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CSOWM - BARIATRIC SURGERY PROCEDURES AND NUTRITION EXAM
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CSOWM - BARIATRIC SURGERY PROCEDURES ANDNUTRITION EXAM 2024-2025
Bariatric and Metabolic Surgery Procedures - Answer - Previously known as
weight loss surgery.
- Affect physiological regulation of body weight.
- Lower morbidity and mortality rates among overweight and obese people.
Combination Procedures - ANSWER Gastric manipulation causes some restriction
and neural/hormonal alterations.
Examples include Sleeve Gastrectomy (SG), Roux-en-Y Gastric Bypass (RYGB),
and Biliopancreatic Diversion (BPD/DS).
Sleeve Gastrectomy (SG) - ANSWER: 80% of the stomach is removed
(particularly the fundus, which dramatically lowers ghrelin production).
Sleeve Gastrectomy (SG) Advantages - ANSWER - done more swiftly, resulting in
shorter anaesthesia duration and a lower degree of post-operative systemic
ANSWER.
- Fewer complications.
- reduced risk of micronutritional disorders.
- Lower risk of long-term problems (obstructions, ulcers, dumping syndrome,
hypoglycemia, etc.).
- Can be updated or transformed.
- provides access to both the biliary and pancreatic ducts (for upper GI/EGD)
- A positive shift in the gut microbiome.
,Sleeve Gastrectomy (SG) Disadvantages and Risks - ANSWER - may aggravate
GERD due to the preservation of acid-producing cells.
- Unknown long-term data (10+ years) on the sustainability of weight loss and
comorbidity benefits.
- contraindicated in patients with severe GERD, lower oesophagal sphincter
incompetency, and Barrett's oesophagus
Roux-en-Y Gastric Bypass (RYGB) - Step 1 Restriction: The surgeon separates the
upper and lower halves of the stomach. The upper portion (or the "pouch") is
subsequently attached to a small intestine limb known as the "Roux limb." The new
stomach pouch limits the amount of food you can eat, causing you to feel full even
after consuming a modest amount.
Step 2 Malabsorption: The pouch is then attached to the center of the small
intestine (the jejunum), bypassing the duodenum and a portion of the jejunum.
Roux-en-Y Gastric Bypass (RYGB) Mechanisms: Ghrelin Suppression
- Nutrient exposure to the gut is adequate for food-induced ghrelin suppression.
- it may result in partial vagotomy.
Increases Satiety and Reduces Appetite.
It promotes nutrient transport into the hindgut (cecum, large colon, small colon, and
rectum), increasing the release of gut hormones (GLP-1, PPY, OXM, CCK) and
bile acids.
Roux-en-Y Gastric Bypass (RYGB) Advantages - ANSWER: More weight loss
than LAGB and SG
- improved comorbidity outcomes (CAD, T2DM, HTN, OSA, GERD, cancer)
, - Life expectancy rose by approximately 7 years due to considerable improvement
or remission of comorbidities.
- beneficial change in gut flora.
Roux-en-Y Gastric Bypass (RYGB) Disadvantages and Risks - ANSWER:
Obstruction (due to hiatal hernia)
- Adhesions
- ulcers (NSAIDs, tobacco smoking), including anastomotic ulcers.
- Dumping Syndrome
Biliopancreatic Diversion (BPD) / Duodenal Switch (DS) - ANSWER 80% of the
stomach is excised (similar to a sleeve gastrectomy), and the gastric pouch is linked
to a very short length of the ileum (bypassing the duodenum and jejunum).
The biliopancreatic loop (section of the small intestine that was skipped) is linked
to the distal part of the digestive loop (piece of the intestine that remains and
through which food will go), forming a channel to the colon.
Biliopancreatic Diversion (BPD) versus Duodenal Switch (DS) Advantages -
ANSWER - higher weight loss at one-year follow-up
- More effective against diabetes than RYGB, SG, and LAGB.
Metabolic Impact
- reduced ghrelin (which reduces hunger).
- increased PYY (which promotes satiety)
- elevated GLP-1 (which promotes satiety).
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