Bariatric Surgery Flashcards
What is Morbid Obesity?
BMI >40 or BMI >35 with comorbid conditions
200% more than ideal weight
100 lbs overweight
What are the classifications of obesity?
Class I: BMI 30.0-34.9
Class II: BMI 35.0-39.9
Class III: BMI 40.0 and above
What are the three main factors that affect obesity?
- genetic
- behavioral
- environmental
What is the Gastric Bypass Roux-en-Y procedure?
pouch is made
duodenum is bypassed
jejunum is attached to the pouch
What is the average weight loss for Gastric Bypass?
77% in 1-1.5 years
at 10 years, usually regain about 10-15%
What are the complications associated with Gastric Bypass?
peritonitis, abdominal wall hernia, staple line disruption, wound infection, GI symptoms, blood clots, nutritional def.
what are some of the long term risks of bypass?
Internal hernia Bowel Obstruction or blockage Narrowing of one of the intestinal connections Flatulence/Gas Diarrhea/Constipation Failure to Lose Weight/Weight Re-gain Vitamin Deficiencies/Malnutrition Ulcers
true or false: people lose more weight by changing their diet than by doing a bariatric surgery?
FALSE
What are some of the benefits of Gastric Bypass?
- Diabetes: 90% become diet controlled
(Most patients leave the hospital on NO medicines) - High blood pressure: 66% resolved; 33% less medications
- Reflux/Heartburn: 95% resolved
- Sleep apnea: 90 % resolved
- Stress Incontinence: 90% resolved
- High cholesterol/triglyceride: 90% resolved
What needs to be considered from a nutrition stand point for bypass surgery?
the surgery is restrictive (1 0z an hour) and malabsorptive
- protein energy malnutrition
- vitamin and mineral malabsorption
- adequate hydration
Obese individuals are at risk for several macronutrient deficiencies. What are they?
Iron
Vit D, E, C
B-12
Protein
is gastric bypass surgery reversible?
yes
What is the laparoscopic sleeve gastrectomy?
New procedure
non-reversible
Causes restriction by making the stomach a long narrow tube
No malabsorption
sleeve surgery helps reduce what appetite stimulant?
grehlin
What are the risks associated with sleeve surgery?
operation risks and n/v
What are the benefits of sleeve surgery?
- NO dumping syndrome
- NO internal hernia
- LESS vit def., protein malnutrition, anemia, and osteoporosis
What is an alternative for the sleeve procedure?
staged procedure.
What needs to be considered from a nutrition stand point for sleeve surgery?
the surgery is restrictive and malabsorptive
- protein energy malnutrition
- vitamin and mineral malabsorption
- adequate hydration
What is gastric banding?
- Molds the stomach into two connected chambers
- Limits the amount of food that can be eaten at one time
- Upper stomach can only hold approximately ½ cup of food
What is the goal of gastric banding?
lose 1-2 pounds a week
do this by tightening and loosening the band
What are some risks associated with gastric banding?
band slips and erosions Port flips Tubing-related complications (port disconnection, tubing kinking) Band leak Esophageal spasm Gastroesophageal reflux disease (GERD) Inflammation of the esophagus or stomach Port-site infection
what has gastric banding been shown to improve besides weight?
diabetes, htn, joint pain, sleep apnea, GERD
What is Biliopancreatic Diversion with or without Duodenal Switch?
combo of bypass and sleeve
What are the nutrition goals post surgery?
0-6 months post op:
60-70 grams protein /day
90 or less grams CHO/day
-initially significantly less
<1300 cals/day
