T12: Obesity/Gastric Bypass Surgery

Question 1

Criteria for bariatric surgery

Answer 1

o BMI ≥40 kg/m2
o BMI ≥35 kg/m2 with other significant comorbidities (Hypertension, type 2 diabetes, heart failure, sleep apnea)

Question 2

before bariatric surgery, must be screened for

Answer 2

o Psychologic, physical, and behavioral conditions that have been associated with poor surgical outcomes
o Illnesses known to reduce life expectancy are not likely to be improved with weight reduction

Question 3

adjustable gastric banding (AGB)

Answer 3

limits stomach size with an inflatable band around fundus of the stomach (most common procedure)

Question 4

sleeve gastrectomy

Answer 4

o 75% of the stomach is removed
· Not reversible

Question 5

sleeve gastrectomy results in

Answer 5

· elimination of hormones produced in the stomach that stimulate hunger (Ghrelin)

Question 6

Roux-en-Y surgical procedure (RYGB)

Answer 6

food bypasses 90% of the stomach, duodenum, and a small segment of jejunum

Question 7

with Roux-en-Y surgical procedure (RYGB) patient will need

Answer 7

cobalamin

Question 8

complication of RYGB

Answer 8

Dumping syndrome: Gastric contents empty too rapidly into small intestine
· Avoidance of sugary foods is recommended

Question 9

Maestro Rechargeable System

Answer 9

Pacemaker-like electrical pulse generator, wire leads, and electrodes implanted in abdomen
· Sends intermittent electrical pulses to vagus nerve which is involved in regulating stomach emptying and signaling feelings of emptiness or fullness to brain

Question 10

what should be in the patient room before arrival

Answer 10

o Larger blood pressure cuff
o Larger gown
o Patient transfer equipment
§ Wheelchair with removable arms

Question 11

pre-op the patient should practice…

Answer 11

Practice cough, deep breathing, turning, and positioning procedures
o Teach spirometer use
o Arrange for CPAP if used at home

Question 12

why do we reevaluate for sedation

Answer 12

sedation gets stored in the fat cell

Question 13

Following bariatric surgery

Answer 13

o Patient now has reduced intake because of anatomic changes
o Attention to nutrition is important to prevent early and/or late complications

Question 14

metabolic syndrome

Answer 14

: Group of risk factors that increase an individual’s chance of developing cardiovascular disease, stroke, and diabetes mellitus (more prevalent in those 60 years of age and older)

Question 15

three of the following symptoms for metabolic syndrome

Answer 15

o Waist circumference ≥40 inches (men) or ≥35 inches (women)
o Triglycerides >150 mg/dL
o HDL cholesterol <40 men, <50 women
o Blood pressure ≥ 130 mm Hg systolic or ≥ 85 mm Hg diastolic
o Fasting glucose ≥ 100 mg/dL

Question 16

intervention for metabolic syndrome

Answer 16

LIFESTYLE MODIFICATIONS are first-line interventions
o Reduce LDL cholesterol
o Stop smoking
o Lower blood pressure
o Reduce glucose levels