Surgical Obesity Management

Question 1

What are the types of restrictive bariatric surgery?

Answer 1

Gastric banding
Sleeve gastrectomy

Question 2

What are the types of malabsorptive bariatric surgery?

Answer 2

Jejunoileal bypass
Biliopancreatic diversion

Question 3

What type of surgery is a combination of malabsorptive and restrictive?

Answer 3

Roux-en-Y gastric bypass

Question 4

What bare problems with gastric banding?

Answer 4

Can break or need to be removed

Question 5

What are problems with sleeve gastrectomy?

Answer 5

Non- reversible
Stomach will re expand

Question 6

What are problems with malabsorptive surgery?

Answer 6

Nutrient deficiency
Vitamin deficiency
Impact on pharmacokinetics and dynamics of medications

Question 7

How does Roux-en-Y impact medications?

Answer 7

1. Decrease absorptive area
2. Decreased GI transit time
3. Increased pH
4. Changes in drug transporters
5. Changes in volume of distribution
6. Reduced bioavailability

Question 8

What types of medications are best for Roux-en- Y?

Answer 8

Liquid > suppository> immediate release oral

Question 9

What types of medications should be avoided with Roux-en-Y

Answer 9

1. Extended/ delayed release
2. Enteric coating
3. NSAIDs
4. Bisphosphonates
5. Potassium chloride

Question 10

What vitamins/ nutrients should be supplemented with after Roux-en-Y?

Answer 10

1. Calcium citrate (1,200-1,500 mg of elemental calcium)
2. 45-60mg elemental iron
3. 400mcg folic acid
4. 2mg copper
5. 100 mg thiamine
6. 2 chewable multivitamins daily (3-6 months); then 1 tab daily

Question 11

How does Roux-en-Y affect alcohol?

Answer 11

Disproportionately high Cmax and Tmax within 10min of consumption above legal limit to drive