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Endocrinology & Reproduction > Bariatric surgery & metabolism > Flashcards

Bariatric surgery & metabolism Flashcards

1
Q

BMI for morbid obesity

A

greater than or equal to 40

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2
Q

BMI for obesity

A

greater than or equal to 30

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3
Q

BMI for overweight

A

greater than or equal to 25

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4
Q

Banned by European medicines agency in ‘08 due to increased risk of serious psychiatric problems and suicidal tendencies

A

Rimonabant: CB1 receptor antagonist

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5
Q

associated with unpleasant side effects such as loose, oily stools

A

orlistat: lipase inhibitor which reduces fat absoprtion

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6
Q

approved but comes wth risk of psychiatric events & suicidial tendencies

A

Contrave: combination of naltrexone and bupropion

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7
Q

like exenatide and used for chronically obese

A

Liraglutide: GLP-1 receptor antagonist

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8
Q

conditions for bariatric surgery

A
  • unable to lose weight through diet, exercise, pharmacotheraphy
  • BMI greater than or equal to 40
  • Obesity history of over 5 years
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9
Q

how is bariatric surgery performed

A

laparoscopy - relatively non-invasive

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10
Q

3 types of bariatric surgery

A

gastric band, gastric sleeve, gastric bypass

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11
Q

gastric band

A

band with inflatable ballon inserted aroundupper stomach to create pouch. restricts passage of food to prolong fullness after eating
balloon size regualted by saline through subcutaneous port
Reversible

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12
Q

which bariatric surgery is reversible

A

gastric band

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13
Q

gastric sleeve

A

vertical sleeve of 200ml of up to 80% of the stomach.
food bypasses the stomach
food has normal passage down GI tract
excised portion is removed

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14
Q

which bariatric surgery results in food bypassing most of stomach but has normal passage through GI

A

gastric sleeve

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15
Q

gastric bypass

A

small pouch 15-30ml is sperated from stomach
this is then connected to lower jejunum
food passes stomach, duodenum and proximal jejunum
gastric remnant remians in situ, but doesnt come in contact with food

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16
Q

mortality rate of gastric sleeve

A

0.1%

17
Q

mortality rate of gastric band

A

0.05%

18
Q

martality rate of gastric bypass

A

0.2%

19
Q

abropstion of what is reduced in all bariatric surgieries

A

calcium - leading to metabolic bone diseases & secondary hyperparathyroidism

20
Q

what defieicnes are sleeve and bypass patients at risk of

A

calcium, folate, iron, B1, B6 B12 and viatmin D

21
Q

how do bariatric surgeries promote weight loss

A
  • reduce capacity of stomach therefore reducing food intake

- reducing the absorptive SA of GI tract, causing nutrient malabsorption

22
Q

unexpeted outcome of bariatric surgery

A

improvements in diabetes within weeks of surgery; not a consequence of weight loss

23
Q

how does gastric bypass improve T2DM

A
  • food more rapidly delivered to L cells of distall GI 5 mins
  • L cells rapidly secrete GLP-1 and PPY which are anorexigenic
  • bypass of mucosal cells in lower stomach leads to lower grehlin secretions which is an orexigenic
24
Q

orexigenic peptide from lower stomach

A

ghrelin

25
Q

anorexigenic peptides from L cells

A

GLP-1

PPY

26
Q

PPY

A

peptide secreted from L cells of distal GI
reduced food intake & enhances inulsin stimulated glucose uptake
anorexigenic

27
Q

how soon after gastric bypass to L cell peptide levels increase

A

within days and remain elevated for years

28
Q

how does gastric sleeve improve T2DM

A

more rapid delivery of food to K-cells of duodenum and L-cells of distal GI
rapied secretion of GIP, GLP-1 and PPY which are anorexigenic

29
Q

how does gastric band improve T2DM

A

food is not rerouted and there is not change in GLP-1 or PPY levels BUT inflation of band is though to stimulate vagal afferent nerve fibres in the stomach
these activate nuerons in the nucleus of the solitary tract
this signalls to acruate nucleus to decrease appeite

30
Q

3 main mechanisms of weight loss and T2DM imporvements from bariatric surgeries

A
  1. physical reduction in food intake and nutrient absorption
  2. decreased food intake through central affects
  3. increased insulin secretion & action
31
Q

what are the central affects of bariatric surgery that reduce food intake

A
  • inreased anorexigenic signalling through PPY, GLP-1
  • reduced orexigencie signalling through less ghrelin
  • increased vagal affernt signal to the ARC
32
Q

other non surgical methods of bariatic weight loss

A
  • gastric ballons

- transpyloric shunt

33
Q

gastric balloon

A

two attached sillicone balloons placed in stomach through mouth filled with saline to restrict food intke
- deaths following use

34
Q

transpyloric shunt

A

for bMI of 35-40
inserted to stomahc via mouth and expands in situ
- high rates of adverse effects

Endocrinology & Reproduction (15 decks)

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