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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
Disadvantages of BPD/Duodenal switch?
1. **more complications/risk 2. **Deficiences (protein, Vitamins, minerals) 3. longer LOS
26
Complications of BPD/Duodenal switch?
Anemia, osteoporosis, kidney stones, malnutrition
27
How is Roux-en Y Gastric Bypass done? | Advantages of Roux-en Y Gastric Bypass?
Stomach stapled, small bowel re-routed 1. **Most effective vs GERD 2. **Rapid wt loss initially w/out changing diet
28
Disadvantages of Roux-en Y Gastric Bypass?
1. Re-routing --> defic 2. **Dumping Syndrome 3. More operative complications, may need revision
29
Complications of Roux-en Y Gastric Bypass?
1. Leaks 2. ulcers 3. hernias 4. bowel obstruction 5. Wt regain
30
What procedure is associated w/Dumping Syndrome?
Roux-en Y Gastric Bypass
31
What procedure is most effective against DM?
BPD/Duodenal Switch
32
What procedure eliminates the hunger hormone?
Sleeve gastrectomy
33
What procedure has lowest mortality & complication rate and is least invasive?
Gastric Banding
34
What procedure is most effective against GERD?
Roux-en Y Gastric Bypass
35
What are causes of acquired hernias?
1. Increased intra-abdominal pressure 2. Older age --> weakened fascia 3. Tissue injury
36
What are the causes of congenital hernias?
1. Fascial opening that doesn't close | 2. Failure of a developmental process to obliterate
37
Where is the inguinal canal located?
Beneath the external oblique aponeurosis
38
What are the boundaries of Hesselbach's triangle?
Base: inguinal ligament Lateral border: inferior deep epigastric vessels Medial border: rectus muscle
39
How does a direct hernia differ from an indirect hernia in regards to location/contents/risks?
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
Where do femoral hernia develop?
in the femoral canal - BELOW the inguinal ligament and MEDIAL to the femoral vein
41
What are femoral hernia's often mistaken with?
Cloquet's node - proximal deep inguinal node NEXT TO (not w/in) the femoral canal
42
How do hernias present?
1. LUMP (worsen w/activity, strain, cough, sneeze) 2. Pain w/exertion or straining 3. Complication (Bowel obstruction)
43
How do you Dx a hernia?
US or CT | CT better for ventral, incisional, traumatic hernias & atypical presentations
44
Do hernias typically need treated w/ABX?
No - clean cases (only do if having surgery)
45
1. What is the treatment for minimally symptomatic hernias? | 2. When is urgent surgical correction needed?
1. Observation | 2. When theres sign of non-reducible incarceration/strangulation
46
Complications associated specifically w/hernias?
1. Urinary retention (esp males w/groin hernias) 2. Hernia recurrence (worst if no mesh and open) 3. Seroma (dont aspirate early)
47
How do you prevent urinary retention associated w/hernias?
Restrict peri-op fluids

Clin Specialties Surgery Exam (13 decks)

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