procedures
  • Combined procedures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Eligibility criteria for bariatric surgery

A

Canadian clinical practice guidelines:
* Previous unsuccessful attempts at losing weight through lifestyle modification
* Have a BMI > 40 kg/m2 or a BMI > 35kg/m2 with obesity related comorbidities (such as T2D)
* Be properly consulted on procedure
* Be emotionally and mentally prepared (psychologically able to receive procedure)
* Have proper support systems
* Be committed to life-long adherence to lifestyle changes after surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pros of bariatric surgery

A
  • Average weight loss of 65%
  • Sustained weight loss
  • Resolution of obesity related comorbidities
  • Reduction in mortality
  • Improved health outcomes and quality of life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cons of bariatric surgery

A
  • Cost
  • Long term issues with fat malabsorption, protein-energy malnutrition, micronutrient deficiencies
  • Permanent procedure (RYGB, VSG)
  • Surgical Complications
  • Dumping syndrome
  • Hypoglycemia (may secrete too much insulin)
  • excess of skin, may need corrective surgery afterwards
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 4 common procedures for bariatric surgery?

A
  • vertical sleeve gastrectomy (VSG)
  • Adjustable gastric banding
  • Roux-en-Y gastric bypass (RYGB)
  • Bilio-pancreatic diversion with duodenal switch
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe VSG

A

Removing a part of the stomach creating smaller stomach (restricted procedure exclusively) so eat little and then feel full

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the adjustable gastric binding

A

Band placed around stomach and is adjustable so can change size; reversible of neccessary (restrictive procedure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe RYGB

A

More complex; reduce size of stomach (gastrectomy) and then also reattach colon directly to stomach and reattach the other colon to get all the enzymes so bypass a certain region of GI tract (malabsorption)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe Bilio-pancreatic diversion with duodenal switch

A

Bypass duodenum but still attach to colon to get enzymes (malabsorption)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Prevalence of bariatric

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

metabolic outcomes of different bariatric procedures

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

bariatric surgery and BMI

A

Bariatric surgery alone results in greater reduction in BMI than multidisciplinary approaches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

bariatric surgery and weight loss

A

Bariatric surgery induces significant and durable weight reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is diabetes remission defined as?

A
  • HbA1c <5.7%
  • Fasting blood glucose <5.6mmol/L
  • Without dependence of diabetic medications
17
Q

How fast can T2D remission post bariatric surgery occur?

A

Diabetes remission results from improvements in both insulin resistance and beta-cell function. The degree of their improvement depends on the
type of surgery performed
* Restrictive procedures are thought to achieve glycemic control purely through weight loss without an entero-hormonal effect (In that case, the remission of diabetes is slow and occurs in parallel with gradual weight loss)
* Roux-en-Y gastric bypass (RYGB) elicits significant hormonal changes after surgery. Glycemic control is acute and immediate via a weight-independent mechanism → ~75% of diabetic patients go into remission within days (sometimes even 24 hours!) after RYGB surgery

18
Q

Effectiveness of bariatric surgery on diabetes remission

A

Bariatric surgery is more effective than multidisciplinary interventions when it comes to diabetes remission
* Gastric bypass: 75%
* BPD/DS: 95%
* Sleeve gastrectomy: 80%
* Gastric banding: 47.9%

Versus NHANES III: 7.3% of T2D adults on a
lifestyle intervention reached HbA1c < 7%
(Saydah 2004)

19
Q

Timeline for diabetes remission

A
20
Q

When does ↓ insulin resistance (HOMA–IR) occur?

A
  • Roux-en-Y, BPD/DS: 2 weeks
  • Sleeve: 1 month
  • Gastric banding: 6 months (due to weight loss)
21
Q

What are common improvements of metabolic markers 2 yr post-surgery

A
  1. Weight loss with↓ visceral fat mass
  2. ↓ fat tissue accumulation & ↓ systemic inflammation
  3. ↑ insulin sensitivity

Huge decreases in markers such as SFD, VFD, VFD/SFD, hs-CRP, leptin, adiponectin

22
Q

what other comorbidities associated with obesity might be resolved by bariatric surgery?

A
  • Hypertension, lipid profile, CVDs
  • Sleep apnea
  • Gastro-oesophagal reflux disease, NAFLD
  • Systemic inflammation
  • Osteoarthritis
  • Quality of life, psychological health
  • Type 2 diabetes mellitus (14 years after surgery, >80% of the patients still maintain normal blood glucose levels)
23
Q

Health agencies recommandations for bariatric surgery

A
24
Q

Proposed theories for improved glycemic control following bariatric surgery

A

Bariatric surgery induces fast and durable improvement of glycemic control in T2D subjects, even before significant weight loss is achieved; Potential mechanisms include:
* Caloric restriction
* Reduction of foregut orexigenic hormones (ghrelin, other unknown factors)
* Increased secretion of incretin by the distal GI tract
* Increased circulating bile acids

25
Q

Proposed hypotheses for improved glycemic control following bariatric surgery

A
  • Hindgut hypothesis: (may secrete something that is good) Nutrients reach the distal bowel rapidly. Potential mediators include GLP1 and other appetite suppressing hormones
  • Foregut Hypothesis: (exclude something that is bad somehow) Exclusion of the duodenum and proximal jejunum prevents an anti-incretin signal (which promotes insulin resistance and T2D)
26
Q

Effects of bariatric surgery on various hormones

A
27
Q

RYGB effect on GLP-1

A

GLP-1 is increased early after Roux-en-Y gastric bypass in humans
* basically restores secretion

28
Q

How does GLP-1 mediate effects with bariatric surgery?

A

Gave meal after surgery and see give rise on all the effects on glucose and so argue huge contribution of GLP-1 in remission because with blocker competency abolish it.

29
Q

How are bile acids effected by bariatric surgery?

A

BA levels are normally decreased in obesity but are re-established following gastric bypass

30
Q

What are bile acids and their role?

A

Bile acids are steroidal molecules and they emulsify and help in digestion of dietary fat

31
Q

How to bile acids act as signalling molecules?

A
  • They act as ligands for the transcription factor Farnesoid X receptor (FXR). FXR controls liver gluconeogenesis, TG and cholesterol metabolism
  • Bile acids also activate TGR5 in L-cells to stimulate GLP1 release.
32
Q

Whole body effect of bile acids as a signalling molecule through FXR and TGR5

A
33
Q

How does microbiota differ in obese individuals?

A

Obesity is associated with ↑ Firmicutes > bacteriodes with a decrease in microbiome diversity
* firmicutes love refined carbs and added sugar
* bacteriodes prefer fibre rich whole foods

34
Q

How does bariatric surgery affect the gut microbiota?

A

Bariatric surgery alters the gut microbiota by ↓ firmicutes/bacteriodes ratio and ↑ diversity
* Mice colonized with stools from bariatric surgery patients displayed reduced fat deposition (so changes in microbiome may not only be consequence but also cause)
* Alterations in gut microbiome could play a role in some of the metabolic improvements

35
Q

Summary of alterations with bariatric surgery

A

NUTR 443 Diabetes and Cardiovascular (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions