Surgical Procedures associated with obesity

Question 1

What are 4 consequences of obesity?

Answer 1

Increased mortality
Increased hypertension risk
increased diabetes risk
Increased cancer risk

Question 2

What is the Swedish obese subjects trail?

Answer 2

A prospective controlled intervention study of bariatric surgery

Question 3

What is the What is the Swedish obese subjects trail primary aim?

Answer 3

Are bariatric surgery or weight loss induced by bariatric surgery reduced mortality?

Question 4

What is the secondary aim for the Swedish obese subjects trail?

Answer 4

Whether bariatric surgery or weight loss induced by bariatric surgery cost efficienct and improve quality of life

Question 5

What are 3 bariatric surgeries?

Answer 5

Gastric banding
Vertical banded gastroplasty
gastric bypass

Question 6

does bariatric surgery reduce mortality compared to control?

Answer 6

yes

Question 7

does bariatric surgery reduce weight compared to control over 20 years?

Answer 7

Not in banding or VBG
GBP leads to effective long term weight loss

Question 8

does bariatric surgery improve T2DM profile compared to control?

Answer 8

Yes increases remission

Question 9

does bariatric surgery reduce incidence of diabetes compared to control?

Answer 9

Yes

Question 10

does bariatric surgery improve CVE profile compared to control?

Answer 10

Yes

Question 11

does bariatric surgery improve cancer profile compared to control?

Answer 11

Yes but only in females

Question 12

How is bariatric surgery achieving weight loss?

Answer 12

Caloric restriction
malabsorption of nutrients

Question 13

How is the malabsorption of nutrients achieved?

Answer 13

Creating a smaller stomach - eating smaller quantities
vagal impaction
bypassing digestion and absorption in duodenum

Question 14

Does the malabsorption theory hold out?

Answer 14

No

Question 15

What cells make gastro intestinal hormones?

Answer 15

Enetroendocrine cells

Question 16

What hormones are changed?

Answer 16

Ghrelin
GLP-1
PYY

Question 17

Where is GLP-1 made?

Answer 17

L-cells distal SI

Question 18

Why do GLP-1 levels increase after surgery?

Answer 18

precedes any significant weight loss - due to new anatomy rather than weight loss

Question 19

What is the name of a GLP-1 analogue?

Answer 19

Semaglutide

Question 20

What does semaglutide treat?

Answer 20

T2D & reducing risk of CVE in persons with T2D and CVD

Question 21

What was the results of the study with semaglutide?

Answer 21

86% of participants lost >5% body weight compared to 32% with placebo

Question 22

What is GLP-1 analogues used in combination with?

Answer 22

GIP

Question 23

What are characteristics of GIP?

Answer 23

Produced by K cells
Proximal small intestine
Levels rise after nutrient ingestion (satiety factor)

Question 24

Does gastric bypass change composition of bacteria in gut?

Answer 24

Yes

Question 25

What happened when mice were given a fecal transplant from the mice that underwent surgery?

Answer 25

Weight loss seen

Question 26

Do plasma bile acids increase or decrease after gastric bypass?

Answer 26

Increase

Question 27

What is the location of bile acid release imprtant?

Answer 27

affects gut hormone release

Question 28

When bile goes into the ileum which hormones increase (compared to duodenum)

Answer 28

GLP-1 levels increase
PYY increases

Question 29

What is dumping syndrome that is associated with bariatric surgery?

Answer 29

Follows high sugar meals leading to osmotic stress -> rapid transit of nutrients into Si which leads to cramps & diarrhea

Question 30

How is food preferences changed in bariatric surgery?

Answer 30

Food tastes different
increased sensitivity to sweet/fatty food
MRI - rewiring of response to food