Bariatric surgery

Question 1

reasons for bariatric surgery

Answer 1

comorbidity resolution 
chronic disease and obesity related condition prevention 
improvement in quality of life 
BMI over 40 
BMI over 35 with comorbid condition 
failure of diet and exercise 
compliant patient

Question 2

what are the 3 types of procedures

Answer 2

restrictive - consume less food
malabsorptive - less calories absorbed
combined

Question 3

what are the 4 procedures

Answer 3

roux en y bypass - combined and hormonal
sleeve gasrectomy - restrictive with hormonal
biliopancreatic diversion wiht duodenal switch - malabsorptive
gastric band - restrictive

Question 4

how does gastric bypass surgery work

Answer 4

cut top portion of stomach and attach the SIthere bypassing the distal stomach, duodenum, and part of jejenum causing malabsorption

Question 5

what are some hormonal changes that occur

Answer 5

increased insulin sensitivity and production
increased satiety
decreased hunger

Question 6

what is sleeve gastrectomy

Answer 6

removed 80% of the stomach so just a narrow tube

Question 7

what is the preoperation diet and whats it for

Answer 7

5 bottles of boost diabetic a day

have to shrink the liver so can access the stomach

Question 8

hwo much protein is needed post op

Answer 8

1g/kg/day for 1 year

Question 9

how many calories are required post op long term

Answer 9

1200kcal per day

Question 10

what type of diet is followed post op

Answer 10

high protein, high fiber, low carb

Question 11

fluid diet post op

Answer 11

minimum 2L/day separate from meals
avoid carbonated
limit caffiene and alcohol

Question 12

phase 1 post op

Answer 12

1-7 days

clear fluids and meal replacement

Question 13

phase 2 post op

Answer 13

1-4 weeks

pureed foods

Question 14

phase 3 post op

Answer 14

4-8 weeks

soft minced foods

Question 15

phase 4 post op

Answer 15

8-12 weeks

regular food

Question 16

required vitamins and minerals

Answer 16

1 multivitamin a day 
iron 
calcium 
vit B12 
vit D

Question 17

potential early complications

Answer 17

bleed
NV
dehydration
staple line leak

Question 18

potential late complications

Answer 18

adehesions 
ulcer - dont smoke!
stomal stenosis 
constipation, diarrhea
pouch dilation

Question 19

what causes dumping syndrome

Answer 19

rapid transit of free sugars or greasy foods into the lower SI

Question 20

timeframe of dumping syndrome

Answer 20

early phase immediate or an hour later

late phase 1-3 hours later due to insulin response

Question 21

symptoms of dumping syndrom

Answer 21

NV 
diarrhea
hypoglycemic symptoms
dizziness
stomach pain

Question 22

early nutrient complications

Answer 22

food intolerance

dumping syndrome

Question 23

late nutrient complications

Answer 23

increased risk of kidney stones
hair loss
reactive hypoglycemia
lack of appetite

Question 24

micronutrient deficiences

Answer 24

vit A, D, B12
thiamine 
copper 
zinc
iron

Question 25

medication changes

Answer 25

NSAIDS increase risk of ulcer
oral contraceptive absorption unknown use other forms
drug absorption unknown so close monitoring
avoid extended release or enteric coated

Question 26

alcohol use after surgery

Answer 26

no alcohol for 12 months than slowly introduce

increased absorption and risk of an ulcer

Question 27

wehn can you get pregnant after surgery

Answer 27

wait 12-18 months becuase increased risk to fetus with rapid weight loss and nutrient deficiencies