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Gastrointestinal 1 > Bariatric Surgery > Flashcards

Bariatric Surgery Flashcards

1
Q

What is the Body Mass Index (BMI)?

A

weight (kg)/ height (m)^2

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2
Q

What BMI qualifies a pt for bariatric surgery?

A
  • severely obese (BMI 35 - 39.9)

- morbidly obese (BMI 40 or more)

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3
Q

What does leptin do?

A
  • decreases appetite

* obese patients may have a decreased sensitization to this hormone.

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4
Q

What does ghrelin do?

A
  • increases appetite.
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5
Q

What is important about the gallbladder regarding bariatric surgery?

A

following surgery, pts are more prone to gallstones, and thus if a pt has gallstones prior to surgery, they will likely be getting a cholecystectomy during the surgery as well.

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6
Q

How has obesity changed over the past 30 years?

A

it has increased in both sexes in all age groups and all racial groups.

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7
Q

How have bariatric operations since 1992 increased?

A
  • increased steadily (200,000 per year now).

* this is reaching 1% those whom need it.

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8
Q

What are the requirements for bariatric surgery?

A
  • BMI >40
  • BMI 35-40 then need either obstructive sleep apnea, T2DM, or HTN.
  • Age >18 (this doesn’t hold true today).
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9
Q

Why do we no longer do jejunoileal bypass?

A

bc it left a large portion of the jejunum with no flow through it, leading to electrolyte abnormalities, osteoporosis, steatosis, protein malnutrition, edema, gallstones, and toxic overgrowth of bacteria in the bypassed intestine.

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10
Q

Why do we no longer do vertical banded gastroplasty?

A
  • its a restrictive procedure that creates a small pouch that empties into the rest of the stomach through a small opening. PTs regained weight eventually.
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11
Q

What general procedures are done today?

A
  • malabsorptive
  • restrictive
  • combination of the two.
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12
Q

What are the most common surgical options today?

A
  • gastric bypass
  • sleeve gastrectomy
  • adjustable gastric band
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13
Q

What is gastric bypass?

A

small gastric pouch (15-30cc) is created by stapling or transecting the proximal stomach to the jejunum (roux limb) called the gastrojejenostomy. A separate jejunojejunal anastomosis is made connecting the original jejunum (near the distal duodenum; called the biliopancreatic limb) to a portion in the midjejunum, for which bile and pancreatic enzymes can enter.
*the length of the roux limb determines how much malabsorption you will have (75-150 cm).

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14
Q

What specific vitamin deficiencies must we take into account for gastric bypass?

A
  • iron because it is absorbed in the duodenum (which you have bypassed) and some in the jejunum.
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15
Q

What are some medical co-morbidities resolved with gastric bypass?

A

T2DM, HTN, hypercholesterolemia, GERD, SLEEP APNEA, and osteoarthritis.

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16
Q

What is dumping syndrome?

A
  • vasomotor response to pts eating a lot of sugar following gastric bypass surgery. Symptoms include swelling, cramping, and light-headedness.
    Most will experience this on occasion.
17
Q

Can anastomic ulcer formation occur where the stomach is connected to the jejunum in gastric bypass?

A

YES.

Risk factors include smoking, NSAIDS, H. pylori, alcohol use, steroids.

18
Q

What almost always accompanies ulcers in gastric bypass?

A
  • stricture formation
19
Q

What is an important concern to be aware of following gastric bypass?

A

abdominal pain over 4 hours could be closed loop obstructions or internal hernias unique to gastric bypass and lethal if ischemic bowel (ischemia usually in 6 hours).

20
Q

What is a vertical sleeve gastrectomy?

A

resection of about 80% of the stomach.
*advantages= no malabsorption bc we are just making the stomach smaller and reduces grehlin (made in the fundus and body which is removed.

21
Q

What are some limitations of vertical sleeve gastrectomy?

A
  • Barrett’s esophagus or esophageal dysmotility bc this surgery increases intraabdominal pressure, increasing the risk of more gastric acid reflux.
22
Q

What are some complications with vertical sleeve gastrectomy?

A
  • gastric leak (due to increased pressure)
  • postop bleeding
  • stenosis
  • volvulus
23
Q

Are laparoscopic adjustable gastric banding procedures going out of style?

A

YES due to band slippage.

24
Q

What is biliopancreatic diversion with duodenal switch (BPD-DS)?

A

combination of sleeve gastrectomy with a very long gastric bypass, used for patients who are EXTREMELY obese.
*not commonly performed due to severe malabsorption problems.

25
Q

What is stomach intestinal pylorus sparing surgery (SIPS)?

A

new procedure that is modified from BPD-DS

Gastrointestinal 1 (21 decks)

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