Bariatric surgery

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Questions and Answers

Among bariatric procedures, which surgery has the highest risk for nutritional deficiencies and severe protein malnutrition

  • Adjustable Gastric Banding
  • Biliopancreatic diversion w/ duodenal switch (correct)
  • Roux-en-Y Gastric Bypass
  • Sleeve Gastrectomy (SG)

Match the surgery procedure with its description:

Roux-en-Y Gastric Bypass = A small proximal gastric pouch is created and half of the jejunum is attached at this point. Duodenum attached to 'remnant' stomach and bile ducts. Adjustable Gastric Banding = Band placed across upper stomach: 1 cm below esophago-gastric junction, then secure band w/ 3-4 gastric sutures fixation of port within subcutaneous fat vs suture to muscle fascia Gastroplasty = Reduces the size of the stomach by applying rows of stainless-steel staples to partition the stomach and create a small gastric pouch, leaving only a small opening (0.8 to 1 cm) into the distal stomach. Biliopancreatic Diversion w/ Duodenal Switch = Majority of stomach have been removed and the ileum connected to a pouch, by passing duodenum and Jejunum. the bypassing small intestine carries the bile and pancreatic enzyme

What is the minimum BMI a patient must have to qualify for bariatric surgery without comorbidities?

  • >30
  • >45
  • >40 (correct)
  • >35

If a patient has a BMI of 35 or greater, what do they need to qualify for bariatric surgery?

<p>Comorbidities (B)</p> Signup and view all the answers

What is one of the primary benefits of bariatric surgery?

<p>Improvement and resolution of insulin resistance (B)</p> Signup and view all the answers

Which of the following is a benefit associated with bariatric surgery?

<p>Decrease in comorbidities (D)</p> Signup and view all the answers

What does bariatric surgery aim to improve in patients besides weight?

<p>Insulin resistance (C)</p> Signup and view all the answers

Which outcome is NOT typically associated with bariatric surgery?

<p>Increased mortality rates (C)</p> Signup and view all the answers

Which type of bariatric surgery is associated with deficiencies in Iron, Calcium, Vitamin B12, and Thiamin?

<p>Sleeve Gastrectomy (A)</p> Signup and view all the answers

Which bariatric procedure has the greatest risk for deficiency in Iron, Calcium, Vitamin B12, Vitamin D, Thiamin, and Folate?

<p>Roux-en-Y Gastric Bypass (C)</p> Signup and view all the answers

What deficiency is commonly associated with Biliopancreatic Diversion w/ Duodenal Switch?

<p>Vitamin KEDA (D)</p> Signup and view all the answers

Which type of surgery typically results in deficiencies of Calcium, Vitamin B12, Thiamin, and Folate?

<p>Adjustable Gastric Banding (C)</p> Signup and view all the answers

What is the primary change made to the stomach during Biliopancreatic Diversion?

<p>The majority of the stomach is removed. (B)</p> Signup and view all the answers

Flashcards

Which bariatric surgery has the highest risk for nutritional deficiencies?

Biliopancreatic diversion with duodenal switch (BPD-DS) is a bariatric surgery that carries the highest risk for nutritional deficiencies and protein malnutrition.

What is Roux-en-Y Gastric Bypass?

A small pouch is created in the stomach, and a portion of the small intestine is attached to it. This reroutes food, limiting how much you can eat and digest.

What is Adjustable Gastric Banding?

A band is placed around the upper stomach, creating a smaller pouch. This restricts food intake and slows down the digestion process.

What is Sleeve Gastrectomy?

The large majority of the stomach is removed, leaving a smaller, tube-like stomach.

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What is Biliopancreatic Diversion w/ Duodenal Switch?

A smaller stomach is created. A section of the small intestine is bypassed, further limiting food absorption.

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What is a Bariatric Surgery?

A procedure that reduces the size of the stomach, often coupled with a change in the pathway of the digestive system.

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What is the BMI requirement for bariatric surgery?

A body mass index (BMI) of 40 or higher qualifies a patient for bariatric surgery.

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Besides BMI, what other factors qualify a patient for bariatric surgery?

A BMI of 35 or higher with certain co-existing health conditions (comorbidities) is also a qualification for bariatric surgery.

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Define 'comorbidities' in the context of bariatric surgery.

Comorbidities are medical problems that exist alongside the primary condition, in this case, obesity.

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What are some examples of comorbidities that can influence bariatric surgery qualifications?

Examples of comorbidities that may qualify a patient for bariatric surgery include type 2 diabetes, high blood pressure, and sleep apnea.

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What is the primary goal of bariatric surgery?

Bariatric surgery is a procedure aimed at reducing the size of the stomach or changing the digestive pathway, intended to help patients lose weight and improve the health conditions related to obesity.

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How does bariatric surgery help with insulin resistance?

Bariatric surgery can help improve insulin resistance, a condition that makes it difficult for the body to use sugar for energy.

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What health problems can bariatric surgery improve?

Conditions like type 2 diabetes, high blood pressure, and sleep apnea often improve after bariatric surgery.

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What is the effect of bariatric surgery on morbidity?

Bariatric surgery can reduce the risk of developing serious health complications associated with obesity.

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How does bariatric surgery help with metabolic disease?

Bariatric surgery helps improve metabolic disease, which is a group of disorders affecting how the body processes energy.

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What is the main benefit of bariatric surgery?

Bariatric surgery can help improve the overall health of patients by addressing the root causes of obesity-related complications.

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What are the common nutrient deficiencies after bariatric surgery?

These are essential nutrients that can become deficient due to malabsorption after certain bariatric surgeries. They are crucial for various bodily functions.

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What is Biliopancreatic Diversion (BPD) Surgery?

Biliopancreatic Diversion (BPD) is a type of weight-loss surgery where a large portion of the stomach is removed, and the small intestine is bypassed to create a smaller pathway for food absorption. This surgery can be performed with or without a Duodenal Switch (BPD-DS), further modifying the digestive tract.

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How is food bypassed in Biliopancreatic Diversion?

In BPD, a small pouch is created in the stomach, and the remaining stomach is connected to the ileum (lower part of the small intestine) directly. This reroutes food, limiting how much you can eat and the amount of nutrients absorbed.

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What is Biliopancreatic Diversion with Duodenal Switch (BPD-DS)?

Biliopancreatic Diversion with Duodenal Switch (BPD-DS) is a more complex version of BPD where a portion of the small intestine is bypassed, further limiting food absorption and nutrient uptake. It's often chosen for patients needing greater weight loss.

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What are the risks of Biliopancreatic Diversion?

BPD and BPD-DS can lead to nutritional deficiencies because they significantly reduce the absorption of nutrients. The bypassed portion of the small intestine normally absorbs vitamins, minerals, and other essential nutrients.

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What are the long-term considerations after Biliopancreatic Diversion?

Patients who undergo BPD or BPD-DS often require lifelong supplementation with vitamins and minerals, such as iron, vitamin B12, and calcium, to prevent deficiencies and maintain good health.

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Study Notes

Sleeve Gastrectomy (SG)

  • 80% of the stomach is surgically removed and permanently removed from the body.
  • Deficiency: Iron, Calcium, Vitamin B12, Thiamin

Roux-en-Y Gastric Bypass

  • A small gastric pouch is formed, and half of the jejunum is connected to this pouch; the other half remains connected to the remaining stomach and bile ducts.
  • Deficiency: Iron, Calcium, Vitamin B12, Vitamin D, Thiamin, Folate

Biliopancreatic Diversion with Duodenal Switch

  • A loose sleeve is created, a loop of bowel is attached from the ileocecal junction to the mesentery in the right upper quadrant (RUQ), the duodenum is mobilized posteriorly to the gastroduodenal artery, and the duodenum is resected distal to the pylorus.
  • Deficiency: Iron, Calcium, Zinc, Vitamin KEDA, Protein

Biliopancreatic Diversion without/with Duodenal Switch (BPD/BPD-DS)

  • A majority of the stomach is removed.
  • The distal small intestine is connected to a pouch.
  • The duodenum and jejunum are bypassed.
  • The bypassed small intestine carries bile and pancreatic enzymes.
  • Deficiency: (Note: specific deficiencies not specified in the new information.)

Adjustable Gastric Banding

  • A band is placed around the upper stomach, approximately 1 cm below the esophago-gastric junction, secured with sutures, and the port for adjustment is placed within subcutaneous fat.
  • Deficiency: Calcium, Vitamin B12, Thiamin, Folate

Bariatric Surgery Qualifications

  • Patients may qualify for bariatric surgery at a BMI of 40 or greater, or a BMI of 35 or greater with comorbidities.
  • Bariatric surgery can improve and resolve conditions, including insulin resistance, metabolic disease, and comorbidities, thereby decreasing morbidity rates.

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