WISEMD Bariatric Flashcards
What is the calculation for BMI?
BMI = Weight (kg) / Height^2 (m^2)
What BMI indicates for bariatric surgery?
1) BMI >= 40
2) BMI >= 35 with severe, weight-related comorbities such as diabetes, hypertension, sleep apnea, and heart disease
What factors influence obesity?
1) Genetics
2) Diabetes
3) Physical activity (calories consumed > calories burned)
4) Medical Illnesses
5) Medications
6) Psychological factors (stress or emotional eaters)
What is the most preventable health problem?
Obesity
In relation to a patient with normal weight, what is the rate of premature death in an obese patient?
4x
What are important points to emphasize in a history that you take from an obese patient who is being consulted for bariatric surgery?
1) How long has the patient been overweight?
2) What weight loss method has the patient tried?
3) What are the patient’s medical comorbidities?
What are the two patterns of fat distribution and in which patients are they more typically found in?
1) Android fat distribution describes the distribution of human adipose tissue mainly around the trunk and upper body, in areas such as the abdomen, chest, shoulder and nape of the neck. This pattern may lead to an “apple-shaped” body or central obesity, and is more common in males than in females
2) Gynoid fat distribution describes fat around the hips, thighs and bottom, causing a “pear-shape”. This more female-patterned fat distribution has been linked to risk factors for cardiovascular disease, in both males and females
What important abdominal defect should be searched for when doing a physical exam on a patient who may be a candidate for bariatric surgery and why? What vascular pathology should be searched for?
1) Hernias should be searched for because if present, they will undergo concomitant repair during surgery
2) Look for DVT as venous stasis in obese patients will put them at higher risk for developing DVT
What preoperative blood tests should be done before bariatric surgery?
1) HgA1C to assess appropriate glycemic control
2) Thyroid function test to rule out hypothyroidism, which would be treated prior to surgery
3) Lipid profile to rule out hypercholesterolemia and hyperlipidemia, which both may require preoperative medical therapy
4) LFTs can rule out steatohepatitis, which may prompt a liver biopsy
5) Micronutrient (iron, folate, thiamine, B12, vit D) levels to assess the need for replacement therapy
Why should a chest X-ray be done on all preoperative patients? Why should an EKG be done?
1) CXR is done to check for cardiomegaly, pulmonary infiltrates, and pulmonary edema, which would be signs of cardiac failure or cardiomyopathy
2) EKG is done to check for right atrial enlargement, right ventricular enlargement, and right heart strain
When should a cardio-pulmonary consult be made? When should a pulmonology consult be made? What should gastric bypass candidates be evaluated by a gastroenterologist for?
1) Multiple risk factors for CAD or abnormal EKG
2) Symptoms of COPD or sleep apnea
3) GI for EGD to check for neoplasms (impossible to evaluate in the distal stomach after gastric bypass), ulcers, hiatal hernias, strictures, or esophagitis
What are the categories and procedures for bariatric surgery? Does combination or restrictive therapy cause more weight loss?
1) Restrictive - Gastric band
2) Malabsorptive, rarely used and not first line therapy - Biliary pancreatic diversion, duodenal switch
3) Combination - Gastric bypass
4) Gastric bypass causes more weight loss than gastric band
What must patients be monitored for POD#1 after gastric bypass surgery? What test can be done to rule out these conditions?
1) Leak
2) Gastric outlet obstruction
3) Gastrograffin swallow may be done to rule out leak or obstruction
What is a very sensitive indicator for a post operative leak after gastric bypass?
Sustained, unexplained tachycardia may warrant immediate surgical exploration
What diet is ordered post operatively after gastric bypass and for how long?
Clear liquid diet for 7-10 days
