Bariatric Surgery

Question 1

What comorbidities must be present for a BMI of 30-34.9 to be a candidate for bariatric surgery?

Answer 1

uncontrollable Type 2 DM and metabolic syndrome

Question 2

Psych disorders that are contraindications for bariatric surgery

Answer 2

bulemia, major depression, psychosis, substance abuse

Question 3

Age range to qualify for bariatric surgery

Answer 3

between 18-65

Question 4

Most common bariatric surgeries in order of prevelance

Answer 4

Roux-en Y gastric bypass (47%), sleeve gastrectomy (28%), and Lap. band surgery (18%)

Question 5

Involves the creation of a small gastric pouch and an anastomosis to a Roux limb of jejunum that bypasses 75-150 cm of small bowel

Answer 5

Roux-en Y gastric bypass

Question 6

Characterized by lightheadedness, nausea, diaphoresis and/or abdominal pain, and diarrhea. Result of eating high sugar meal after gastrojejunostomy

Answer 6

dumping syndrome

Question 7

Hormonal alterations that result in decreased appetitie after gastrojejunostomy

Answer 7

ghrelin inhibition and increased GLP-1/CCK

Question 8

Majority of greater curvature of stomach is removed and a tubular stomach is created. More resistant to stretching due to absence of fundus

Answer 8

sleeve gastrectomy

Question 9

Compartmentalizes the upper stomach by placing an adjustable tight band around entrance to the stomach taht is connected to a subcutaneous infusion port.

Answer 9

lap. band surgery

Question 10

Bariatric surgery with the lowest mortality rate

Answer 10

lap band

Question 11

Major vital signs to monitor post surgery.

Answer 11

hypoglycemia and hypotension

Question 12

How often should BP and weight be checked post operatively?

Answer 12

every 4-6 weeks for the first 6 months. Then at 9 and 12 months post surgery

Question 13

Which type of surgery doesn’t cause significant macronutrient deficiencies?

Answer 13

Roux-en Y gastric bypass

Question 14

Deficiency associated with lap band surgery

Answer 14

folate

Question 15

Deficiency associated with sleeve gastrectomy

Answer 15

B12

Question 16

Type of formulations of medications that should be used postoperatively

Answer 16

crush or liquid. Insulin instead of oral antidiabetics

Question 17

What class of medications should be avoided postoperatively?

Answer 17

NSAIDs

Question 18

Average caloric intake for the first month after surgery

Answer 18

400-800 kcal diet/day

Question 19

T/F Improvement in DM control happens regardless of the amount of weight lost

Answer 19

true

Question 20

Gastric pouch severe distention secondary to mechanical obstruction or paralytic ileus. Progressive distention and rupture. May be fatal

Answer 20

Gastric remnant distention

Question 21

Sx include: hiccups, LUQ tympany, shoulder pain, abdominal distention, tachycardia, SOB, large gastric bubble on xray

Answer 21

gastric remnant distention

Question 22

After several weeks post-op may present with N/V, dysphagia, GE reflux, inability to tolerate oral intake

Answer 22

stomal stenosis

Question 23

Occur near the gastrojejunostomy. Acid injury to the jejunum or associated with gastrogastric fistula

Answer 23

marginal ulcers

Question 24

Sx include: RUQ pain that lasts longer the 6 hrs and starts post eating, worse with deep inspiration, shoulder pain, N/V, fever,

Answer 24

Acute cholecystitis/cholelithiasis

Question 25

Cause of mesenteric swirl

Answer 25

internal hernia

Question 26

Results in severe micro and macronutrient deficiencies. In severe cases may require intestinal transplantation

Answer 26

short bowel syndrome

Question 27

May be secondary to insulinoma. May be secondary to islet cell hypertrophy. Slowing food transit time may resolve the symptoms

Answer 27

severe hypoglycemia

Question 28

Changes in bowel habits associated with the different surgeries

Answer 28

RYGB often has diarrhea. Constipation seen post gastric banding

Question 29

What would be the diagnosis if you had a gastric band patient who came in with persistent nausea, vomiting and inability to tolerate secretions or oral intake?

Answer 29

stomal obstruction

Question 30

Treatment for stomal obstruction

Answer 30

NG tube to decompress until edema subsides or surgery for band revision

Question 31

What would be the diagnosis if you had a gastric band patient who came in 2yrs post surgery with infection, failure of weight loss, N/V, epigastric pain, hematemesis?

Answer 31

band erosion

Question 32

What are the most common complications of sleeve gastrectomies?

Answer 32

GERD, bleeding, stenosis of stoma, and leaks***