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Advanced Medical Nutrition Therapy > MNT for Bariatric Surgery > Flashcards

MNT for Bariatric Surgery Flashcards

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USMLE® Step 1 flashcards
1
Q

____ ____ is a surgical procedure performed on the stomach or intestines to induce weight loss

A

Bariatric surgery

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2
Q

What are the two ways to qualify for bariatric surgery?

A

-BMI greater than 40
-BMI greater than 35 with a comorbidity such as diabetes, sleep apnea, hypertension, or hyperlipidemia

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3
Q

What are some nutrition concerns of bariatric surgery?

A

-Intractable N/V
-Dumping syndrome (GB)
-Dehydration
-Protein malnutrition
-Micronutrient deficiencies
-Weight loss failure or regain

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4
Q

What are some considerations for bariatric surgery?

A

-Must understand the risks and benefits
-Motivation and ability to adhere to long-term lifestyle changes
-No active substance abuse
-Psychological illness (binge eating/bulimia)
-Pregnancy (should wait12-18 months post-op)

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5
Q

What are the four common bariatric surgery options?

A

-Gastric Bypass
-Sleeve gastrectomy
-Adjustable gastric band (out of date)
-Biliopancreatic diversion (high incidence of nutrient deficiencies)

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6
Q

The gastric bypass is ____ and ____

A

Restrictive and malabsorptive

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7
Q

The sleeve gastrectomy is ____

A

Restrictive

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8
Q

The adjustable gastric band is ____ and ____

A

Restrictive and adjustable

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9
Q

There is a long term average loss of ____-____% excess weight with gastric bypass

A

60-80

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10
Q

There is a long term average loss of ____% of excess weight with the sleeve

A

50%

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11
Q

Bariatric surgery can also improve comorbidities such as…

A

-Diabetes
-Hypertension
-GERD
-Reduction in medication
-Quality of life

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12
Q

The gastric bypass is also known as _____ ____ ____

A

Roux-en-Y gastric bypass

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13
Q

With gastric bypass, a small gastric pouch (about ____ mL) is created by a stable partition

A

30

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14
Q

With gastric bypass, the ___ ___ is attached to the gastric pouch via a narrow anastomosis (about 2 cm)

A

Distal jejunum

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15
Q

With gastric bypass, food bypasses the…

A

-Distal stomach
-Duodenum
-Proximal jejunum

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16
Q

Weight loss from gastric bypass is caused by…

A

-Restricted intake
-Decreased hunger
-Malabsorption
-Possible decrease in ghrelin production

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17
Q

Advantages of the gastric bypass:

A

-Gold standard of weight loss surgery
-Restrictive and malabsorptive
-Usual weight loss is 60-80% excess body weight in the first 2 years

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18
Q

Disadvantages of gastric bypass:

A

-Gastrointestinal rerouting
-Portion of the digestive tract is bypassed, which may result in nutritional deficiencies
-“Dumping syndrome” can occur
-Difficult to reverse
-More cuts= more changes of leaks

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19
Q

Gastric bypass complications:

A

-Dumping syndrome
-Leaks
-Blood clots
-Bleeding
-Ulcers
-Wound infections
-Bowel obstruction
-Internal hernias
-Organ failure
-Sepsis
-Death

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20
Q

Advantages of the sleeve gastrectomy:

A

-Continuity of gastrointestinal tract
-No rerouting
-Decrease in hunger by removing fundus and therefore ghrelin production
-Usually achieve loss of 50% excess body weight at 2 years

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21
Q

Disadvantages of the sleeve gastrectomy:

A

-Pouch can stretch
-Complicatications

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22
Q

Complications of sleeve gastrectomy:

A

-Reflux
-Leaks
-Sepsis
-Nausea
-Vomiting
-Bleeding
-Blood clots
-Vitamin deficiencies
-Death

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23
Q

If someone has a very high BMI, which procedure is recommended?

A

Gastric bypass

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24
Q

If someone is a type 2 diabetic on insulin, which procedure is recommended?

A

Gastric bypass

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25
Q

If someone has GERD, ulcers, or Barrett’s, which procedure is recommended?

A

Gastric bypass

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26
Q

If someone is a smoker, which procedure is recommended?

A

Sleeve

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27
Q

If someone has had chronic NSAID use, which procedure is recommended?

A

Sleeve

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28
Q

If someone has had previous hernia repairs, which procedure is recommended?

A

Sleeve

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29
Q

What are some contraindications for bariatric surgery?

A

-Previous Nissen Fundoplication
-Previous stomach surgery
-Cirrhosis
-Portal hypertension
-Not cleared by psych
-Very complication medical history that would make any surgery too high risk

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30
Q

What are the most common nutritional concerns post-op?

A

-Intolerance to certain foods from nausea and vomiting
-Dumping syndrome
-Nutritional deficiencies
-inadequate protein intake
-Weight regain
-“diet mentality”

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31
Q

In preparation for surgery, patients should eat 3 meals per day, focusing on ____ ____ and fruits and vegetables (+1 starch serving per meal, eaten last)

A

Lean protein

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32
Q

Before surgery, patients should aim for ___ ounces of non-caloric/non-carbonated fluids

A

64

33
Q

Before surgery, patients should also begin taking a ____

A

Multivitamin

34
Q

Before surgery, patients should also begin ____ ___ and mindful eating habits

A

Physical activity

35
Q

7 days prior to surgery, the patient should begin the ____ ___-___ diet

A

Liquid pre-op

36
Q

There is usually 6 days of a full liquid diet that consists of…

A

-Protein shakes
-Clear liquids (sugar free: Jell-O, popsicles, broths, crystal lite, Mio, G2 Gatorade, coffee/tea, milk)

37
Q

Those on the full liquid diet should limit caffeine to ____ ounces per day

A

16

38
Q

On the last day of pre-op, the patient should have ___ ____ only (protein shakes and milk are eliminated)

A

Clear liquids

39
Q

Patient should be NPO ____ hours prior to surgery

A

6

40
Q

Phase I of the post-op diet consists of ____ and begins the day the patient leaves the hospital (similar to the pre-op liquid diet)

A

Liquids

41
Q

The two goals for phase I of the post-op diet are…

A

-Protein
-Hydration

42
Q

Those on phase I of the post-op diet should get at least ___-___ g of protein per day

A

30-40

43
Q

Those on phase I should also try to sip ____ all day long

A

Fluids

44
Q

Acceptable liquids for those on phase I post-op diet:

A

-Sugar free: water, sports drinks, broths, Jell-O, popsicles, coffee/tea, milk, protein shakes, condensed strained soups with milk

45
Q

If someone on phase I of the post-op diet has symptoms of low blood sugar, we should treat with a small amount of ____ (like fruit juice or Gatorade)

A

Sugar

46
Q

In phase I of post-op, patients shouldn’t…

A

-Drink through straws
-Chew gum
-Take big gulps of fluid

47
Q

Phase II of the post-op diet is ___ ___

A

Soft foods

48
Q

Those on phase II of the post-op diet should eat ___ meals, focusing on eating protein first

A

3

49
Q

___-___ grams of protein per day is the goal for phase II of the post-op diet

A

60-80

50
Q

To start, those on phase II should have a ___-___ ounce meal, and slowing increase to ___ ounces

A

1-2; 4

51
Q

People in phase II should take small bites, chew thoroughly, and put the fork down between bites to ensure eating ____

A

Slowly

52
Q

People on phase II should not drink during or ____ minutes after meals

A

30

53
Q

People on phase II should begin a _____ regimen

A

Vitamin

54
Q

What are some acceptable foods for phase II of the post-op diet?

A

-Cottage cheese
-Yogurt
-Eggs
-Crockpot meat
-Fish that flakes
-Thinly sliced lunch meat
-Lean ground beef
-Soups
-Soft cooked/mushy vegetables,
-Applesauce
-Diced peaches

55
Q

Phase III of the post-op diet is building upon textures to get back to a ___ ___ (i.e crockpot chicken -> baked chicken breast with chicken stock -> grilled chicken breast)

A

Regular diet

56
Q

Patients in phase III should focus on nutritionally balanced meals with ____ as the most important macronutrient

A

Protein

57
Q

In phase III, patients should keep a ___ ____ to keep track of the amount of protein consumed per day

A

Food log

58
Q

Every recovery and progression back to normal food is ____

A

Individualized

59
Q

What are some common food intolerances in people after bariatric surgery?

A

-Tough meat
-Raw vegetables
-Dried fruits and skins
-Carbonated beverages
-Dairy products
-Seeds, nuts, and popcorn
-Sweets (gastric bypass)

60
Q

After bariatric surgery, people are commonly deficient in vitamin B12 due to…

A

-Decreased meat intake
-Decreased HCL and pepsin levels
-Decreased intrinsic factor

61
Q

After bariatric surgery, people are commonly deficient in iron due to…

A

-Decreased intake of heme iron
-Decreased HCl
-Bypassed duodenum (RYGB)
-Menstruating women are at high risk

62
Q

After bariatric surgery, people are commonly deficient in calcium due to…

A

-Decreased intake
-Bypassed duodenum
-Vitamin D deficiency
-Steatorrhea

63
Q

After bariatric surgery, people are commonly deficient in folate due to…

A

-Decreased intake
-Vitamin B12 deficiency

64
Q

After bariatric surgery, people are commonly deficient in fat-soluble vitamins due to…

A

Biliopancreatic diversions

65
Q

Patients who had gastric bypass should get ___ servings of multivitamin per day, while those with the sleeve should get ___ serving

A

2; 1

66
Q

After both gastric bypass and sleeve gastrectomy, patients should get ____-____ mg of calcium per day

A

1200-1500

67
Q

Those who had gastric bypass should get their calcium from ___ ___, while someone with the sleeve can get it from either ___ ___ or ____

A

Calcium citrate; calcium citrate or carbonate

68
Q

Patients who received gastric bypass or the sleeve should get ____ IU of vitamin D per day

A

3000

69
Q

After either gastric bypass or the sleeve, patients should get ____-____ mcg per day of cyanocobalamin (vitamin B12)

A

500-1000

70
Q

After either gastric bypass or the sleeve, patients should get ____ mg of thiamin (vitamin B1)

A

12

71
Q

____ ____ should be taken as instructed for both gastric bypass and the sleeve

A

Ferrous sulfate

72
Q

What is included in initial visits for those looking to get bariatric surgery?

A

-Qualify for surgery and have bariatric coverage
-Smoking cessation
-Lab work
-Cardiac clearance
-EKG
-Pulmonary clearance and sleep study
-RD visits

73
Q

Before surgery, patients will also have monthly visits as well as a final ___-___ visit

A

Pre-op

74
Q

Eliciting ____ ____ is a big part of the roles of an RD

A

Behavior change

75
Q

What are two challenges of the RD in the bariatric setting?

A

-Limited amount of time with patients
-Eliminating diet mentality

76
Q

Medical management of obesity is a ___-___ weight loss approach

A

Non-invasive

77
Q

What are some weight loss drugs approved by the FDA?

A

-Orlistat
-Phentermine
-Belviq
-Contrave
-Qsymia
-Saxenda

78
Q

With medical management of obesity, the RD can encourage ____ ____ and exercise

A

Lifestyle modification

Advanced Medical Nutrition Therapy (14 decks)

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