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Flashcards in Bariatric Surgery Deck (68)
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1

Indications for Bariatric surgery?3

1. BMI ≥ 40 kg/m2 without comorbidities

2. BMI 35-39.9 kg/m2 with comorbidity

3. BMI 30-34.9 kg/m2 (w/specific comorbodities)

2

BMI 35-39.9 kg/m2 with comorbidity which comorbities? 13

1. Type 2 DM 2. OSA

3. HTN

4. Hyperlipidemia

5. Obesity-hypoventilation syndrome (OHS)

6. Pickwickian syndrome (OSA+OHS)

7. Nonalcoholic steatohepatitis (NASH)

8. Pseudotumor cerebri

9. GERD

10. Venous stasis disease

11. Severe urinary incontinence

12. Debilitation arthritis

13. Impaired quality of life

3

BMI 30-34.9 kg/m2 with what comorbidites? 2

1. Uncontrollable Type 2 DM

2. Metabolic syndrome Lack of evidence to support long term benefit in this group

4

Contraindications to bariatric surgery? 10

1. History of bulimia

2. Age > 65 or less than 18

3. For lipid or glycemic control

4. For CV risk reduction

5. Untreated major depression or psychosis

6. Binge-eating disorders

7. Current drug or alcohol abuse

8. Severe cardiac disease with prohibitive anesthetic risks

9. Severe coagulopathy

10. Inability to comply with requirements including (life-long nutritional supplements) & dietary changes**

5

Preoperative assessment includes what? 3

1. Psychological

2. Medical

3. Anesthetic risk

6

Preoperative assessment requires a team approach Who? 5

1. Nutritionist

2. Medical bariatric specialist

3. Psychologist/Psychiatrist

4. Clinical nurse specialist

5. Surgeon

7

Goals of the psychologic assessment 4

1. Is the patient able and willing to make the necessary changes?

2. Identification of mental disorders

3. Social history in regards to previous weight loss attempts, physical activity, substance abuse, compulsive eating

4. Does the patient have the cognitive ability to do this and the support to carry it through?

8

Components of the psychological assessment 4

1. Behavioral

2. Cognitive/emotional

3. Current life situation

4. Expectations

9

Medical assessment includes? 2

Complete history and physical exam

10

Mechanisms of weight loss with surgery 3

Restriction

Malabsorption

Both

11

Restrictive surgeries do what? What are the three general processes?

Limit caloric intake by reducing the stomach's capacity:

1. Resection

2. Bypass

3. Creation of a proximal gastric outlet

12

Specific Restrictive surgeries? 3

1. Vertical banded gastroplasty

2. Laparoscopic adjustable gastric banding

3. Sleeve gastrectomy

13

Malabsorptive surgeries do what? How is this accomplished? 2

Decrease the effectiveness of nutrient absorption by shortening the length of the functional small intestine:

 

1. bypass of the small bowel absorptive surface area

2. diversion of the biliopancreatic secretions that facilitate absorption

14

Malabsorption surgeries 2

1. Jejunoileal bypass

2. Duodenal switch operation

15

Combination restrictive/malabsorptive surgeries 3

1. Roux-en-Y gastric bypass (RYGB)

2. Biliopancreatic diversion

3. Biliopancreatic diversion with duodenal switch

16

3 Most common bariatric surgeries

1. Roux-en-Y gastric bypass (47%)

2. Sleeve gastrectomy (28%)

3. Laparoscopic adjustable gastric band (18%)

17

Roux-en Y gastric bypass (RYGB)

Most commonly performed bariatric surgery in the US

47% of weight loss surgeries done in 2011

Describe this?

18

RYGB surgery

1. Gastric pouch is how big?

2. Gastric pouch attached to a section of small bowel ______cm in length (gastrojejunostomy)

3. Cut ends of the _____________and the __________are then connected 75 to 150 cm distal from the gastrojejunostomy

1. Gastric pouch less than 30 ml

 

2.  75-150 cm in length (gastrojejunostomy)

 

3. biliopancreatic limb, the Roux limb 

19

RYGB

Major digestion and absorption of nutrients occurs where?

in the common channel where pancreatic enzymes and bile mix

20

Weight loss mechanism

1. What part of restrictive?

2. What contributes to the malabsorption part?

3. What suppressses the appetite?

4. What two substances are increased post bypass? and what will this promote?

1. Small pouch is restrictive

2. There is malabsorption because of the “removed” small bowel

3. Ghrelin inhibition (suppresses appetite)

4. GLP-1 and CCK increased post bypass (may promote an anorectic state)

21

Gastrojejunostomy can result in ____________with high sugar meals

Describe this?

1. Dumping syndrome

2. lightheadedness, nausea, diaphoresis and/or abdominal pain, and diarrhea

22

Expected weight loss with RYGB

 

Up to 70% of extra weight in 2 years

23

Describe the Sleeve gastrectomy?

 

Second most common weight loss surgery performed worldwide

28% of all procedures in 2011

24

Sleeve Gastrectomy

1. Most of the what is removed?

2. Advantages? 2

3. New stomach is resistant to what?

4. Contains a few _______producing cells

1. Most of the greater curvature of the stomach is removed

2. Safer and technically less difficult to perform than RYGB

3. New stomach is resistant to stretching without the fundus

4. ghrelin 

25

Weight loss mechanism: for sleeve gastrectomy?

4

1. Restrictive

2. Alterations in gastric motility

3. Decreased ghrelin levels

4. Increased GLP-1 and PYY (promote less hunger)

26

Expected weight loss with sleeve gastrectomy?

60% of excess weight lost in 2 years

27

Laparoscopic adjustable gastric band surgery

Describe this?

18% of bariatric surgeries done in 2011

28

1. What is the lap band and where is it placed?

2. How does it work?

3. Goal of band adjustments? 2

1. Soft silicone ring connected to an infusion port placed in the subcutaneous tissue

2. Ring is inflated with saline to cause variable degrees of restriction

3. Goal of band adjustments

-Allow a cup of dried food

-Satiety for at least 1.5 to 2 hrs after a meal.

29

1. Lowest mortality rate among bariatric pts?

 

1. Lap band

30

Weight loss mechanism for Lap Band?

Purely restrictive