Upper GI (Bariatric Surgery, GERD & HH) Flashcards
Criteria Guidelines for Bariatric Surgery:
-BMI of 40, or…
•BMI of 35 w/ one or more severe obesity-
related medical complication (Examples: HTN, DM, HF,
OSA)
•Psychological, physical & behavior screening
Define Bariatric Surgery…
Defined: surgery on stomach or intestines to help
a person with extreme obesity loses weight
Name the two categories of Bariatric Surgery:
- Restrictive
• Results in less food eaten - Malabsorptive
• Results in less food absorbed (length of small intestine is decreased)
Name the two types of Restrictive Bariatric Surgery:
- Sleeve gastrectomy (Removal of part of the stomach)
2. Intragastric balloon (Not a surgery: minimally invasive procedure; temporary, relatively new type of procedure)
What is the Roux-en-Y procedure?
It is a combination of Restrictive & Malabsorptive, it is also the MOST COMMON type of Bariatric Surgery!
Sleeve Gastrectomy (Restrictive):
Most of the greater curvature of the
stomach is removed and a tubular stomach
is created. It is permanent.
Intragastric Balloon (Restrictive):
• Consists of soft, saline-filled balloon that promotes a feeling of satiety (fullness) & restriction. • 400-700 ml of saline • Maximum of six months. (After that, ↑ risk for leakage.) • (Three devices currently approved by the FDA.)
Roux-en-Y procedure (Restrictive & Malabsorptive):
***Gold standard among bariatric procedures • Most common bariatric procedure • Restricts intake & lessens absorption • 15 ml pouch • Avg. hospital stay = 2-3 days • Lose 60-70% of weight in 1-2 years • Permanent procedure
Which Bariatric procedure is known as the gold standard among bariatric procedures??
Roux-en-Y procedure
Which Bariatric procedure is the most common bariatric procedure?
A. Intragastric Balloon
B. Sleeve gastrectomy
C. Roux-en-Y procedure
C. Roux-en-Y procedure
Outcomes of Roux-en-Y procedure:
Due to loss of weight: • Increased glucose tolerance • Decreased diabetes • Decreased BP • Decreased cholesterol/triglycerides • Decreased GERD • Decreased sleep apnea
Adverse outcomes of Roux-en-Y procedure:
- Decreased absorption of iron, cobalamin/Vitamin B12, folic acid, & calcium
- Dumping syndrome
Will the patient that gets bariatric surgery require vitamin supplements?
YES. Due decreased absorption and malabsorption, the patient will lose vitamins, iron, and more. The patient will require vitamin supplementation for the rest of their lives.
What is dumping syndrome?
A phenomenon that happens when the stomach is smaller, the patient takes in hyperosmolar (highly concentrated in simple sugars) meal and then fluid shifts into the stomach and dumps into the small intestine. Results in profuse diarrhea, dizziness and lightheadedness, causes the patient to experience hypovolemia.
Bariatric Surgery Post Op Nursing Care:
Routine post-op management:
• Enhance mobility
• Pain management
• Risk for wound infection, dehiscence & evisceration
• Resumption of liquids & food – extensive patient & family teaching
Also-NG to LWS -> water/sugar-free liquids -> high-protein
liquids -> pureed diet (2 weeks) -> solid food (4-6
weeks)
What is the Long-term Diet Recommendation?
The DASH Diet!
(Dietary Approaches to Stop Hypertension)
Name the recommended DASH diet servings per food group:
6-8 servings per day whole grains
4-5 servings per day vegetables
4-5 servings per day fruit
2-3 servings per day low fat or fat free dairy
4-5 servings per week nuts, seeds, legumes
less than 6 servings per day lean meat, poultry, fish
less than 5 servings per week sweets
2-3 servings per day fats, oils
Typical GI-Related Drug Therapy includes:
- Antacids- Quick, but short-lived relief; take them 1-3 hrs after meals & @ hs (bedtime)
- H²R blockers (Antihistamines)
cimetidine (Tagamet), famotidine (Pepcid)
OTC or prescription - PPI’s (Proton Pump Inhibitors)-Decreases gastric acid secretion
• omeprazole (Prilosec), lansoprazole (Prevacid), esomeprazole (Nexium), pantoprazole
(Protonix)
• OTC or prescription - Cytoprotective agent- Coats the stomach
• sucralfate (Carafate) - Prokinetic agent – (GERD)- Enhances gastric emptying, also promotes appetite
• metoclopramide (Reglan)
Define GERD:
Backward flow (“reflux”) of GI contents into esophagus, caused by loosened LES (Lower Esophageal Sphincter)
What is the most common symptom of GERD?
Heart burn
What are the clinical manifestations of GERD?
- Heartburn
- Regurgitation
- May also report respiratory symptoms
GERD complications include:
•Esophagitis •Barrett’s esophagus (chronic esophagitis, with changes at the cellular level (esophageal metaplasia) •Respiratory s/s: •Cough, bronchospasms
Diagnostic tests for GERD:
- Barium swallow
* EGD
Due to the cost/discomfort of GERD diagnostic tests, name another option:
Due to cost/discomfort, often a
high-dose PPI x 2 weeks is given as a first
step in diagnosing GERD
Lifestyle modifications for GERD:
- Avoid triggers
* Quit smoking (immediate improvement in LES)
Nutritional therapy for GERD:
- Avoid fatty foods
- Small, frequent meals w/ no fluids during meals (result: decreases distention)
- Avoid late night snacking; Keep HOB up/allow patient to sit up for 2-3 hrs pc (after meals)
- Elevate HOB with 4-6 inch blocks
- Weight loss, if indicated (decreases intra-abdominal pressure)
True or False?
There are available drug therapy options for GERD
True
What are the two procedural options for severe GERD?
LINX device insertion & Fundoplication
Describe LINX device insertion:
• Endoscopic procedure
• Augments the LES with a ring made up of a series of rare earth magnets
• The magnets have sufficient attraction to increase LES closure pressure, but it permits food passage with swallowing
LINX device insertion will strengthen the LES closure
Describe Fundoplication:
• Endoscopic or open procedure
Open: Patient will have an abdominal insertion with primary intention
Endoscopic/Laparoscopic: Patient will not an incision site, due to the scope procedure
Nissan Fundoplication procedure:
Provides a 360 degree “wrap” or collar around the esophagus. Mobilization of the fundus is generally accomplished by diving the short gastric vessels to the spleen
What is a Hiatal Hernia?
Herniation of a portion of the stomach
into the esophagus through an
opening in the diaphragm.
Also known as: diaphragmatic /esophageal hernia
What are the causes and the symptoms of a Hiatal Hernia?
Cause: Often structural (pressure on LES), such as pregnancy, obesity (increases intra- abdominal pressure)
Symptoms:
May be asymptomatic, or if present, similar
to GERD symptoms
The treatment for Hiatal Hernia is similar to which other condition?
Treatment for Hiatal Hernia is similar to that of GERD
How is Barrett’s Esophagus condition confirmed?
Confirm with biopsy
True or False?
Not everyone who has Hiatal Hernia (HH), has Barrett’s Esophagus.
True
Those with Barrett’s Esophagus’s risk for developing esophageal cancer is increased by how much??
30-40 fold increase
