Bariatric Surgical Procedures (Online Lecture)

Question 1

morbid obesity

Answer 1

more than two times ideal body weight or body mass index >40kg/m2 or more than 100 pounds greater than ideal body weight

Question 2

medical management includes weight loss diet in conjunction with

Answer 2

behavior modification

Question 3

first approach aimed at weight loss and then maintence, how do we do this?

Answer 3

setting goals for weight loss
improving diet
increasing physical activity
addressing barriers to change
self monitoring
need adequate rest
involved in plan

Question 4

why do we need adequate rest

Answer 4

sleep loss increase coritsol which leads to weight gain

Question 5

pharmacologic management includes medications that

Answer 5

inhibit reuptake of serotonin and norepinephrine
and/or prevent digestion of fats

Question 6

when do we use pharmacologic

Answer 6

diet/lifestyle tried first

Question 7

would we monitor the patient while on meds

Answer 7

yes

Question 8

minimally invasive management

Answer 8

vagal blocking therapy

Question 9

surgical management

Answer 9

roux en Y
gastric banding
sleeve gastrectomy
biliopancreatic diversion

Question 10

vagal blocking therapy

Answer 10

pacemaker delivering pulses to block vagus nerve which decreases gastric contraction and emptying leading to feeling full, decreasing cravings which lead to less caloric intake

Question 11

surgical management only preferable after

Answer 11

other measures have failed, insurance coverage varies widely can help treat comorbidities

Question 12

preop care
- similar to any other abdominal surgical procedure

Answer 12

review of lab studies
ECG
lipid and liver panels
consent

Question 13

NPO time period

Answer 13

12 hr and clear liquid 48 hr period before

Question 14

vertical banded gastroplsty

Answer 14

vertical line of staples placed to create a small stomach pouch to which a band is connected to provide an outlet to the small intestine

Question 15

circumgastric banding

Answer 15

limits size of stomach by placement of inflatable band around funds of stomach
this band can be inflated or deflated to change the size of stomach as the client looses weight

works by making initial stomach part smaller so patient gets fuller quicker and will consume less calories

Question 16

gastric bypass

Answer 16

gastric resection combined with malabsorption surgery
clients stomach, duodenum and part of jejunum is bypassed so fewer calories are absorbed

Question 17

banding malabsoption issues

Answer 17

no malabsorption issues compared to other procedures because the food is digested and absorbed as it would normally be

Question 18

bilopancreatic diversion anatomy change

Answer 18

removal of part of the stomach
large portion of intestine is bypassed

Question 19

bilopancreatic diversion action

Answer 19

reduce amount of food consumption = smaller stomach significant amount of bowel is bypassed which equals decreased absorption of calories and nutrients impact gut hormones that control hunger, fullness, and blood sugar control

Question 20

bilopancreatic diversion often done for what patients

Answer 20

diabetic

Question 21

laparoscopic vs open

Answer 21

laparoscopic is 1-2 days in the hospital which is not likely to have complications

open 4-5 days in the hospital

Question 22

pain control

Answer 22

helps us prevent other complications (atelectasis)
PCA: opioid
oral: this is after they can handle oral liquids

Question 23

NGT management

Answer 23

never reposition tube: movement can disrupt suture line
- if pulled out notify MD immediately
removed 2nd or 3rd day upon return of bowel sounds and flatus which is done by surgeon

Question 24

post op reintroduction of foods
- first

Answer 24

clear liquids 1 ounce cups

Question 25

post op reintroduction of foods - after clear liquids 1 ounce cups

Answer 25

pureed foods, juice, soups and milk products added 24-48 hours after clear liquid tolerated

Question 26

post op reintroduction of foods - after pureed foods, soups and milk products

Answer 26

increase volume to 1 ounce over 5 mins or until satisfied

Question 27

post op reintroduction of foods - how long are they on diet of liquids or pureed foods

Answer 27

6 weeks

Question 28

post op reintroduction of foods - after 6 weeks

Answer 28

regular foods

Question 29

post op reintroduction of foods - when patient is on regular foods the emphasis is on

Answer 29

nutrient dense foods

Question 30

post op reintroduction of foods - when patient is on regular foods what is the protocol they should follow

Answer 30

smaller more frequent meals- not to exceed 1 cup size high fowler position nutrient dense foods consume fluids before or after meals (30-60 mins)

Question 31

what will occur if too much liquid is ingested

Answer 31

nausea, vomiting, discomfort will occur

Question 32

what are some equipment we will need

Answer 32

bariatric bed/chair/commode lifts/trapeze

Question 33

this patients will require meticulous

Answer 33

skin care

Question 34

complications

Answer 34

hemorrhage deep vein thrombosis bowel obstruction dysphagia

Question 35

intra abdominal hemorrhage

Answer 35

increase RR/HR, urine output, restlessness, anxiety vomiting of blood/stool/drain

Question 36

if patient is bleeding within first 72 hours it is caused by a

Answer 36

dislodged staple = surgery

Question 37

if a patient is bleeding within 72 hr- month is caused by a

Answer 37

gastric ulder

Question 38

deep vein thrombosis - prevention

Answer 38

SCD stocking, profilaxis, heparin, ambulation

Question 39

bowel obstruction

Answer 39

do not insert a NGT

Question 40

dysphagia

Answer 40

education - typically most severe 4-6 weeks - may persist for 6 months - eat slowly, chew completely, avoid tough foods

Question 41

dumping syndrome what happens

Answer 41

vasomotor and GI response results from food entering small intestine instead of stomach

Question 42

dumping syndrome s/s

Answer 42

tachycardia, nausea, diarrhea, abdominal cramping

Question 43

dumping syndrome occurs how long after eating

Answer 43

15 mins- 2 hours

Question 44

how is dumping syndrome relieved

Answer 44

having a BM or bowels are empty

Question 45

dumping syndrome vasomotor response

Answer 45

food moving quickly which increases glucose which increases the release of insulin which then causes a reactive hypoglycemia - palpations - pallor - dizziness - warmth - headache

Question 46

dumping syndrome can cause

Answer 46

reluctant to eat which leads to anorexia

Question 47

what is one way to avoid dumping syndrome

Answer 47

eat food slowly and chewing completely

Question 48

dehiscence prevention

Answer 48

binder

Question 49

what foods should post op patients avoid

Answer 49

high protein foods high in sugar and fat alcoholic beverages

Question 50

life style modifications

Answer 50

increased physical activity

Question 51

what other surgery is needed after weight stabilizes

Answer 51

plastic for excess skin