Bariatric surgery Flashcards
dumping syndrome
Constellation of symptoms due to rapid movement due to the altered anatomy. seen in 50% of Roux en Y gastric bypass surgery. can be late or early based on timing and etiology of post-prandial symptoms.
Early dumping syndrome timing and causes
see symptoms within 15-30 minutes of eating and see abdominal pain, diarrhea, nausea. This is rapid emptying of hypertonic gastric contents into small intestine which can also see rapid fluid shifts between the plasma and high osmolality of the bowel.
Early dumping syndrome presentation
15-30 minute post prandial see abdominal pain, diarrhea, nausea. see hypotension and tachycardia too.
Late dumping syndrome timing and causes
this happens 2-3 hrs after eating and from surge of insulin. See pts are hyperglycemic due to speedy transit and absorption of simple carbs into the small intestine, but this is then countered by surge of insulin causing hypoglycemia. Here we can see severe post prandial hypoglycemia that can cause loss of consciousness or seizure.
Late dumping syndrome presentation
diziness, confusion, fatigue and diaphoresis from hypoglycemia.
initial management of people with dumping syndrome
for both early and late dumping syndrome: eating small frequent meals and replacing simple sugars with complex carbohydrates and incorporating high fiber and protein rich foods in diet.
internal hernia can occur in RYGB surgery as
abdominal pain, small bowel obstruction or strangulation and occurs in 5% of all surgeries
short bowel syndrome happens after
massive resection of small bowel. See malabsorptive diarrhea with nutrient deficiencies and dehydration and weight loss.
stomal stenosis presents with
nausea/vomiting, GERD, dysphagia after procedure and seen in 6 to 20% of roux en Y gastric bypass surgeries
Symptoms of acquired copper deficiency?
related to gastric surgery
See leukopenia, anemia, (normocytic, microcytic, macrocytic), osteoporosis, and neurological symptoms. fragile hair, skin depigmentation, muscle weakness and ataxia. See neuropathy similar to vitamin B12 deficiency. Can also see positive Babinski (bilateral extensor plantar reflex)
How can zinc supplementation cause copper deficiency with patients who have history of bariatric surgery?
increased zinc intake can compete with copper absorption into the GI tract.
causes of acquired copper deficiency
gastric surgery, prolonged total parenteral nutrition,
excessive zinc ingestion, malabsorptive enteropathies (celiacs dx, inflammatory bowel dx)
how to confirm diagnosis of low copper levels?
low serum copper and ceruloplasmin levels
How to improve neurological deficits related to acquired copper deficiency
stop zinc supplements and supplement with copper
B12 deficiency on labs
see high MCV and normocytic anemia and borderline B12 deficiency
if pt has neurological symptoms and normocytic anemia why is less likely that folate deficiency is a cultprit?
because folate deficiency doesn’t cause neurological symptoms
presentation of copper deficiency
ataxia, spasticity with muscle weakness, positive Romberg and Babinski, dorsal column dx
Consideration of B12 deficiency too
When do we get nerve conduction studies if concerned for muscle weakness related to malabsorption?
when we have documented low copper levels
complication/presentation of Vitamin B12 deficiency
see macrocytic anemia
cognitive defects
peripheral neuropathy - loss of vibratory sense and proprioception
Roux-en Y gastric bypass has complications regarding malabsorption with:
doesn’t affect macronutrient absorption but can have micronutrient absorption:
deficiencies in Ca, Fe, vitamin B12, fat soluble vitamins (A D E K) and thiamine and folate
fat soluble vitamins are
vitamin A, D, E, K
how to correct vitamin B12 deficiency related to Roux En Y gastric bypass?
daily oral supplementation can help reverse neuropathy. IV and IM vitamin B12 who do not improve with supplementation
how to monitor vitamin B12 levels in gastric bypass?
should be done 3 months post surgery, 6 months and annually after RYGB.
vitamin A deficiency clinical presentation:
night or complete blindness, poor bone growth, dermatological issues, immune deficiencies
