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test > Bariatric Surgery and Ostomies > Flashcards

Bariatric Surgery and Ostomies Flashcards

1
Q

What is bariatric surgery?

A

Weight reduction surgery for the morbidly obese

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2
Q

What is morbid obesity?

A
  1. BMI > 40 (i.e. > 100 lbs over ideal body weight) 2. BMI > 35 with a medical problem related to morbid obesity
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3
Q

What is the BMI?

A

Body Mass Index

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4
Q

What is the formula for BMI?

A

Body weight in kg / (Height in m)^2

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5
Q

What medical conditions are associated with morbid obesity?

A

Sleep apnea, CAD, pulmonary disease, diabetes, venous stasis ulcers, arthritis, infections, sex hormone abnormalities, HTN, breast cancer, colon cancer

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6
Q

What are the current options for bariatric surgery?

A

Gastric bypass (malabsorptive) Vertical-banded gastroplasty

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7
Q

What is a gastric bypass?

A

Stapling off a small gastric pouch (restrictive), and a Roux-en-Y limb to gastric pouch (bypass)

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8
Q

How does gastric bypass work?

A
  1. Creates a small gastric reservoir 2. Causes dumping symptoms when a patient eats too much food or high-calorie foods; food is dumped into the Roux-en-Y limb 3. Bypass of small bowel by Roux-en-Y limb
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9
Q

Which bariatric surgery works best overall?

A

Gastric bypass

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10
Q

What are the possible post-operative complications after weight reduction surgery?

A

Gallstones (if gallbladder in situ), anastomotic leak, marginal ulcer, stenosis of pouch or anastomosis, malnutrition, incisional hernia, spleen injury, iron deficiency, B12 deficiency

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11
Q

What is the most common sign of an anastomotic leak after a gastric bypass?

A

Tachycardia

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12
Q

What is the incidence of anastomotic leak after bariatric surgery?

A

3%

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13
Q

What is the mortality rate of an anastomotic leak after bariatric surgery?

A

10%

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14
Q

What is a lap-band?

A

LAParoscopically placed BAND around the stomach with a subcutaneous port to adjust constriction. Results in small gastric reservoir

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15
Q

What is a Petersen’s hernia?

A

Internal herniation of small bowel through the mesenteric defect from the Roux-en-Y limb after gastric bypass.

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16
Q

What is an ostomy?

A

Operation that connects the GI tract to the abdominal wall skin or the lumen of another hollow organ.

17
Q

What is a stoma?

A

Opening of an ostomy

18
Q

What is a gastrostomy?

A

G-tube through the abdominal wall to the stomach for drainage or feeding

19
Q

What is a jejunostomy?

A

J-tube through the abdominal wall to the jejunum for feeding

20
Q

What is a Kock pouch?

A

“Continent ileostomy” Pouch is made of several ileal loops and the patient must access the pouch with a tube intermittently

21
Q

What is a colostomy?

A

Connection of colon mucosa to the abdominal wall skin for stool drainage

22
Q

What is an end colostomy?

A

Proximal end of colon brought to the skin for stool drainage

23
Q

What is a mucous fistula?

A

Distal end of transected colon brought to the skin for decompression. The mucosa produces mucus, an ostomy is a fistula, and, hence, the term mucous fistula. (Proximal colon brought up as a colostomy or, if the proximal colon is removed, an ileostomy.)

24
Q

What is a Hartmann’s pouch?

A

Distal end of transected colon stapled and dropped back into the peritoneal cavity, resulting in a blind pouch. Mucus is decompressed through the anus. (Proximal colon is brought up as an end colostomy or, if proximal colon is removed, an end ileostomy.)

25
Q

What is a loop colostomy?

A

Loop of large bowel is brought up to the abdominal wall skin and a plastic rod is placed underneath the loop. The colon is the opened and sewn to the abdominal wall skin as a colostomy.

26
Q

What is an ileal conduit?

A

Loops of stapled-off ileum made into a pouch, anastomosed to the ureters, and then brought to the abdominal wall skin to allow drainage of urine in patients who undergo removal of the bladder

27
Q

What is a Brooke ileostomy?

A

Ileostomy folded over itself to provide clearance from skin

28
Q

Why doesn’t an ileostomy or colostomy close?

A

Epithelialization (mucosa to skin)

29
Q

Why doesn’t a gastrostomy close?

A

Foreign body (the plastic tube)

30
Q

If the plastic tube, G-tube or J-tube, is removed, how fast can the hole to the stomach or jejunum close?

A

In a matter of hours

31
Q

What is a tube check?

A

Gastrografin contrast study to confirm that a G-tube or J-tube is within the lumen of the stomach or jejunum

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