bariatric surgery

Question 1

obesity increases risk of _______

Answer 1

multiple co-morbidities

Question 2

what is obesity

Answer 2

accumulation of fat stores

Question 3

obesity causes a ________ state

Answer 3

pro-inflammatory

Question 4

what is the formula for BMI

Answer 4

weight(kg) / height (m)^2

Question 5

why is central obesity more detrimental to health

Answer 5

added stress on vital organs

Question 6

what is the criteria for bariatric surgery

Answer 6

> 18yrs old
BMI > 30kg/m^2
absence of : eating disorder, major psychiatric diagnosis, use of tobacco and other controlled substances
failure of non-surgical attempts at weight loss

this is a last resort for weight loss

Question 7

what branch of medicine deals with management of body weight

Answer 7

bariatric

Question 8

bariatric surgery can result in numerous post-surgery complications…what is one of the biggest/most important complication

Answer 8

macronutrient and micronutrient deficiencies

Question 9

how does bariatric surgery affect food consumption and energy intake

Answer 9

it reduces it

Question 10

up to what % can gastric capacity be reduced to

Answer 10

95%

Question 11

bariatric surgery compromises _______ and ______ of nutrients.
What does this induce and why

Answer 11

digestion and absorption

this induces malabsorption due to anatomical changes that bypass major nutrient absorptive sites in SI

Question 12

how much does bariatric surgery reduce BW

Answer 12

35-65% of baseline

Question 13

bariatric surgery _____ co-morbidities such as diabetes, hyperlipidemia, hypertension

Answer 13

resolves

Question 14

does the current infastructure in Canada support the growing demand for bariatric surgery?

Answer 14

no

Question 15

what are the three types of bariatric surgery

Answer 15

restrictive
malabsorptive
combined (restrictive and malabsorptive)

Question 16

outline restrictive bariatric surgery

Answer 16

• reduced total capacity of stomach

- promotes satiety with very little food intake

Question 17

outline malabsorptive bariatric surgery

Answer 17

• changes anatomy of the stomach and SI

- changes digestion and absorption of nutrients

Question 18

outline combined bariatric surgery

Answer 18

-combination of stomach restriction and change in anatomy of SI

Question 19

what is the most common type of bariatric surgery

Answer 19

combined (restrictive and malabsoptive)

Question 20

what are three types of RESTRICTIVE surgery

Answer 20

• Vertical banded Gastroplasty
• fixed gastric banding
• adjustable gastric banding

Question 21

what is the most commonly performed gastric bypass and bariatric surgery

Answer 21

Roux-en-gastric bypass (RYGP)

Question 22

outline RYGP (Roux-en-gastric bypass)

Answer 22

• mixed restrictive and malabsorptive
• most common gastric bypass and bariatric surgery
• stomahc and duodenum are pratically excluded from digestion
• small pouch is created and connected to part of jejunum
• can be used as a second surgery if sufficient weight loss does not occur with first

Question 23

what are the key micronutrient issues with bariatric surgery

Answer 23

-primarily due to combination of decreased intake and decreased absorption
(could also consume and absorb but cant use it)

• also due to poor compliance to supplements
  
  • poor tolerance, depression, cost

(iron, B12, folate, thiamin, Vit D and Ca)

Question 24

what is the most common miconutrient deficiency after bypass surgery

Answer 24

IRON

Possible exam question

Question 25

what are the reasons for a iron deficiency after bypass surgery (need to know at least 3 reasons)

Answer 25

- reduced intake of heme iron; poor tolerance to meat consumption (this already give 2 reasons....less uptake and less absorption) - surgery causes bypass site for absorption (less absorption) - reduced HCl in stomach to reduce ferric iron to ferrous iron for absorption (reduced ferrous iron is better absorbed) - low compliance with iron supplementation (poor digestive tolerance to oral iron supplements, supplements can cause gastric irritation of the newly created pouch) - could also be partly bc of GI blood loss during surgery

Question 26

what should the iron deficient patient take to maintain iron stores after bypass surgery

Answer 26

iron supplementation

Question 27

what is another common complication of bariatric surgery (besides iron)

Answer 27

-Vitamin B12

Question 28

what deficiency is common with Roux-en-Y gastric bypass

Answer 28

Vit B12

Question 29

what is the reasons for a B12 deficiency after bariatric surgery

Answer 29

- reduced Gastric acid produced from the newly created small pouch (inadequate to cleave B12 from animal protein) - decreased intrinsic factor (key for B12 deficiency) - limited meat intake due to poor tolerance

Question 30

which is a more common bariatric complication/deficiency, folate or B12

Answer 30

B12

Question 31

what is the primary reason for a folate deficiency after bariatric surgery

Answer 31

poor intake.....absorption is okay easy to prevent with a supplement

Question 32

what is done to prevent a folate bariatric complication

Answer 32

a supplement is always included

Question 33

list the possible deficiencies of bariatric surgery

Answer 33

- Iron (#1) - B12 - Folate - Thiamin - Vit D and Ca - zinc - copper - fat soluble vitamins

Question 34

which deficiency is the most common pre-existing deficiency of obese patients (before surgery)

Answer 34

Vit D

Question 35

is a Vit D deficiency corrected or worsened after surgery/weight loss?

Answer 35

worsened...theres a lot of Vit D in fat stores

Question 36

what is the least tolerated food in Roux-en-Y patients

Answer 36

milk

Question 37

is a Vit E deficiency common after bariatric surgery?

Answer 37

no

Question 38

what are two micronutrients supplemented after bariatric surgery?

Answer 38

zinc, copper

Question 39

what micronutrients are rarely an issue in bariatric surgery complications

Answer 39

riboflavin B6 Vit C Vit E multi vitamin and mineral supplements are routinely given before and after bariatric surgery