Lecture 16: Bariatric Surgery

Question 1

obesity is BMI > ___

Answer 1

30

Question 2

what are the 2 approved obesity meds in Canada?

Answer 2

orlistat and liraglutide

Question 3

three lifestyle treatments for obesity?

Answer 3

diet, exercise, counselling

Question 4

most effective means for long term / sustained wt loss and education?

Answer 4

bariatric surgery

Question 5

two types of restrictive bariatric surgery?

Answer 5

laparoscopic gastric banding, gastric sleeve

Question 6

example of combination bariatric surgery?

Answer 6

roux-en-y gastric bypass, biliopancreatic diversion with duodenal switch

Question 7

gastric band filled with ___ which causes ____

Answer 7

saline; stomach become smaller

Question 8

gastric banding wt loss is _____ and _____ vs resection

Answer 8

slower; gradual

Question 9

complications of banding?

Answer 9

erosion, bleeding, slipping

Question 10

in gastric sleeve, ____ of stomach removed and _____ stomach created

Answer 10

greater curvature; tubular

Question 11

in roux en y, create a small ____ the size of an ___

Answer 11

gastric pouch; egg/tbsp

Question 12

in roux en y, jejunum divided into these 2 limbs:

Answer 12

roux limb (jejunum), biliopancreatic limb (duodenum)

Question 13

food flows straight from pouch to ___ limb (bypass stomach), stomach continues to make digestive juices that flow into ___ limb reattached below other limb, forming ____ shape

Answer 13

roux; bilipancreatic; Y

Question 14

biliopancreatic diversion with duodenal switch involves sleeve gastrectomy with ___, creation of small ___ limb with short common channel (____cm)

Answer 14

pylorus; roux; 100-150

Question 15

biliopancreatic diversion duodenal switch typically used for ______ patients

Answer 15

advanced bariatric (BMI >50)

Question 16

is bilipancreatic diversion duodenal switch reversible?

Answer 16

no

Question 17

biliopancreatic diversion has risk of _____, so it is important to follow ______ after surgery

Answer 17

anastomosis due to eating too much; bariatric surgery diet

Question 18

gold standard of bariatric surgeries

Answer 18

roux en y

Question 19

benefits of sleeve gastrectomy compared to roux en y?

Answer 19

less invasive, technically easier, faster to perform, safer

Question 20

total weight above reference ideal of BMI 24.9 is referred to as:

Answer 20

excess weight

Question 21

expected outcomes of weight loss for surgery are ____% actual weight, ___% excess weight

Answer 21

20-30; 50-60

Question 22

wt loss with bariatric surgery steepest during first ___ months and levels out after ____ years

Answer 22

6; 3

Question 23

gastric sleeve may worsen but roux en y resolve _____

Answer 23

GERD

Question 24

high prevalence of ___ in ppl undergoing surgery

Answer 24

depression

Question 25

criteria to be a surgical candidate:

Answer 25

BMI >40 or 35-40 if have 2+ med conditions (type 2 diabetes, sleep apnea, cardiopulmonary probs, hypertension, previous wt loss attempts), age 18-59, nonsmoker, no active substance abuse, not pregnant/lactating, be motivated to change, committed to all aspects of program, psych and med fit for surgery

Question 26

wait time shorter than ___ months for surgery not necessarily better cuz programs must be done beforehand

Answer 26

6

Question 27

RD role to look for:

Answer 27

wt loss, micronutrient deficiencies, other comorbidities/symptoms

Question 28

2-3 weeks prior to surgery called ____ period, involves ____ program

Answer 28

peri-operative; optifast (low cal , low fat, high pro)

Question 29

why need peri-op nutr management?

Answer 29

reduce liver size and visceral fat tissue around liver (if liver too big will tear during surgery, if too much fat around won’t be able to access stomach and have to do open surgery)

Question 30

why no juice for post op bariatric pt?

Answer 30

high risk of dumping syndrome

Question 31

fluids allowed for POD 1-2?

Answer 31

water, broth, tea, diluted fruit juice, no sugar added jello (15mL q15min - 30 mL q15min)

Question 32

nutr management weeks 1-2 post op:

Answer 32

chewable vit/min supplement, protein supplements, liquid diet (protein powder and shakes), eating strategies (eat slow, eat/drink 1 tbsp q5min, stop if pain)

Question 33

nutr management week 3-4 post op:

Answer 33

consume 1-1.5L calorie free fluids/d, commence pureed diet, separate liquids and solids by 30 min, choose foods from all food groups

Question 34

if have anastomotic leak, what to do?

Answer 34

• feeding below the tear
• wouldn’t want to feed by NG (stomach too small still)
• could start PN
• we can educate the team about importance of nutr support in these cases even though pt don’t seem like a typical malnourished person

Question 35

nutr management weeks 5-9 post op:

Answer 35

vit/min supplement switch to pill form, consume 1.5-2L cal free fluids/d, commence soft texture diet (60-80gprotein/d), eat 3 meals with 2-3 small snacks/d, cut food into pea size, eat high pro foods first

Question 36

for life, eat __ first, __ second, ___ third

Answer 36

protein; veg/fruit; grain/starch