Module 6: Gastric Bypass Surgery Flashcards
3 categories of weight loss surgery
- restrictive
-limits amount of food that can enter stomach - malabsorptive
-bowel length shortened, reduced absorbed food
3.combines
-both
3 common surgerical procedures
1) Vertical banded gastroplasty (VBG)
- vertical staple
2) Adjustable gastric banding (AGB)
- band circles top of stomach
3) Roux-en-Y (RYBG) MOST COMMON
-gastric pouch
Swedish obese study shows after 1 year:
-Lower Body weight
-Higher HDL-C
-Many cases of
T2D within target
Swedish obese study shows after 10 years
-Weight re-gain
-Reoccurance of co-morbidities
Success in surgery (and limitation of diabetes) influenced by:
Amount of time patient had diabetes prior (less than 10 = better resolution)
What does BRAVE stand for in RYGB surgery
B-bile flow alteration
R-reduction in gastric size
A-anatomical gut rearrangement
V-vagal manipulation
E-enteric gut hormone modulation
B-bile flow alteration - how?
-Bile and nutrients mix lower in intestine than normal
-reduced nutrient absorption- MORE bile acids in large intestine
B-bile flow alteration - how does it help?
More bile acids = trigger release of GLP-1 and FGF19
-improves insulin sensitivity and reduces lipogenesis
R-reduction in gastric size - long or short term affect
Not long-term benefits, not sustainable
A-anatomical gut rearrangement - what does that affect
Nutrient digestion and absorption
A-anatomical gut rearrangement- how?
Duodenum and part of jejunum bypassed
(site for nutrient absorption)
V-vagal manipulation - how?
-manipulation/alteration of vagus nerve signalling (brain to stomach, vice verse)
NOT CUT
V-vagal manipulation- what does it do
-influence body weight, food intake, blood glucose levels
E-enteric gut hormone modulation- what does it do
Increase incretin activity - Incretin effect comparable to lean individuals within 1 month
Blood lipids after RYGB
-reduction in blood TAG
-reduction in cholesterol, VLDL-C, LDL-C
-increase in bl HDL-C
