Gastric Bypass Surgery Flashcards
What is the difference between malabsorptive and restrictive types of bariatric surgery?
Two primary approaches: restrictive and restrictive+malabsorptive operations.
- Roux-en-Y gastric bypass (a combination of restrictive and malabsorptive effect)
- Adjustable gastric banding (restrictive).
In Roux-en-Y gastric bypass, the proximal stomach is separated from the remaining part of the stomach with staples. The most common nutritional deficiencies after Roux-en-Y gastric bypass surgery are of protein, iron, vitamin B12, folate, vitamin D, and calcium
In the banding procedure, a fluid-filled band is placed around the stomach near the fundus, reducing functional stomach volume. Nutrition deficits can also occur with this procedure
Both techniques can be performed by laparoscopy or laparotomy.
What are potential complications in the pregnancy for patients with malabsorptive and restrictive bariatric surgery?
- Nutritional deficits
- maternal intestinal obstruction
- gastrointestinal hemorrhage
- maternal death
- anastomotic leaks
- internal hernias
- ventral hernias
- band erosion
- band migration
What type of bariatric surgery is considered malabsorptive?
Roux-en-Y gastric bypass
What type of bariatric surgery is considered restrictive?
Adjustable gastric banding
In a patient with malabsorptive bypass what micronutrient are affected?
- protein
- iron
- vitamin B12
- folate
- vitamin D
- calcium
Can patients with a history of malabsorptive or restrictive bariatric surgery undergo gestational DM screening with glucose load?
It depends. Assess if patients have had symptoms of abdominal cramps, bloating, nausea, vomiting, and diarrhea with glucose load while eating in the past. If so, then do not give glucose test
What is dumping syndrome?
Dumping syndrome is related to the ingestion of refined sugars or high glycemic carbohydrates that the stomach rapidly empties into the small intestine.
Fluid shifts from the intravascular compartment into the bowel lumen result in small-bowel distention.
Hyperinsulinemia and consequent hypoglycemia can occur later, resulting in tachycardia, palpitations, anxiety, and diaphoresis
How does bariatric surgery impact pregnancy outcomes?
the rate of following decreased:
- hypertension (including chronic and gestational hypertension and preeclampsia)
- pregestational diabetes
- gestational diabetes
Describe your baseline lab of a patient with bariatric surgery?
Monitor the following every trimester:
- blood count
- iron
- ferritin
- calcium
- vitamin D
What are the options for correcting iron deficiency in patient with gastric bypass
Oral verses IV. Start with oral but can also use parenteral route
Why is oral iron absorption impacted by bariatric surgery?
Iron is absorbed in the duodenum which is bypassed in malabsorptive surgeries
How do you follow a patient in pregnancy with a history of bariatric surgery?
- Detailed anatomy
- Fetal growth
- Monitor the following every trimester: blood count, iron, ferritin, calcium, vitamin D
- Assess for surgical complications (obstruction, leak, band erosion/migration)
