Bariatric Surgery Lecture Powerpoint

Question 1

Benefits/cons of robotic surgery (2 and 2)

Answer 1

+majorly improved dexterity as can angle tools around corners
+enhanced 3D visual field for surgeon
-no tactile feedback
-expensive and take long time

Question 2

Normal BMI range, overweight range, class I obesity range, class II obesity range, morbid obesity range

Answer 2

• 18.5-24.9
• 25-29.9
• 30-34.9
• 35-39.9
• 40+

Question 3

Etiology of obesity (3)

Answer 3

• unknown
• familial component
• thrifty gene hypothesis (more efficient absorption of calories ingested was evolutionary advantageous until modern society)

Question 4

Leptin is an appetite ___ while ghrelin is a ____

Answer 4

suppressor, stimulant

Question 5

Obesity treatment options (3)

Answer 5

• diet, exercise, behavior changes
• weight loss medications
• weight loss surgery (surgery is most effective long term than medical management)

Question 6

Roux en Y gastric bipass has a __% chance of curing type 2 diabetes

Answer 6

80%

Question 7

Who qualifies for bariatric surgery? (3)

Answer 7

• patients with BMI of 40 or above, or more than 100 lbs overweight
• BMI of 35 and 1 or more obesity related comorbidities
• inability to achieve healthy weight loss sustained for period of time with prior weight loss efforts

Question 8

Who doesn’t qualify for bariatric surgery? (4)

Answer 8

• untreated depression
• binge eating disorder
• endocrine caused obesity
• prohibitive anesthetic risks

Question 9

Pre-op for bariatric surgery (2)

Answer 9

• protein shake protocol based on BMI 2 weeks before surgery

- 2 days prior only allowed clear liquids (goal to shrink liver by mobilizing hepatic fat)

Question 10

3 main types of bariatric surgery and a description of them

Answer 10

• lap band (least common, restrict stomach with device, lowest complication rate but not as efficient weight loss)
• sleeve gastrectomy (most common, restrictive type, reduce stomach volume by 85%, huge decrease in ghrelin secretions as result seeing good long term outcomes in weight loss, but can see malabsorption complications and it is nonreversible)
• Route en y gastric bipass (gold standard bariatric procedure, very effective weight loss, cut stomach at gastric pouch (just distal to GE junction) and staple off stomach, then locate ligament of trietz, cut it in half and anastamose distal end to create gastrojejunostomy, and then anastamose the proximal jejunum to the a further distal portion of the jejunum creating a JJ anastamosis, has highest risk of morbidity and mortality)

Question 11

Ligament of trietz

Answer 11

Divides the duodenum from the jejunum

Question 12

1 presenting sign for bariatric emergency as complication due to surgery

Answer 12

-tachycardia (a leak until proven otherwise!!!)

Question 13

Post op diet for bariatric surgeries (2)

Answer 13

• clear liquids, protein supplements

- avoid gum chewing for blockage, alcohol, straws or carbonated beverages for gas build up

Question 14

Dumping syndrome

Answer 14

A complication seen in post gastric bipass surgery patients where when they eat high carbohydrate simple sugar meals it goes immediately thru the digestive tract causing diarrhea, diaphoresis, dizziness, etc as a malabsorption occurs

Question 15

Malabsorption/nutritional considerations post gastric bipass patient (5)

Answer 15

• protein levels monitored as primarily absorbed in duodenum
• carb digestion begins after jejunojejunostomy, decreased absorption
• B12 deficiency as intrinsic factor is released from parietal cells in stomach, might need PO or IM
• iron defficiency absorption occurs in duodenum
• Ca2+ deficiency absorption occurs in the duodenum