Lecture 25-Bariatric Surgery Flashcards
What are the ADA considerations for bariatric surgery? (3)
- BMI > 35. Although there is little evidence to support this outside of research protocols as bariatric surgery shows little impact on glycemic response
- Type II diabetes that’s difficult to control with lifestyle changes and drugs
- People who have this surgery will need lifelong lifestyle changes and medical attention
What are the 3 types of restrictive gastric bypass?
- vertical banded gastroplasty
- sleeve gastrotectomy
- gastric banding
Describe sleeve gastrotectomy outcomes
- 40-60% EBWL
- pylorous intact so theortetically no dumping
- may be step 1 of duodenal switch for very overweight patients
Describe gastric banding (5)
- 40% will need reoperation
- 1/2 of the people will lose 30-50%, but this is not very good for grazers or people that ingest mostly liquid calories
- can get retractable vomitting. If hedonic signals persist then overeating can cause this vomitting or stretching of the stomach. When vomitting occurs check for thiamin deficiency
- may have to make multiple adjustments
- ghrelin still high in first year
What are the 2 types of malabsorptive surgeries?
- duodenal sleeve
- duodenal switch/biliopancreatic diversion
Describe DS/biliopancreatic diversion
- 80-95% EBWL
- fat (72%) and protein (25%) malabsorption but no CHO malabsorption
- no gastric dumping
- watch Cu, Zn
- Will need lipophilic vit supplements (A, D, E, K); >2400 mg Ca/day (in form of citrate)
- at risk for Vit D malabsorption
What is the type of combined malabsorptive and restrictive surgeries?
Roux-en-Y
Describe Roux-en-Y
- an anastomatic stricture
- 60-70% EBWL
- Fe most common deficiency (50% by 20 yrs post op)
- Vit B12 2nd most common deficiency
- Vit D deficiencies common
- Some dumping (~40-60%)
metabolic syndrome
- entails symptoms from abdominal obesity, diabetes, dyslipidemia, hypertension
What are the likely reasons why GB can contribute to alleviation of metabolic syndrome symptoms? (7)
- better body response to insulin
- higher hepatic sensitivity to insulin
- Beta cell function improvement (likely GLP-1)
- increase adiponectin
- decrease CRP and IL-6
- decrease ghrelin
- weight loss
Describe blood composition after Roux-en-Y.
- blood glu doesn’t change
- increase in beta-hydroxybutyrate
- leptin deficiency
Why do biliopancreatic diversions cause a change in insulin sensitivity?
- Because you are now providing all of the ingested nutrients to the distal ileum where incretins are secreted.
- Thus, you are releasing more of them (specifically, GLP-1) in response to the higher glu and this accounts for the heightened sensitivity to insulin
What are the risk factors for adverse events following GB?
- people with extreme BMI values
- people with a history of deep vein thrombosis or pulmonary embolus
- people diagnosed with obstructive sleep apnea
- people with impaired functional status
What factors should be taken into account when considering someone’s risk for adverse events following GB?
- short term post-op risks
- long term post-op risks
- risks associated with extreme obesity
What are the top 3 late complications of Roux-en-Y?
- dumping
- Vit B12 deficiency
- anemia
