Bariatric Surgery Flashcards
What comorbidities must be present for a BMI of 30-34.9 to be a candidate for bariatric surgery?
uncontrollable Type 2 DM and metabolic syndrome
Psych disorders that are contraindications for bariatric surgery
bulemia, major depression, psychosis, substance abuse
Age range to qualify for bariatric surgery
between 18-65
Most common bariatric surgeries in order of prevelance
Roux-en Y gastric bypass (47%), sleeve gastrectomy (28%), and Lap. band surgery (18%)
Involves the creation of a small gastric pouch and an anastomosis to a Roux limb of jejunum that bypasses 75-150 cm of small bowel
Roux-en Y gastric bypass
Characterized by lightheadedness, nausea, diaphoresis and/or abdominal pain, and diarrhea. Result of eating high sugar meal after gastrojejunostomy
dumping syndrome
Hormonal alterations that result in decreased appetitie after gastrojejunostomy
ghrelin inhibition and increased GLP-1/CCK
Majority of greater curvature of stomach is removed and a tubular stomach is created. More resistant to stretching due to absence of fundus
sleeve gastrectomy
Compartmentalizes the upper stomach by placing an adjustable tight band around entrance to the stomach taht is connected to a subcutaneous infusion port.
lap. band surgery
Bariatric surgery with the lowest mortality rate
lap band
Major vital signs to monitor post surgery.
hypoglycemia and hypotension
How often should BP and weight be checked post operatively?
every 4-6 weeks for the first 6 months. Then at 9 and 12 months post surgery
Which type of surgery doesn’t cause significant macronutrient deficiencies?
Roux-en Y gastric bypass
Deficiency associated with lap band surgery
folate
Deficiency associated with sleeve gastrectomy
B12
Type of formulations of medications that should be used postoperatively
crush or liquid. Insulin instead of oral antidiabetics
What class of medications should be avoided postoperatively?
NSAIDs
Average caloric intake for the first month after surgery
400-800 kcal diet/day
T/F Improvement in DM control happens regardless of the amount of weight lost
true
Gastric pouch severe distention secondary to mechanical obstruction or paralytic ileus. Progressive distention and rupture. May be fatal
Gastric remnant distention
Sx include: hiccups, LUQ tympany, shoulder pain, abdominal distention, tachycardia, SOB, large gastric bubble on xray
gastric remnant distention
After several weeks post-op may present with N/V, dysphagia, GE reflux, inability to tolerate oral intake
stomal stenosis
Occur near the gastrojejunostomy. Acid injury to the jejunum or associated with gastrogastric fistula
marginal ulcers
Sx include: RUQ pain that lasts longer the 6 hrs and starts post eating, worse with deep inspiration, shoulder pain, N/V, fever,
Acute cholecystitis/cholelithiasis
Cause of mesenteric swirl
internal hernia
Results in severe micro and macronutrient deficiencies. In severe cases may require intestinal transplantation
short bowel syndrome
May be secondary to insulinoma. May be secondary to islet cell hypertrophy. Slowing food transit time may resolve the symptoms
severe hypoglycemia
Changes in bowel habits associated with the different surgeries
RYGB often has diarrhea. Constipation seen post gastric banding
What would be the diagnosis if you had a gastric band patient who came in with persistent nausea, vomiting and inability to tolerate secretions or oral intake?
stomal obstruction
Treatment for stomal obstruction
NG tube to decompress until edema subsides or surgery for band revision
What would be the diagnosis if you had a gastric band patient who came in 2yrs post surgery with infection, failure of weight loss, N/V, epigastric pain, hematemesis?
band erosion
What are the most common complications of sleeve gastrectomies?
GERD, bleeding, stenosis of stoma, and leaks***
