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27 Cards in this Set
- Front
- Back
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name the 3 components of metabolic syndrome
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insulin resistance (Type II DM)
dyslipidemia HTN |
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what are the current NIH guidelines which permit bariatric surgery
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BMI> 40 or BMI>35 with at least 1 medical co-morbidity
and have failed dietary therapy |
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in the era of OPEN abdominal bariatric surgery, this was the most common cause of perioperative mortality
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PE
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Hypoventilation syndrome of obesity (Pickwickian Syndrome)
considered at this BMI clinical clues Diagnostic requirements why is this important |
BMI>60
plethoric faces, clinically cyanotic, difficulty with normal respirations/minimal exertion PaCO2>PaO2, elevated HCT increased perioperative M/M |
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what is the incidence of Gallstone or Sludge formation following Bariatric surgery
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30%
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what is the current recommended technique for placement of LAP_BAND
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pars Flaccida
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this is the most common location of of stomach herniation thru LAP Band... how do you prevent this
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Posterolateral fundal herniation
numerous interrupted sutures far posterolaterally |
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ideal location of the BAND in relation to the GE junction
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1cm below GE junction
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what is the proper orientation of LAP Band
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2'-8' position
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name the 6 essential components of successful Roux-en-Y
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small gastric pouch
gastric pouch created by the cardia (decreases dilation) pouch divided from the distal part of the stomach Roux Limb at least 75 cm in length enteroenterostomy constructed to prevent stenosis / obstruction close all potential spaces to prevent internal hernia |
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Roux-en-Y
after mobilizing the omentum, where is the initial division of the jejunum |
30-40 cm distal to the ligament of Treitz
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what is the typical length of Roux limb
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BMI<50 = 80-120 cm
BMI>50 = 150 cm |
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a special internal hernia which occurs in the potential space posterior to a gastrojejunostomy. Caused by the herniation of intestinal loops through the defect between the small bowel limbs, the transverse mesocolon and the retroperitoneum
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Petersens hernia
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when preforming a sleeve gastrectomy, it is vital to be cautious of theses 3 steps
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Preserve Left gastric Vessels
preserve lesser curvature vessels. prevent any twisting |
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primary complication of sleeve gastrectomy
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leakage along the gastric staple line
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what is the MC S/Sx of intra-abdominal leak following bariatric surgery
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Tachycardia - MC
tachypnea / agitation |
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pts who undergo RNY are at a lifelong risk of these nutrient deficiencies
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iron
folate Vitamin A Vitamin D Vitamin B12 |
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this is the MC expected medical consequence after Duodenal switch and/or biliopancreatic diversion
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diarrhea
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which bariatric procedure has the highest rate of Estimated weight loss
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BPD- Duodenal switch
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a specific complication seen after any bariatric surgery: seen after severe prolonged vomiting. will see neurologic deficits
- Treatment |
Wernickes encephalopathy
Thiamine (B1) |
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COMPLICATION OF RNY,
MC cause of severe life threatening intra-abdominal complication. give mc site |
Anastomotic leak
gastrojejunostomy |
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complication seen 4-6 wks s/p RNY. progressive intolerance to solids then to liquids, in which each was previously tolerated.
Tx |
Stenosis of Gastrojejunostomy
EGD Balloon dilation |
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this occurs in 2-10% RNY pts.
continuous boring epigastric abdominal pain. Treatment |
Marginal Ulcer
medical Tx for H pylori, PPI. *unless the ulcer has fistulized creating a recurrent source of acid |
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2 MC long term metabolic complications of RNY
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Iron and B12 deficiencies
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which form of Iron is best supplement for RNY pts, why
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Gluconate
absorbed in non-acid environment, |
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most complications of RNY are reduced if the procedure is done laparoscopically... this is the exception, with a slightly higher incidence in laparoscopic
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Bowel obstruction.
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most significant and specific long term complication seen in after BPD,
seen in 12% give 2 treatments if becomes to severe |
Protein malnutrition
reverse procedure or lengthen the common channel |
