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CSOWM Metabolic and Bariatric Surgery exam with complete solutions 2024_2025
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CSOWM Metabolic and Bariatric Surgery exam with complete solutions 2024_2025
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CSOWM Metabolic and Bariatric Surgeryexam with complete solutions 2024/2025
Bariatric & Metabolic Surgery Procedures - ANSWER✓✓-Group of
surgical procedures that impact the physiological regulation of body
weight and improve morbidity and mortality rates
Purely restrictive weight loss surgery - ANSWER✓✓-Laparoscopic
adjustable gastric band (LAGB)
Weight loss surgeries that are combination (Malabsorptive &
restrictive) -Gastric manipulation, causing some restriction &
neural/hormonal) - ANSWER✓✓-Sleeve gastrectomy (SG) & Roux-en-
Y Gastric bypass (RYGBP)
Bypass surgery that is combination of malabsorptive/restriction and
of both macronutrients & micronutrients - ANSWER✓✓-
Biliopancreatic Diversion (BPD/DS)
Cholecystokinin (CCK) - ANSWER✓✓-Hormone secreted by the
duodenum; suppresses appetite and levels decrease during dieting
and weight loss
Glucose-dependent insulinotropic polypeptide (GIP) - ANSWER✓✓-
Hormone secreted by the duodenum and jejunum; normal function
for energy storage; Levels increase during dieting and weight loss
Ghrelin - ANSWER✓✓-Hormone from the gastric fundus; Functions to
stimulate appetite for high fat, high sugar foods; Levels increase
during diet and weight loss
,Glucagon-like peptide 1 (GLP-1) - ANSWER✓✓-Hormone secreted in
the ileum of the small I; Functions to suppress appetite and increase
satiety; Levels have a decreased functionality with diet and weight
loss
Peptide YY (PYY) - ANSWER✓✓-Hormone secreted in the distal small
I; Suppresses appetite; There is a decrease in this hormone found in
obese persons with weight loss
Insulin - ANSWER✓✓-Hormone secreted from the beta cells of the
pancreas; Functions to regulate energy balance and signal satiety in
the brain; There is resistance to this hormone in obese persons;
Levels decrease after dieting
Leptin - ANSWER✓✓-Hormone secreted from the adipocytes;
Regulates energy balance & suppresses appetite; Levels decrease
during weight loss
Metabolic and bariatric surgery changes to gut hormones? -
ANSWER✓✓-The opposite of restrictive dieting
RYGB + SG changes in gut hormones - ANSWER✓✓-They don't see a
decrease in RMR; decrease in appetite and hunger; increase in
satiety; decrease in ghrelin, increase in GLP-1, PYY, CCK, and amylin
Amylin - ANSWER✓✓-co-secreted with insulin by beta cells in
response to nutrient stimuli. Delays nutrient uptake and suppresses
glucagon secretion after meals. Satiating effect.
LAGB + Hunger hormones - ANSWER✓✓-Studies show an increase in
ghrelin 6-12 months s/p procedure; may be why decrease in wt loss
with this Adjustments and food choices essential for wt loss and
maintenance
LAGB - Too tight fitting - ANSWER✓✓-Dysphagia, reflux/cough,
regurgitation, maladaptive eating
LAGB- Goal of fill (Saline fill) - ANSWER✓✓-Satiety, small meals
satisfying
, LAGB- Needing a fill (saline fill) - ANSWER✓✓-Hungry, big meals,
looking for food
LAGB downside - ANSWER✓✓-Soft meals still go in easy, which can
still allow for increase in calorie intakes to weight gain (Ex: increase
in refined, icecream, etc)
LAGB history - ANSWER✓✓-First approved in 2001 in US; Lost <25-
30% of excess weight in up to 40% of patients; Many complications
found: Band erosion, infection, intolerance to band symptoms,
slippage of band, difficulty swallowing, GERD, Pouch dilation, port
infection (Most now having removed than put in)
These two procedures impact the physiological regulation of body
weight with being restrictive mainly in the 1st 3 post-op months -
ANSWER✓✓-RYGB + SG
The largest endocrine organ in the body - ANSWER✓✓-The GI tract
Sleeve Gastrectomy procedure - ANSWER✓✓-Laparoscopically (~6
small inserts) ; ~80% of the gastric fundus removed; Food will
empty into the duodenum normally through gastric sphincter;
ghrelin still produced in GI
The primary place where ghrelin is produced - ANSWER✓✓-Gastric
fundus
Advantages of SG - ANSWER✓✓-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)
Disadvantages of SG - ANSWER✓✓-May exacerbate GERD;
contraindicated in pts with severe GERD, lower esophageal-
sphincter incompetence; Barrett's esophagus; There is a lack in
longterm data (>10 years) of the durability of this weight loss or
changes in comorbidities (Studies currently being published)
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