Bariatric Surgery Flashcards
pros of surgical treatment for obesity
*50-75% weight loss
*less than or equal to 15% failure rate
*medical CO-MORBIDITIES IMPROVE/resolve
cons of surgical treatment for obesity
*expensive
*early/late surgical risks
*long-term nutritional deficiencies common
indications for bariatric surgery - categories
- obesity class
- age
- history of FAILED DIETARY + DRUG TREATMENT
- contraindications
indications for bariatric surgery - OBESITY CLASS
*BMI > 40
OR
*BMI > 35 + uncontrollable metabolic complications
indications for bariatric surgery - AGE
*most programs consider patients age 18-65+
*surgery in children < 18 yo is increasing
CONTRAINDICATIONS for bariatric surgery
*advanced renal, hepatic, cardiopulmonary disease
*untreated cancer
*dementia
*substance abuse
*depression
*noncompliance
bariatric surgical options
- restrictive: laparoscopic sleeve gastrectomy (LSG)
- combination restrictive + malabsorptive: laparoscopic Roux-en-Y gastric bypass
sleeve gastrectomy
*stomach is resected to 15% of its original size
*MOA: reduced meal side; fat malabsorption
*advantages: easy to perform; up to 60% EWL at 4 years
*disadvantages: non-reversible; not as effect as RYGB for very high BMI patients
risks with sleeve gastrectomy
*death -> 1 in 500
*leaks
*bleeding
*gastric stenosis
*GERD
*dilation and weight gain
laparoscopic Roux-en-Y gastric bypass (RYGB)
*stomach is bypassed and a roux-en-Y limb is created
*MOA: increased secretion of anorexic gut hormones GLP-1 and PYY
*advantages: up to 75% EWL at 4 years; immediately improves insulin resistance & glucoregulation; best improvement in other metabolic co-morbidities
*disadvantages: GREATEST INCIDENCE OF LONG-TERM NUTRITIONAL COMPLICATIONS
surgery-related risks of Roux-en-Y gastric bypass (RYGB)
*early:
-death -> 1 in 300
-leaks
-pulmonary embolism
-deep vein thrombosis
*late:
-ulcers, strictures
-bowel obstruction
-dumping syndrome
-cholecystitis
nutritional complications of Roux-en-Y gastric bypass (RYGB)
- protein deficiency
- mineral deficiencies (iron + calcium malabsorption)
- vitamin deficiencies (B1, B3, B9, B12, A, and D)
- bacterial overgrowth
- enteric hyperoxaluria
protein deficiency in Roux-en-Y gastric bypass (RYGB)
*malabsorption: impaired intra-luminal digestion + decreased small bowel surface area
*protein-loosing enteropathy: SIBO -> mucosal inflammation -> disrupted blood-gut barrier (leaky gut)
*symptoms:
-hypoalbuminemia
-peripheral edema
-low transferrin, prealbumin, IgG/A
-worsening diarrhea, gas, bloating
-UNEXPLAINED RAPID WEIGHT GAIN
treatment of protein deficiency post-Roux-en-Y gastric bypass (RYGB)
- rule out SIBO
- evaluate for protein-losing enteropathy
- INCREASE INTAKE OF HIGH PROTEIN FOODS
mineral deficiencies in Roux-en-Y gastric bypass (RYGB)
- iron malabsorption
-bypassed gastric Fe3+ reduction
-bypassed duodenal Fe2+ absorption - calcium malabsorption
-secondary to fat malabsorption
symptoms of iron malabsorption post-Roux-en-Y gastric bypass (RYGB)
*pica (usually manifests as ice chewing)
*iron-deficiency microcytic anemia
symptoms of calcium malabsorption post-Roux-en-Y gastric bypass (RYGB)
*accelerated osteoporosis
*enteric hyperoxaluria
*oxalate kidney stones
treatment of iron deficiency post-Roux-en-Y gastric bypass (RYGB)
*increased intake of red meats (heme iron is better absorbed)
*oral (inorganic) iron supplements
*oral heme iron supplements
*IV iron infusions
treatment of calcium deficiency post-Roux-en-Y gastric bypass (RYGB)
*increased intake of calcium-rich foods
*oral calcium supplementations:
-Ca oxide (can cause diarrhea)
-Ca citrate & glycinate are more efficiently absorbed
vitamin deficiencies in Roux-en-Y gastric bypass (RYGB)
- B vitamins (thiamine, niacin, folate) - loss of absorptive surface area
- vitamin B12 (reduced gastric intrinsic factor availability + ineffective IF binding)
- fat soluble vitamins (A and D) secondary to fat malabsorption
symptoms of B-vitamin deficiencies post-Roux-en-Y gastric bypass (RYGB)
*glossitis & cheilosis
*macrocytic anemia
*neurologic dysfunction
symptoms of vitamin A/D deficiencies post-Roux-en-Y gastric bypass (RYGB)
*night blindness
*accelerated osteoporosis
treatment of vitamin deficiencies post-Roux-en-Y gastric bypass (RYGB)
*AVOID large, solid multivitamin pills; instead:
-GUMMY VITAMINS
OR
-supplement vitamins INDIVIDUALLY
post-bariatric surgery diet
*new eating pattern (“behavioral pylorus”):
-multiple small meals
-careful mastication
-slow: 20-30 minutes to eat a meal
-solid and liquid foods at separate times
*new dietary composition (increased protein and decreased fat)
*supplements (vitamins + minerals)
