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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?

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
IN MORBIDLY OBESE PATIENTS, WHAT IS CONSIDERED TO BE THE ONLY EFFECTIVE THERAPY?
BARIATRIC SURGERY
26
REMISSION OF DIABETES IS MORE EFFECTIVELY ACHIEVED THROUGH BARIATRIC SURGERY OR MEDICAL THERAPY?
BARIATRIC SURGERY
27
WHAT IS THE MOST POTENT TYPE OF BARIATRIC SURGERY TO REDUCE T2D?
GASTRIC BYPASS
28
AFTER GASTRIC BYPASS, UP TO WHAT % OF INDIVIDUALS SHOW WHO WERE DIABETIC SHOW NO SIGNS OF DIABETES?
UP TO 80%
29
% OF DIABETIC INDIVIDUALS WHO WILL END UP DIABETES FREE AFTER GASTRIC BAND?
45-60%
30
RESOLUTION OF T2D VS WEIGHT LOSS AFTER BARIATRIC SURGERY; WHAT HAPPENS FIRST?
T2D IS RESOLVED WITHIN A FEW DAYS AFTER SURGERY, PRIOR TO ANY WEIGHT LOSS HAPPENING
31
HORMONAL CHANGES AFTER GASTRIC BYPASS:
- 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
APART FROM GASTRIC BYPASS SURGERY, WHICH OTHER PROCEDURE IS FOLLOWED BY TEMPORARY DECREASE IN GHRELIN LEVES?
GASTRIC BAND
33
HOW DO GLP1 AND PYY AFFECT THE HYPOTHALAMUS?
THEY BOTH DECREASE AgRP/NPY NEURON ACTIVITY, THUS SUPPRESSING FOOD INTAKE
34
WHAT IS GLP1 AND WHAT DOES IT DO?
IT IS AN INCRETIN SECRETED BY THE INTESTINE AND IT INCREASES INSULIN SECRETION FROM BETA CELLS OF THE PANCREAS
35
MEAN MORTALITY RATE FOR BARIATRIC SURGERY?
0.3%
36
MOST SEVERE MACRONUTRIENT COMPLICATION ASSOCIATED WITH MALABSORPTIVE SURGICAL PROCEDURES?
PROTEIN MALNUTRITION
37
% OF OBESE PATIENTS WITH ANEMIA?
10%
38
WHICH OF THE 3 MAIN BARIATRIC SURGERY PROCEDURES PUTS THE PATIENT AT THE HIGHEST ANEMIA RISK?
GASTRIC BYPASS
39
PEOPLE ARE AT INCREASED RISK OF WHICH CONDITIONS AFTER BARIATRIC SURGERY?
- 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
BARIATRIC SURGERY AND IMPACT ON FERTILITY?
IT DOESN'T NOT SEEM TO IMPACT ODDS OF PREGNANCY
41
HOW LONG SHOULD A WOMAN WAIT POST BARIATRIC SURGERY BEFORE STARTING TO PLAN PREGNANCY?
18 MONTHS
42
LOW LEVELS OF WHICH FAT SOLUBLE VITAMIN AFFECT MORE THAN 50% OF PATIENTS AFTER BARIATRIC SURGERY?
VITAMIN K
43
WHICH PART OF THE SMALL INTESTINE IS VIT B1 PRIMARILY ABSORBED IN?
JEJENUM
44
WHAT IS THE ESSENTIAL COMPONENT OF THE MANAGEMENT OF BARIATRIC PATIENTS AND WHY?
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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