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Flashcards in Midterm 2 quick Deck (70)
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1

Name the indications for bariatric surgery (5)

 BMI ≥ 40
OR
 BMI > 35 with significant obesity-related comorbidities (e.g. MetS, OSA, Osteoarthritis, HTN, …)
 Acceptable operative risk (risk of surgery < risk of not undergoing surgery)
 Failure of non-surgical weight loss attempts
 Well-informed, compliant, and motivated patient (need to understand lifestyle habits still have to change despite the surgery being done)

2

Name the contraindications to bariatric surgery (6)

- Active pregnancy
- Cirrhosis
- Active substance abuse
- Uncontrolled psychiatric illness
- Pulmonary hypertension
- Severe cardiac and respiratory disease

3

Name 2 possible problematics of adjustable gastric bands (AGBs)

Can lead to band erosion and damage the tissue of the stomach.
Band can also leak which requires more surgeries to fix.

4

Name the 3 mechanisms of weight loss in bariatric surgeries.

1. Gastric restriction (reduced PO intake)
2. Malabsorption (length of common limb)
3. Gut hormones
a) decreased Ghrelin (parietal cells of stomach)
b) Increased leptin
c) PYY involved in DM resolvement

5

Name 5 possible EARLY (< 30 days) complications of bariatric surgeries.

- Anastomotic leak
- stricture
- Obstruction
- Bleeding
- Infection

6

Name possible LATE (> 30 days) complications of bariatric surgeries.

Ulcer, stricture, obstruction, hernia, nutrition deficiencies, dumping syndrome, weight regain or weight loss failure, psychological complications, malnutrition, gastric reflux

7

Bariatric surgeries: Nutrition guidelines preop?

Very low-calorie diet (VLCD) 2 weeks prior to surgery (can be more depending on the BMI and where the patient carries the weight)
o 800-900 calories
o Low Carb (< 100g/d), high protein, moderate fat
o Shakes, milk products etc.
o Induces ketosis

8

Bariatric surgeries: Nutrition guidelines postop?

Texture progression and portion progression

Texture progression: Clear fluids (1-3 days) --> full fluids/puree (5 weeks) --> solids
Otherwise, vomiting ++

Portion progression: After surgery, stomach is swollen and inflamed. 1/2 cup --> 1 cup later
To reduce vomiting

9

Name 4 reasons why nutritional deficiencies are common in bariatric surgeries.

Reduced dietary intake

Removal of fundus (fewer parietal cells)
=Reduced gastric acidity (hydrochloric acid helps in the digestion of protein, calcium and iron) and Reduced intrinsic factor (IF)

Bypassed intestines (malabsorption)

Tolerance issues (more vomiting, more dysphagia (temporary)…) Beef and eggs usually difficult after surgery

10

What are the 5 nutrients to watch for deficiencies in RYGB?

Calcium (Less acid + absorbed in duodenum)
Iron (less acid + absorbed un duodenum)
VD
Folate
Vitamin B12 (IF in stomach)

11

What are the 8 nutrients to watch for deficiencies in BPD-DS?

Calcium
Iron
ADEK (usually absorbed in the jejunum and beginning of ileum which are bypassed)
Folate
B12

12

Name the thiamin supplement recommendations for sleeve gastrectomy, RYGB and BD-DS.

12 mg/d for each.

13

Name the B12 supplement recommendations for sleeve gastrectomy, RYGB and BD-DS.

Same for all:
Oral: 350-500 mcg/d
IM: 1000 mcg/mo

14

Name the Folate supplement recommendations for sleeve gastrectomy, RYGB and BD-DS.

Same for all:
400-800 mcg/d
Women of childbearing age: 800-1000 mcg/d

15

Name the VD supplement recommendations for sleeve gastrectomy, RYGB and BD-DS.

300 IU/d for all until 25OHD WNL

16

Name the VA supplement recommendations for sleeve gastrectomy, RYGB and BD-DS.

sleeve gastrectomy: Standard MVI
RYGB: Standard MVI
BPD-DS: 10,000 IU/d

17

Name the VE supplement recommendations for sleeve gastrectomy, RYGB and BD-DS.

sleeve gastrectomy: Standard MVI
RYGB: Standard MVI
BPD-DS: standard MVI

18

Name the VK supplement recommendations for sleeve gastrectomy, RYGB and BD-DS.

sleeve gastrectomy: Standard MVI
RYGB: Standard MVI
BPD-DS: 300 mcg/d

19

Name the Iron supplement recommendations for sleeve gastrectomy, RYGB and BPD-DS.

Same for all:
18 mg/d from MVI
Menstruating: 45-60 mg elemental total

20

Name the Calcium supplement recommendations for sleeve gastrectomy, RYGB and BPD-DS.

Sleeve gastrectomy: 1200-1500 mg/d
RYGB: 1200-1500 mg/d
BPD-DS: 1800-2400 mg/d

21

Name the zinc supplement recommendations for sleeve gastrectomy, RYGB and BPD-DS.

Sleeve gastrectomy: 11 mg men, 8mg women
RYGB: 11-22 mg men; 8-16 mg women
BPD-DS: 122 mg men; 16 mg women

60 mg BID if hair loss

22

Name the copper supplement recommendations for sleeve gastrectomy, RYGB and BPD-DS.

Sleeve gastrectomy: 1 mg/d
RYGB: 2 mg/d
BPD-DS: 2 mg/d

23

When is LBM loss post op bariatric sx?

3 months post op
May lead to decreased RMR and reduced muscle strength and physical function --> risk of weight regain

24

What are the protein recommendations for AGB, VGS, RYGB and BPD-DS?

1.0-1.5 g/kg IBW for 3 first
1.5-2.0 g/kg IBW for BPD-DS

25

WHat are the 4 main tolerance issues post bariatric surgery?

Dehydration
Constipation (reduced PO and fiber intake)
Diarrhea (lactose intolerance, dumping syndrome, sugar alcohols...)
Food intolerances (dysgeusia, regurgitation and esophageal dysphagia)

26

What are the symptoms of the early phase of dumping syndrome?

1-30 min after meal; D/t rapid transit of hyperosmotic food into the jejunum (usually simple sugars)
Symptoms: dizziness, nausea, weakness, rapid pulse, diarrhea

27

What to do to avoid dumping syndrome?

- Healthy snacking
- Advise glucometer
- Avoidance of trigger foods (limit simple CHO)
- Label reading (≤ 25g absorbable carb)

28

Name 5 causes for weight regain post-op

Dietary habits
o Increased calories: sugar and fat
o Grazing: emotional eating
o Not delaying fluids (drinking and eating at the same time)
• Poorly controlled thyroid
• New medications (weight promoting, antidepressants)
• Stopped exercising
• Surgical reasons? (only in 10% of cases; unlikely…)

29

What can influence serum creatinine levels? (7)

Diet
Muscle breakdown
Lab calibration bias
Extra-renal elimination (gut bacteria)
Age
Antibiotics (inhibit secretion)

30

What can a high calcium x phosphorus product result in?

metastatic calcification in soft tissue areas:
• Conjunctivae of the eye
• Heart, especially aortic valve and blood vessels
• Lungs
• Extremities