bariatric surgery Flashcards
obesity increases risk of _______
multiple co-morbidities
what is obesity
accumulation of fat stores
obesity causes a ________ state
pro-inflammatory
what is the formula for BMI
weight(kg) / height (m)^2
why is central obesity more detrimental to health
added stress on vital organs
what is the criteria for bariatric surgery
> 18yrs old
BMI > 30kg/m^2
absence of : eating disorder, major psychiatric diagnosis, use of tobacco and other controlled substances
failure of non-surgical attempts at weight loss
this is a last resort for weight loss
what branch of medicine deals with management of body weight
bariatric
bariatric surgery can result in numerous post-surgery complications…what is one of the biggest/most important complication
macronutrient and micronutrient deficiencies
how does bariatric surgery affect food consumption and energy intake
it reduces it
up to what % can gastric capacity be reduced to
95%
bariatric surgery compromises _______ and ______ of nutrients.
What does this induce and why
digestion and absorption
this induces malabsorption due to anatomical changes that bypass major nutrient absorptive sites in SI
how much does bariatric surgery reduce BW
35-65% of baseline
bariatric surgery _____ co-morbidities such as diabetes, hyperlipidemia, hypertension
resolves
does the current infastructure in Canada support the growing demand for bariatric surgery?
no
what are the three types of bariatric surgery
restrictive malabsorptive combined (restrictive and malabsorptive)
outline restrictive bariatric surgery
- reduced total capacity of stomach
- promotes satiety with very little food intake
outline malabsorptive bariatric surgery
- changes anatomy of the stomach and SI
- changes digestion and absorption of nutrients
outline combined bariatric surgery
-combination of stomach restriction and change in anatomy of SI
what is the most common type of bariatric surgery
combined (restrictive and malabsoptive)
what are three types of RESTRICTIVE surgery
- Vertical banded Gastroplasty
- fixed gastric banding
- adjustable gastric banding
what is the most commonly performed gastric bypass and bariatric surgery
Roux-en-gastric bypass (RYGP)
outline RYGP (Roux-en-gastric bypass)
- mixed restrictive and malabsorptive
- most common gastric bypass and bariatric surgery
- stomahc and duodenum are pratically excluded from digestion
- small pouch is created and connected to part of jejunum
- can be used as a second surgery if sufficient weight loss does not occur with first
what are the key micronutrient issues with bariatric surgery
-primarily due to combination of decreased intake and decreased absorption
(could also consume and absorb but cant use it)
- also due to poor compliance to supplements
- poor tolerance, depression, cost
(iron, B12, folate, thiamin, Vit D and Ca)
what is the most common miconutrient deficiency after bypass surgery
IRON
Possible exam question
what are the reasons for a iron deficiency after bypass surgery (need to know at least 3 reasons)
- reduced intake of heme iron; poor tolerance to meat consumption (this already give 2 reasons….less uptake and less absorption)
- surgery causes bypass site for absorption (less absorption)
- reduced HCl in stomach to reduce ferric iron to ferrous iron for absorption (reduced ferrous iron is better absorbed)
- low compliance with iron supplementation (poor digestive tolerance to oral iron supplements, supplements can cause gastric irritation of the newly created pouch)
- could also be partly bc of GI blood loss during surgery
what should the iron deficient patient take to maintain iron stores after bypass surgery
iron supplementation
what is another common complication of bariatric surgery (besides iron)
-Vitamin B12
what deficiency is common with Roux-en-Y gastric bypass
Vit B12
what is the reasons for a B12 deficiency after bariatric surgery
- reduced Gastric acid produced from the newly created small pouch (inadequate to cleave B12 from animal protein)
- decreased intrinsic factor (key for B12 deficiency)
- limited meat intake due to poor tolerance
which is a more common bariatric complication/deficiency, folate or B12
B12
what is the primary reason for a folate deficiency after bariatric surgery
poor intake…..absorption is okay
easy to prevent with a supplement
what is done to prevent a folate bariatric complication
a supplement is always included
list the possible deficiencies of bariatric surgery
- Iron (#1)
- B12
- Folate
- Thiamin
- Vit D and Ca
- zinc
- copper
- fat soluble vitamins
which deficiency is the most common pre-existing deficiency of obese patients (before surgery)
Vit D
is a Vit D deficiency corrected or worsened after surgery/weight loss?
worsened…theres a lot of Vit D in fat stores
what is the least tolerated food in Roux-en-Y patients
milk
is a Vit E deficiency common after bariatric surgery?
no
what are two micronutrients supplemented after bariatric surgery?
zinc, copper
what micronutrients are rarely an issue in bariatric surgery complications
riboflavin
B6
Vit C
Vit E
multi vitamin and mineral supplements are routinely given before and after bariatric surgery
