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FOO > WEIGHT LOSS SURGERY; CONDITIONS AND CONSEQUENCES > Flashcards

WEIGHT LOSS SURGERY; CONDITIONS AND CONSEQUENCES Flashcards

1
Q

OTHER NAMES FOR WEIGHT LOSS SURGERY?

A

BARIATRIC SURGERY

METABOLIC SURGERY

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2
Q

WHICH CONDITIONS CAN BE TREATED WITH WEIGHT LOSS SURGERY?

A

OBESITY, DIABETES, HIGH BP, SLEEP APNEA AND HIGH CHOLESTEROL

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3
Q

ACCORDING TO CURRENT NICE GUIDELINES, BARIATRIC SURGERY IS RECOMMENDED FOR WHICH PEOPLE?

A
  • THOSE WITH BMI HIGHER THAN 40
  • THOSE WITH BMI BETWEEN 35 AND 39.5 IF OTHER SIGNIFICANT DISEASES ARE PRESENT THAT COULD BE IMPROVED WITH WEIGHT LOSS
  • THOSE WITH A BMI OF 30-34.9 AND RECENT ONSET OF T2D
    (PATIENTS SHOULD HAVE PREVIOUSLY TRIED ALL APPROPRIATE NON-SURGICAL MEASURES)
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4
Q

HOW MANY PEOPLE HAVE BARIATRIC SURGERY IN ENGLAND EACH YEAR?

A

7 000

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5
Q

HOW MANY PEOPLE IN ENGLAND ARE ELIGIBLE FOR WEIGHT LOSS SURGERY’

A

ABOUT 3.6 MILLION

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6
Q

WOMEN VS MEN; WHO IS MORE ELIGIBLE FOR BARIATRIC SURGERY AND WHO UNDERGOUES IT MORE?

A
  • MORE WOMEN THAN MEN ELIGIBLE IN ENGLAND (58.4 VS 41.7%)

- MORE WOMEN THAN MEN HAVE THE SURGERY (76.1 VS 23.9%)

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7
Q

CAN CHILDREN BE CONSIDERED FOR BARIATRIC SURGERY?

A

YES, BUT IT IS A GRAY AREA, ASSESSED ON CASE BY CASE BASES

GENERALLY THE SURGERY SHOULD BE AVOIDED IN CHILDREN

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8
Q

PATIENTS WITH WHICH BMI ARE ELIGIBLE FOR BARIATRIC SURGERY REGARDLESS OF WHETHER THEY HAVE TRIED LIFESTYLE OR DRUG INTERVENTIONS (ALL NON-SURGICAL MEASURES)?

A

50+ KG/M2

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9
Q

‘RECENT ONSET’ T2D MEANS:

A

DIAGNOSED WITHIN 10 YEAR TIME FRAME

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10
Q

PATIENTS OF WHICH ETHNIC BACKGROUND SHOULD BE CONSIDERED FOR BARIATRIC SURGERY AT A LOWER BMI?

A

PATIENTS WITH AN ASIAN ETHNIC BACKGROUND

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11
Q

AFTER GASTRIC BYPASS SURGERY, UP TO HOW MANY PATIENTS REGAIN WEIGHT?

A

50%

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12
Q

UP TO HOW MANY PEOPLE REGAIN THE WEIGHT LOST THROUGH LIFESTYLE MODIFICATIONS IN 5 YEARS?

A

90%

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13
Q

BARIATRIC SURGERY CAN RESULT IN WHAT PERCENTAGE OF EXCESS WEIGHT LOST IN THE PATIENT?

A

70%

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14
Q

SURGICAL PROCEDURES FOR WEIGHT LOSS ARE CLASSIFIED INTO?

A
  • RESTRICTIVE PROCEDURES (STOMACH’S CAPACITY GREATLY REDUCED)
  • MALABSORPTIVE PROCEDURES (MALABSORPTION IS THE PRIMARY DRIVER OF WEIGHTLOSS)
  • A COMBINATION OF MALABSORPTIVE AND RESTRICTIVE ELEMENTS
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15
Q

3 MAIN PROCEDURES IN WEIGHT LOSS SURGERY:

A
  • ADJUSTABLE GASTRIC BANDING (GASTRIC BAND)
  • GASTRIC BYPASS (ROUX-EN-Y GASTRIC BYPASS)
  • SLEEVE GASTRECTOMY
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16
Q

PRINCIPLE OF ADJUSTIBLE GASTRIC BAND?

A
  • AN ADJUSTABLE SILICONE BAND IS PLACED AROUND THE UPPER STOMACH, A FEW CM BELOW THE BEGINNING OF THE STOMACH
  • THIS CREATES A 15 TO 30 mL GASTRIC POUCH
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17
Q

MAXIMUM NORMAL STOMACH VOLUME?

A

2 TO 4 LITRES

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18
Q

GASTRIC BYPASS SURGERY PRINCIPLE?

A
  • A SMALL, VERTICALLY ORIANTED GASTIC POUCH IS CREATED, WHICH REMAINS ATTACHED TO THE ESOPHAGUS AT ONE END AND AT THE OTHER END IT IS CONNECTED TO A SMALL SECTION OF THE SMALL INTESTINE, THUS BYPASSING THE REMAINING STOMACH AND THE INITIAL LOOP OF THE SMALL INTESTINE
19
Q

SLEEVE GASTRECTOMY PRINCIPLE?

A
  • THE OPERATION INVOLVES DIVISION OF THE STOMACH VERTICALLY, WHICH REDUCES ITS SIZE BY 75%
  • THE PYLORIC VALVE (SPHINCTER, AT THE STOMACH EXIT) IS PRESERVED SUCH THAT THE STOMACH DIGESTION AND FUNCTION REMAIN UNALTERED
20
Q

SLEEVE GASTRECTOMY REDUCES STOMACH SIZE BY?

A

75%

21
Q

OF THE MAIN 3 BARIATRIC SURGICAL PROCEDURES, WHICH ONE IS THE MOST EFFECTIVE IN WEIGHT LOSS?

A

GASTRIC BYPASS

22
Q

% OF THEIR EXTRA WEIGHT PEOPLE LOSE WHICH EACH TYPE OF BARIATRIC SURGERY?

A
  • GASTRIC BYPASS: 60% OF EXTRA WEIGHT LOSS (80% IN MORBIDLY OBESE)
  • GASTRIC SLEEVE: 50%
  • GASTRICAL BAND: 40%
23
Q

OTHER BARIATRIC PROCEDURES (EXCEPT FOR THE SLEEVE, BAND AND BYPASS):

A
  • BILIOPANCREATIC DIVERSION (A LOT OF COMPLICATIONS LIKELY, MINIMAL ABSORPTION)
  • INSTRAGASTRIC BALLOON (TEMPORARY, UP TO 6 MONTHS)
  • PRIMARY OBESITY SURGERY ENDOLUMENA (USE OF SMALL TOOLS TO CREATE FOLDS IN THE LUMEN OF THE STOMACH TO MAKE IT SMALLER)
24
Q

BARIATRIC SURGERY VS NON SURGICAL WEIGHT MANAGEMENT; WHAT IS MORE EFFECTIVE IN WEIGHT LOSS AND WEIGHT LOSS MAINTENANCE?

A

BARIATRIC SURGERY IS MORE EFFECTIVE IN BOTH ASPECTS

25
Q

IN MORBIDLY OBESE PATIENTS, WHAT IS CONSIDERED TO BE THE ONLY EFFECTIVE THERAPY?

A

BARIATRIC SURGERY

26
Q

REMISSION OF DIABETES IS MORE EFFECTIVELY ACHIEVED THROUGH BARIATRIC SURGERY OR MEDICAL THERAPY?

A

BARIATRIC SURGERY

27
Q

WHAT IS THE MOST POTENT TYPE OF BARIATRIC SURGERY TO REDUCE T2D?

A

GASTRIC BYPASS

28
Q

AFTER GASTRIC BYPASS, UP TO WHAT % OF INDIVIDUALS SHOW WHO WERE DIABETIC SHOW NO SIGNS OF DIABETES?

A

UP TO 80%

29
Q

% OF DIABETIC INDIVIDUALS WHO WILL END UP DIABETES FREE AFTER GASTRIC BAND?

A

45-60%

30
Q

RESOLUTION OF T2D VS WEIGHT LOSS AFTER BARIATRIC SURGERY; WHAT HAPPENS FIRST?

A

T2D IS RESOLVED WITHIN A FEW DAYS AFTER SURGERY, PRIOR TO ANY WEIGHT LOSS HAPPENING

31
Q

HORMONAL CHANGES AFTER GASTRIC BYPASS:

A
  • GLUCAGON-LIKE-PROTEIN 1 (GLP-1) AND PEPTIDE YY (PYY) LEVELS ARE INCREASED
  • GHRELIN LEVELS DECREASE FOR A SHIRT PERIOD AFTER THE SURGERY (THEN RETURN TO NORMAL)
32
Q

APART FROM GASTRIC BYPASS SURGERY, WHICH OTHER PROCEDURE IS FOLLOWED BY TEMPORARY DECREASE IN GHRELIN LEVES?

A

GASTRIC BAND

33
Q

HOW DO GLP1 AND PYY AFFECT THE HYPOTHALAMUS?

A

THEY BOTH DECREASE AgRP/NPY NEURON ACTIVITY, THUS SUPPRESSING FOOD INTAKE

34
Q

WHAT IS GLP1 AND WHAT DOES IT DO?

A

IT IS AN INCRETIN SECRETED BY THE INTESTINE AND IT INCREASES INSULIN SECRETION FROM BETA CELLS OF THE PANCREAS

35
Q

MEAN MORTALITY RATE FOR BARIATRIC SURGERY?

A

0.3%

36
Q

MOST SEVERE MACRONUTRIENT COMPLICATION ASSOCIATED WITH MALABSORPTIVE SURGICAL PROCEDURES?

A

PROTEIN MALNUTRITION

37
Q

% OF OBESE PATIENTS WITH ANEMIA?

A

10%

38
Q

WHICH OF THE 3 MAIN BARIATRIC SURGERY PROCEDURES PUTS THE PATIENT AT THE HIGHEST ANEMIA RISK?

A

GASTRIC BYPASS

39
Q

PEOPLE ARE AT INCREASED RISK OF WHICH CONDITIONS AFTER BARIATRIC SURGERY?

A
  • GALLSTONES
  • ANEMIA
  • VIT B12 DEFICIENCY (ANEMIA + NEUROLOGICAL AND PSYCHIATRIC SYMPTOMS)
  • FOLATE DEFICIENCY
  • B1 DEFICIENCY
  • VIT C DEFICIENCY
  • REDUCTION IN BONE MINERAL DENSITY (CALCIUM AND VIT D DEFICIENCY)
  • LOW LEVELS OF FAT SOLUBLE VITAMIN
40
Q

BARIATRIC SURGERY AND IMPACT ON FERTILITY?

A

IT DOESN’T NOT SEEM TO IMPACT ODDS OF PREGNANCY

41
Q

HOW LONG SHOULD A WOMAN WAIT POST BARIATRIC SURGERY BEFORE STARTING TO PLAN PREGNANCY?

A

18 MONTHS

42
Q

LOW LEVELS OF WHICH FAT SOLUBLE VITAMIN AFFECT MORE THAN 50% OF PATIENTS AFTER BARIATRIC SURGERY?

A

VITAMIN K

43
Q

WHICH PART OF THE SMALL INTESTINE IS VIT B1 PRIMARILY ABSORBED IN?

A

JEJENUM

44
Q

WHAT IS THE ESSENTIAL COMPONENT OF THE MANAGEMENT OF BARIATRIC PATIENTS AND WHY?

A

NUTRITIONAL SURVEILLANCE:

  • INCREASES ADHERENCE TO HEALTHY DIET AND ADEQUATE SUPPLEMENTATION
  • PREVENTS RISK OF WEIGHT REGAIN
  • FACILITATES DETECTION OF NUTRITIONAL DEFICIENCIES
  • CONTRIBUTES TO MAINTAINING A GOOD QUALITY OF LIFE

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