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CSOWM Metabolic and Bariatric Surgery
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CSOWM Metabolic and Bariatric Surgery
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CSOWM Metabolic and Bariatric SurgeryAcarbose - ANS-Drug that can help with reactive hypoglycemia; oral administration;
delays the breakdown of starch into sugar; Side effects: bloating, flatulence, diarrhea
Active PA factor - ANS-1.6-1.9
Advancing the diet takes how long ? - ANS-Can take 6-9 months
Advantages of SADI-S - ANS-2-4cm duodenum left; Highly effective for long-term
weight loss & remission of T2DM; Simpler and faster to perform (1 intestinal connection)
than RYGB or BPD/DS; Excellent option for pt. who already had a sleeve gastrectomy &
is seeking further weight loss
Advantages of SG - ANS-Performed more quickly, decrease in complications and
micronutrient deficiencies; decreased risk of longterm complications (Intestinal
obstructions, ulcers, dumping syndromes, severe hypoglycemia, other dysfunctional
glycemic syndromes); Allows access to both biliary and pancreatic ducts; Can be
revised or converted to a variety of other procedures (Bypass or BPD)
Amount of PA thats Grade A evidence to assist in keeping weight off/supporting
LBM/healthy bones? - ANS-150-300 min/week of moderate PA minimum per week;
including strength training 2-3x per week
Amylin - ANS-co-secreted with insulin by beta cells in response to nutrient stimuli.
Delays nutrient uptake and suppresses glucagon secretion after meals. Satiating effect.
Aspiration therapy - ANS-Gastrostomy tube + secondary device + reservoir (Reservoir
delivers water to stomach, water mixes with food, then drains from stomach (aspirates)
& 25-30% of calories removed 20-30 min after eating- No time frame limit, encourages
slower eating & better food choices (2016 FDA approved)
Aspiration therapy outcomes - ANS-14.2-21.5% TBWL @ 12 months + improvements in
metabolic + cardiac markers
At home, what is number 1 priority post sx as diet progressing? - ANS-Hydration- 60+
oz fluid
, Avoid what type of drugs with a Roux-en-Y - ANS-NSAIDs are contraindicated (Aspirin/
Ibprofen)
Bariatric & Metabolic Surgery Procedures - ANS-Group of surgical procedures that
impact the physiological regulation of body weight and improve morbidity and mortality
rates
Biliopancreatic Diversion/Duodenal switch (BPD/DS) procedure - ANS-Stomach divided,
~80% of fundus removed (basically sleeve gastrectomy performed); Then the small I
divided at the duodenum and is resected so the ielum is not attached to the pyloris,
bypassing the jejunum; The biliopancreatic loop joins the digestive loop forming a
common channel that flows to the colon; Will decrease the amt of calories and nutrients
absorbed, causing malabsorption of macro and micronutrients. NOT common in the US
d/t higher risks
Both sleeve + RYGB have been able to improve the following by >/= 50% - ANS-DM,
HTN, Sleep apnea, GERD (up to 70-80% with RYGB), SG falls short with GERD only
50% or under
BPD-DS disadvantages - ANS-Up to 9 incidences of diarrhea per day d/t malabsorption;
increased complications and risk of mortality than others; Greater protein &
vitamin/mineral deficiencies, Need to stay connected to surgical center life long +
compliance to f/u & strict adherence to dietary vitamin supplementation needed to avoid
severe deficiencies; Longer hospital stay (>/= 3 nights post) SG is 24hrs post or 1 night;
RYGB 2 nights post.
Bypass surgery that is combination of malabsorptive/restriction and of both
macronutrients & micronutrients - ANS-Biliopancreatic Diversion (BPD/DS)
Calcium - ANS-Supports skeletal structure, impacts muscle contracting, nerve function,
regulates heart beat
Carbohydrates per day to aim for post sx - ANS-Aim for a minimum of 50g/day to spare
the protein for repair and the carbs for brain function per the WHO recs but also >/=
30-50g is okay too
Carbs - ANS-energy
Cholecystokinin (CCK) - ANS-Hormone secreted by the duodenum; suppresses
appetite and levels decrease during dieting and weight loss
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