Obesity: Bariatric and metabolic surgery lecture Flashcards
What are the most common comorbidities with severe obesity?
- High blood pressure
- Infertility
- Cancers
- 6-8 yrs at least reduced life expectancy with severe obesity
What is the result of diet, lifestyle programs, on obese?
max 5% weight reduction after five years. Surgery = only proven long-term therapy
What is the clinical pathway for bariatric surgery?
Referral
Multidisciplinary screening (psychologist & dietician)
Preparation (group, motivation)
Operation
Lifestyle modification
Consolidation phase (follow-up)
is the gastric band surgery still used?
No, bc there are more powerful options
Gastric bypass: characteristics?
Not necessary to take stomach out (blood supply)
Disconnect very small stomach
Connect Sl to it
Connect duodenum to lower part of small intestine
Does not work for very very overweight people, the tension inhibits the connection of small intestine and stomach
Gastric sleeve: characteristics?
Small stomach (disconnect a part of the stomach)
Same function as gastric band
Hormonal signalling changes when decreasing stomach volume
Lot of patients can cut medication already two days after the surgery: no weight loss yet, but perhaps ..
gut-brain axis
Early complications of bariatric surgery:
- bleeding
- leakage
- thrombosis
- pneumonia
Late complications of bariatric surgery:
Vitamin deficiencies
Gallstones
Ulcer
Internal herniation
Adhesions/bowel obstruction
Incisional hernia
Deficiencies before operation: how come?
- Unvaried eating pattern
- Unbalanced diet (relatively high fat/carbohydrates and low protein, dairy, vegetables & fruit)
- Underlying chronic condition
- Medication
What is usually deficient before operation?
Vit D, B12, folic acid, iron: check
Dumping may occur as a result of the surgery. How to treat this?
- Prevention rapid increase glucose
- Consult dietician (fast & slow carbs)
- Meals max. 30 gr Ch, in between 15 gr
- Frequent (5-6) small meals throughout the day
- Start meds
- Consider surgery
Patient case:
Bariatric operation 2 years ago
Diagnosed diabetes before surgery
Stopped using metformin last year (lowers blood sugar)
Drinks alcohol
Multivitamin supplement use
> los 30 kg, now has BMI of 27kg/m2
Symptoms:
- abdominal pain
- nausea
- diarrhoea 3-4x a day
- cold sweats
- dizziness
- exhausted feeling
- tingling sensation in fingertips
Complaints after every meal, but especially after Ch
Lab results: endomysial antibodies were not there
Endoscope shows no ulcers, no inflammation
Most likely diagnoses from this list:
-coeliac
- hypoglycaemia
- dumping
- peptic ulcer disease
-cholecystitis
- diabetic neuropathy
- exc alcohol cons
- vit B12 deficiency
- vit B6 intoxicatino
- zinc deficiency
Dumping:
- abdominal pain, nausea, diarrhoea and dizziness
- within 13-50 min after meal
Vit B12 deficiency:
- tired, weak, exhausted
- tingling finger, change of speech
- metformin inhibits absorption
- lab: low value, apparently
