Flashcards in LAGB Review - All Areas Deck (24)
What are the contraindications for LAGB?
- Autoimmune Conditions
- Lupus, Scleroderma
- Chronic Steroid Use
- Inflammatory Diseases of the GI Tract
- Ulcers, Esophagitis, Crohns Disease
- Severe Cardiopulmonary Disease
- Portal Hypertension
- Esophageal/Gastric Varices
- Advanced Cirrhosis
- Psychological Impairment
- Active Addictions
What are the Dietary Advancement Phases after LAGB?
- Clear Liquids due to inflammation from surgery
= 2 days - 1 week
- Full/Pureed Liquids
= 1 week to 4 weeks
- Soft Foods
= 2 - 4 weeks
- Regular diet
What are the signs that a LAGB patient is in the Optimal Zone?
- Early and prolonged satiety
- Small meals satisfy
- Satisfactory weight loss or maintenance
What are some common ways to prevent LABG complications, or reduce long term effects of complications?
- Early recognition and treatment is essential
- Peri-Operative anti-coagulation is important
- Prevention of post-operative complications are the responsibility of the entire healthcare team
What is the most common cause of litigation with bariatric surgery?
- Failure to recognize and/or treat complications.
LAGB dehydration is handled how?
- Determine the reason and treat
- Remember insensible fluid loss
- eg. Hot weather and exercise = increased fluid loss
How is band prolapse/slippage diagnosed?
- Diagnosis is usually confirmed with Barium Swallow
What is the first step with band slippage treatment?
- Remove the fluid from the band
If the prolapse/slippage is a concentric dilation, is small and the symptoms improve, what is the treatment process for the patient?
- Re-train the patient - Behavior modification and eating rules
- Re-adjust the band slowly
If the prolapse/slippage is large, what are the treatment options?
- Revision surgery
- Band reposition
- Band removal and replacement
- Conversion to GB, Sleeves, DS
What are the signs and symptoms of an obstruction, in a LAGB patient?
- Food and liquid intolerance
- Substernal pain
How is an obstruction diagnosed, in a LAGB patient?
- Diagnosis is by UGI and or EGD
What is the treatment for an obstruction in a LAGB patient?
- Decompress the band and treat the cause
What types of foods may LAGB patients have difficulty with?
- Doughy, sticky foods like bread, dried fruits
- Pasta, Rice, chips
- Raw vegetables - instruct patient to chew thoroughly, Use caution with stringy, fibrous vegetables like celery, pineapple, asparagus
- Caution with nuts
- Dry foods difficult to digest, and can form a bolus in the pouch
What are the signs and symptoms that a LAGB patient needs a fill?
- Eating big meals
- Looking for food
- Satiety that does no last beyond 2 hours
What are the signs and symptoms that a LAGB is Too Tight?
- Weight gain, maladaptive eating
- Chest pain with food/fluids
- Increased hunger
- Increased saliva
What is the treatment for a LAGB that is too tight?
- Deflate the band according to tolerance and re-educate
What are the potential nutritional deficiencies with LAGB patients?
- Reduced micronutrient absorption =
- B1 - Thiamin reduction due to eating less fortified breads and cereals
- Folate - reduction due to eating less volume of fruits and vegetables
- Reduced food intake and reduced volume also effect these nutrients
What are the LABG Supplement Recommendations per ASMBS?
- Multivitamin - 100% DV for at least 2/3 of nutrients - 1 per day
- Calcium - 1500 mg/day - divided into 3 doses (no more than 500-600mg per dose at a time)
- B-Complex - optional 1 per day
- Iron - none additional
- Vitamin D - no current recommendation
- Protein - no current recommendation
What are the signs and symptoms of a DVT?
- Throbbing, aching, heavy sensation in the calf
- Redness, swelling, warmth
- Leg pain with activity
- Homan's sign is not reliable
What is the treatment for a DVT?
- Best Treatment is prevention
- Compression stockings
What are the signs and symptoms of a PE (Pulmonary Embolism)?
- Shortness of breath
- Chest Pain
What do you do if you suspect a PE?
- Immobilize the patient
- Start supplemental O2
- Call physician immediately