Obesity 5 Flashcards
why is bariatric surgery benficial?
Reduces mortality
Fewer cancer deaths
Fewer MI deaths
Surgery effective against diabetes and reduced medications taken, weight, and dyslipidemia
is laparoscopic bariatric surgery safe?
YES
qualifications for bariatric surgery
- BMI >40
- BMI >35 with comorbidity, T2DM, or hyperglycemia inadequately controlled
insurance requirements for surgery
- 6 months of visits and notes from doctor
- lab work up
- continued attempts to lose weight during the process
most popular bariatric surgery
sleeve gastrectomy
sleeve gastrectomy length or surgery and stay
1 hour
1-2 night stay
sleeve gastrectomy pros
- simple
- expected 55-70% weight loss
- reduces comorbidities
sleeve gastrectomy complications
- leaks
- reflux
- Barrett’s esophagus
- narrowing of sleeve
- bleeding
- GERD
gastric bypass lengths
2 hours
2 night stay
gastric bypass pros
- 52-68% weight loss
- effective for GERD and diabetes
- sustained long term weight loss and comorbidity resolution
gastric bypass cons
- restriction
- hormonal changes
- malabsorption (mainly in distal bypass)
gastric bypass risks
- mortality
- PE
- leak
- stricture
- ulcer
6. internal hernia - vitamin deficiencies
- osteoporosis
- dumping syndrome
duodenal switch pros
- 70% weight loss
- best improvement of DM and comorbidites
what is duodenal switch?
combination of sleeve and bypass
duodenal switch cons
- complex operation
- greater malabsorption
- short common channel
- greater risk of nutritional deficiencies and diarrhea
duodenal switch aka
SADS
SADI-S
SIPS
gastric band is the only option that is easily
reversible and adjustable
gastric band pros
- fast (<1 hour)
- 35-55% weight loss
- low overall risk
for gastric band to work you need to:
- chew well
- follow up regularly for band adjustments
- avoid maladaptive eating behavior
gastric band complications
- Band Slippage/Prolapse
- Band Erosion
- Tubing Leak
- Port access difficulties
- Port Infection
- Esophageal dilation
sleeve gastrectomy is right choice for
first step or on way to BPD/DS
sleeve gastrectomy is not good to treat
GERD
Roux-en-Y gastric bypass (RYGB) best for
diabetes or bad reflux
Biliopancreatic diversion with duodenal switch (BPD/DS) best for
diabetes and most weight loss
early dumping syndrome is mainly seen in __, but also a bit in __
early dumping syndrome is mainly seen in gastric bypass, but also a bit in sleeve gastrectomy
early dumping syndrome: within _ hours of meal
early dumping syndrome: within 1 hours of meal
symptoms of early dumping syndrome
(palpitations, hypotension, light-headedness) and GI symptoms (abdominal pain, nausea, diarrhea)
what triggers early dumping syndrome
intake of high osmolar food (i.e. sugars, simple/processed carbs) and rapid emptying into the small bowel that is not quite ready to handle it
diagnosis of early dumping syndrome
- careful history
- temporal relationship between food and symptoms
treatment of early dumping syndrome
Dietary modification
Reduce simple carbs, increase proteins
Chew slowly
Eat small portions
Don’t drink fluids for 30 min after a meal
Octreotide if diet doesn’t help
Surgery if above doesn’t help
surgery options for early dumping syndrome
- Gastric outlet restriction (i.e. endoscopic or surgical suturing to narrow the anastomosis)
- Gastrostomy tube in gastric remnant
- Reversal of gastric bypass
late dumping syndrome __ hours after meal
late dumping syndrome 1-3 hours after meal
how long after surgery does late dumping syndrome develop
2-4 years
symptoms of late dumping syndrome
Adrenergic symptoms (anxiety, agitation, tremors, palpitations, tachycardia)
Neuroglycopenic symptoms (confusion, fatigue, memory, weakness, dizziness, blurry vision, ataxia, speech problems, seizures, syncope)
late dumping syndrome is related to beta islet cell __
late dumping syndrome is related to beta islet cell hyperplasia
late dumping syndrome complaints due to
hyperinsulinemia and hypoglycemia
diagnosis of late dumping syndrome
baseline and postprandial glucose and isnulin levels
dietary management of late dumping syndrome
Avoid rapidly absorbed simple carbs.
Increase proteins, fiber
Multiple small meals throughout the day
medications for late dumping syndrome
Nifedipine – reduce insulin release
Acarbose – slow food digestion
Diazoxide - reduce insulin release
Octreotide - reduce insulin release and slow glucose absorption
surgical treatment of late dumping syndrome
Anastomosis restriction (endoscopic or surgical)
Gastrostomy tube in the bypassed stomach (helps avoid oral intake)
People don’t want to live like this as permanent solution -> if patient responds well to this, can help determine if the patient would benefit from reversal of bypass
nutrient deficiencies with bariatric surgery
- protein
- thiamine
- iron
- B12, B6, folate
- calcium
- vitamin D
- trace minerals
- zinc, copper, selenium
- other fat soluble vitamins A, E, K
- B1
bariatric surgery iron deficiency
- Deficiency is very common in patients even before bariatric surgery, and a common deficiency after bariatric surgery
- Primary absorption in duodenum, proximal jejunum
- Optimal absorption requires acid, give with Vit-C
- Don’t take together with calcium or with acid reducing medications
- Can be more severe with menstruation, may require IV repletion
bariatric surgery B12 deficiency
- Common both before bariatric surgery and after surgery
- B12 requires intrinsic factor binding, acid environment (stomach)
- Absorption in terminal ileum
- Deficiency can lead to decreased blood cell counts, peripheral neuropathy, central neuropathy. Neuropathy can be irreversible.
bariatric surgery B1 deficiency most common in
RYGB and DS
B1 deficiency can lead to
life-threatening cardiovascular and neurologic complications that are potentially irreversible
B1 deficiency treatment
PO thiamine if mild acute deficiency
IV thiamine if significant deficiency, very symptomatic, suspected to not be absorbing, or suspected poor compliance
