Day 7 - GI2

Question 1

Possible complications after partial gastrectomy for recurrent gastric ulcers

Answer 1

(1) Dumping (P/w postpandrial GI discomfort nausea, vomiting, ab cramping, diaphoresis, palpations, & flushing) (2) Alkaline reflux gastritis (burning epigastric pain, exacerbated by meals) (3) Early satiety (4) Deficiences of B12, Iron, &/or Calcium (Iron & Ca need acid around to be absorbed - which is why chronic Antacid use can increase risk of osteoporosis) (5) Efferent & afferent syndromes (epigastric pain 2/2 obstrx of duodenal limb)

Question 2

Surgical therapies for obesity

Answer 2

Candidates: BMI > 40 or > 35 w/ high risk comorbidities (DM, OSA, CM, severe joint disease); Bariatric surgery shown to provide sustained weight loss (30-45%), reduction or cure of DM, reduction/cure of dyslipidemia/HTN, reduced mortality; Prior to bariatric surgery, psychiatric consult for overeating or emotional eating (depression & suicide may increase in first year after surgery); Surgical outcomes are better if 5-10% body weight lost before bariatric surgery; Preferred: Laparascopic gastric banding (silicone band at top of stomach to cause early satiety, OR 1 hr, return to work in 1 wk, band requires tightening with weight loss, complications: iron/Vit D deficiences, 13% reop), Most common: Gastric bypass surgery (Rou-en-Y, higher operation mortality, leakage, wound infx, incisional hernia - complications reduced by laparascopic gastric bypass)

Question 3

Bariatric surgery complications

Answer 3

Mortality rate 1%, Anastomotic leakage 2%, Wound infection 8%, Incisional hernia Up to 30%; Laproscopic Rou-en-Y can reduce complications; Lap band has fewest complications