Role of Bariatric Surgery Flashcards
Describe an apple shape.
- More visceral fat
- higher risk of weight-related health problems
Describe a pear shape
- Less visceral fat
- Lower risk of weight related health problems
What are the features of obesity metabolic syndrome?
- Stroke
- Cataracts
- Coronary heart disease
- Diabetes
- Dyslipidaemia
- Hypertension
- Severe pancreatitis
- Cancer
- Phlebitis
- Gout
- Skin problems
- Osteoarthritis
- Gynaegologic abnormalities
- Gall bladder disease
- NAFLD
- Pulmonary disease
- Idiopathic intracranial hypertension
What are the options for bariatric surgery?
- Restritive
- Malabsorptive
- Combiantion
What should be taken into account when deciding a management plan?
Patients choice
- Peers
- Celebrities
- Safety
Bariatric MDT choice
- Personal/units experience
- Patients BMI/co-morbidities/diet
What are the advantages of a laparoscopic adjustable gastric banding procedure?
Relatively minor surgery
-Reversible and adjustable
Low operative complication rate
-Mortality 0.1%
What are the disadvantages of a laparoscopic adjustable gastric banding procedure?
- Requires an implanted medical device
- Easier to cheat
- Risk of prolapse or slippage
- 15% will require revisional surgery
What are the advantages of a laparoscopic sleeve gastrectomy?
- Good medium term outcomes
- No ‘dumping’ syndrome
- No small bowel manipulation
- No foreign body
What are the disadvantages of a laparoscopic sleeve gastrectomy?
- More invasive surgery
- Long staple line (bleeding/leak)
- Short pedigree
- Mortality 0.4%
What are the advantages of laparoscopic gastric bypass?
- Quick and dramatic weight loss
- Pedigree
- Dumping syndrome
What are the disadvantages of a laparoscopic gastric bypass?
- More invasive surgery
- Malabsorptive component requires lifelong supplements
- More complex if requires revision
- Mortality 0.5%
What are the possible complications of bariatric surgery?
- Anastomotic leak
- DVT/PE
- Infection
- Malnutrition
- Vitamin and mineral deficiencies
- Hair loss
- Excess skin
- Addiction transfer
What effect will an increase in GLP-1 have on the brain?
- Decrease migraine
- Decrease depression
- Decrease BIH
- Decrease stroke
- Decrease appetite
- Increase satiety
- Increase cognitive function
What effect will an increase in GLP-1 have on the skin?
Decrease psoriasis
What effect will an increase in GLP-1 have on the pancreas?
- Decrease T2DM
- Increase insulin production
What effect will an increase in GLP-1 have on the respiratory tract?
- Decrease OSA
- Decrease asthma
What effect will an increase in GLP-1 have on the musculoskeletal system?
- Decrease osteoarthritis
- Decrease gout
What effect will an increase in GLP-1 have the heart?
- Decrease CVD
- Decrease hypercholesterolemia
- Decrease hypertension
What effect will an increase in GLP-1 have on the GIT?
- GERD
- Decrease Ghrelin
- Increase PYY
- Altered bile acids
- Altered gut microbiota
What are the general effects an increase in GLP-1 will have on the body?
- Decrease mortality
- Decrease certain cancers
- Difference in metabolic adaptation to weight loss
- Increase in diet induced thermogenesis
- Decrease in insulin resistance
- Increase in glucose disposal
- Decrease in PCOS
- Decrease in urinary stress incontinence
What are the 4 tiers of management in bariatric medicine?
- Universal interventions
- Lifestyle interventions
- Specialist services
- Surgery
