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Clin Specialties Surgery Exam > Lecture 12: Bariatrics & Hernias > Flashcards

Lecture 12: Bariatrics & Hernias Flashcards

1
Q

Which hormone is known as the satiety hormone? Where is it produced?

A

Leptin - produced in adipose tissue, inhibits hunger

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2
Q

How is leptin altered in obesity?

A

Increased production but decreased sensitivity - dont feel full

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3
Q

Which hormone is known as the hunger hormone because it stimulates hunger? Where is it produced?

A

Ghrelin - (stomach goes Grrr when hungry)

- produced in fundus

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4
Q

How does Ghrelin differ from Leptin?

A

Ghrelin opposes Leptin and it doesn’t affect satiety

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5
Q

How does insulin affect leptin?

A

insulin blocks leptin in the brain causing increased hunger

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6
Q

What hormone increases satiety?

A

Peptide YY

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7
Q

What hormone increases insulin sensitivity and decreases energy storage and hunger?

A

GLP-1

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8
Q

What are the top 2 consequences of obesity?

A
  1. DM

2. HTN

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9
Q

What is obesity the single most reliable predictor of?

A

Type 2 DM

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10
Q

For each 1% of body wt lost, how is your DBP and SBP affected?

A

lose 1% body wt:

  • 1 mm Hg decrease in DBP
  • 2 mm Hg decrease in SBP
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11
Q

For BMI >35 what is the only method for sustained wt loss?

A

Surgery

note: surgery is ToC when BMI > 40

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12
Q

Bariatric surgery is what type of wound classification? And therefore what ABX should be used?

A

Clean contaminated - use Cefazolin or Clindamycin

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13
Q

What are the components of the NIH criteria for bariatric surgery?

A
  1. BMI > 40 or BMI > 35 + comorbid illness
  2. Hx of failed sustained wt loss on a supervised wt reduction program
  3. No substance abuse, psychoses or uncontrolled depression
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14
Q

What is the purpose of malabsorptive bariatric procedures? Example?

A

They shorten the digestive tract

Ex: BPD

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15
Q

What is the purpose of restrictive bariatric procedures? Examples?

A

Reduce the amount of food the stomach can hold

Ex: Sleeve Gastrectomy, Gastric Band surgery

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16
Q

What is the gold standard bariatric procedure?

A

Sleeve gastrectomy

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17
Q

What parts of the stomach are kept and removed in Sleeve gastrectomy? Results in?

A

Keep antrum - limits food intake
Remove fundus

Result: smaller stomach –> produce no ghrelin, faster transit time –> more insulin sensitivity & satiety

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18
Q

Advantages of sleeve gastrectomy?

what is the main disadvantage?

A
  1. Laproscopic
  2. **No rerouting of GI tract (no defic)
  3. **Eliminate hunger hormone
  4. Fewer complications than bypass
  5. Fairly rapid initial wt loss

Disadv: NOT reversible

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19
Q

What is done during Gastric Banding? Result?

A

Band is placed around stomach –> limits food intake & promotes satiety but DOES NOT decrease hunger

20
Q

Advantages of Gastric Banding?

A
  1. **LOWEST mortality/complication rate, least invasive
    (No rerouting, stapling, or cutting)
  2. **AJUSTABLE & REVERSIBLE
  3. Low malnutrition risk
21
Q

Disadvantages of Gastric Banding?

A
  1. **Need regular adjustments & f/u
  2. **Limited applications (low BMI, not long term)
  3. High long term failure rate
  4. Requires implanted device
  5. Slower wt loss initially
22
Q

Complications of Gastric Banding?

A
  1. Obstruction
  2. Dilatation of pouch/esophagus
  3. Band displaces
  4. Food intolerance
  5. Erosion - may cause infection
  6. Leak
  7. Failure to lose wt & can regain it
23
Q

What is the purpose of combined bariatric procedures? Examples?

A

Shorten the GI tract and reduce amt of food the stomach can hold
Ex: BPD/Duodenal switch, Roux-en Y Gastric Bypass

24
Q

Advantages of BPD/Duodenal switch?

A
  1. **Most wt loss overall
  2. **Most effective vs DM
  3. **Incr satiety AND decr hunger
  4. Can eat normally
  5. No dumping syndrome
  6. decr fat absorption
25
Q

Disadvantages of BPD/Duodenal switch?

A
  1. **more complications/risk
  2. **Deficiences (protein, Vitamins, minerals)
  3. longer LOS
26
Q

Complications of BPD/Duodenal switch?

A

Anemia, osteoporosis, kidney stones, malnutrition

27
Q

How is Roux-en Y Gastric Bypass done?

Advantages of Roux-en Y Gastric Bypass?

A

Stomach stapled, small bowel re-routed

  1. **Most effective vs GERD
  2. **Rapid wt loss initially w/out changing diet
28
Q

Disadvantages of Roux-en Y Gastric Bypass?

A
  1. Re-routing –> defic
  2. **Dumping Syndrome
  3. More operative complications, may need revision
29
Q

Complications of Roux-en Y Gastric Bypass?

A
  1. Leaks
  2. ulcers
  3. hernias
  4. bowel obstruction
  5. Wt regain
30
Q

What procedure is associated w/Dumping Syndrome?

A

Roux-en Y Gastric Bypass

31
Q

What procedure is most effective against DM?

A

BPD/Duodenal Switch

32
Q

What procedure eliminates the hunger hormone?

A

Sleeve gastrectomy

33
Q

What procedure has lowest mortality & complication rate and is least invasive?

A

Gastric Banding

34
Q

What procedure is most effective against GERD?

A

Roux-en Y Gastric Bypass

35
Q

What are causes of acquired hernias?

A
  1. Increased intra-abdominal pressure
  2. Older age –> weakened fascia
  3. Tissue injury
36
Q

What are the causes of congenital hernias?

A
  1. Fascial opening that doesn’t close

2. Failure of a developmental process to obliterate

37
Q

Where is the inguinal canal located?

A

Beneath the external oblique aponeurosis

38
Q

What are the boundaries of Hesselbach’s triangle?

A

Base: inguinal ligament
Lateral border: inferior deep epigastric vessels
Medial border: rectus muscle

39
Q

How does a direct hernia differ from an indirect hernia in regards to location/contents/risks?

A

Direct

  • MEDIAL to inferior epigastric vessels
  • NO peritoneal sac
  • low risk of incarceration

Indirect (MC)

  • LATERAL to inferior epigastric vessels
  • Peritoneal sac
  • high risk of incarceration/strangulation
40
Q

Where do femoral hernia develop?

A

in the femoral canal - BELOW the inguinal ligament and MEDIAL to the femoral vein

41
Q

What are femoral hernia’s often mistaken with?

A

Cloquet’s node - proximal deep inguinal node NEXT TO (not w/in) the femoral canal

42
Q

How do hernias present?

A
  1. LUMP (worsen w/activity, strain, cough, sneeze)
  2. Pain w/exertion or straining
  3. Complication (Bowel obstruction)
43
Q

How do you Dx a hernia?

A

US or CT

CT better for ventral, incisional, traumatic hernias & atypical presentations

44
Q

Do hernias typically need treated w/ABX?

A

No - clean cases (only do if having surgery)

45
Q
  1. What is the treatment for minimally symptomatic hernias?

2. When is urgent surgical correction needed?

A
  1. Observation

2. When theres sign of non-reducible incarceration/strangulation

46
Q

Complications associated specifically w/hernias?

A
  1. Urinary retention (esp males w/groin hernias)
  2. Hernia recurrence (worst if no mesh and open)
  3. Seroma (dont aspirate early)
47
Q

How do you prevent urinary retention associated w/hernias?

A

Restrict peri-op fluids

Clin Specialties Surgery Exam (13 decks)

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