Bariatric Surgery and Ostomies Flashcards
What is bariatric surgery?
Weight reduction surgery for the morbidly obese
What is morbid obesity?
- BMI > 40 (i.e. > 100 lbs over ideal body weight)
2. BMI > 35 with a medical problem related to morbid obesity
What is the BMI?
Body Mass Index
What is the formula for BMI?
Body weight in kg / (Height in m)^2
What medical conditions are associated with morbid obesity?
Sleep apnea, CAD, pulmonary disease, diabetes, venous stasis ulcers, arthritis, infections, sex hormone abnormalities, HTN, breast cancer, colon cancer
What are the current options for bariatric surgery?
Gastric bypass (malabsorptive) Vertical-banded gastroplasty
What is a gastric bypass?
Stapling off a small gastric pouch (restrictive), and a Roux-en-Y limb to gastric pouch (bypass)
How does gastric bypass work?
- Creates a small gastric reservoir
- Causes dumping symptoms when a patient eats too much food or high-calorie foods; food is dumped into the Roux-en-Y limb
- Bypass of small bowel by Roux-en-Y limb
Which bariatric surgery works best overall?
Gastric bypass
What are the possible post-operative complications after weight reduction surgery?
Gallstones (if gallbladder in situ), anastomotic leak, marginal ulcer, stenosis of pouch or anastomosis, malnutrition, incisional hernia, spleen injury, iron deficiency, B12 deficiency
What is the most common sign of an anastomotic leak after a gastric bypass?
Tachycardia
What is the incidence of anastomotic leak after bariatric surgery?
3%
What is the mortality rate of an anastomotic leak after bariatric surgery?
10%
What is a lap-band?
LAParoscopically placed BAND around the stomach with a subcutaneous port to adjust constriction.
Results in small gastric reservoir
What is a Petersen’s hernia?
Internal herniation of small bowel through the mesenteric defect from the Roux-en-Y limb after gastric bypass.
What is an ostomy?
Operation that connects the GI tract to the abdominal wall skin or the lumen of another hollow organ.
What is a stoma?
Opening of an ostomy
What is a gastrostomy?
G-tube through the abdominal wall to the stomach for drainage or feeding
What is a jejunostomy?
J-tube through the abdominal wall to the jejunum for feeding
What is a Kock pouch?
“Continent ileostomy”
Pouch is made of several ileal loops and the patient must access the pouch with a tube intermittently
What is a colostomy?
Connection of colon mucosa to the abdominal wall skin for stool drainage
What is an end colostomy?
Proximal end of colon brought to the skin for stool drainage
What is a mucous fistula?
Distal end of transected colon brought to the skin for decompression.
The mucosa produces mucus, an ostomy is a fistula, and, hence, the term mucous fistula.
(Proximal colon brought up as a colostomy or, if the proximal colon is removed, an ileostomy.)
What is a Hartmann’s pouch?
Distal end of transected colon stapled and dropped back into the peritoneal cavity, resulting in a blind pouch.
Mucus is decompressed through the anus.
(Proximal colon is brought up as an end colostomy or, if proximal colon is removed, an end ileostomy.)
What is a loop colostomy?
Loop of large bowel is brought up to the abdominal wall skin and a plastic rod is placed underneath the loop.
The colon is the opened and sewn to the abdominal wall skin as a colostomy.
What is an ileal conduit?
Loops of stapled-off ileum made into a pouch, anastomosed to the ureters, and then brought to the abdominal wall skin to allow drainage of urine in patients who undergo removal of the bladder
What is a Brooke ileostomy?
Ileostomy folded over itself to provide clearance from skin
Why doesn’t an ileostomy or colostomy close?
Epithelialization (mucosa to skin)
Why doesn’t a gastrostomy close?
Foreign body (the plastic tube)
If the plastic tube, G-tube or J-tube, is removed, how fast can the hole to the stomach or jejunum close?
In a matter of hours
What is a tube check?
Gastrografin contrast study to confirm that a G-tube or J-tube is within the lumen of the stomach or jejunum
