Please enable JavaScript.
Coggle requires JavaScript to display documents.
Bariatric Surgery:
Restrictive
Malabsorptive (Potential…
Bariatric Surgery:
- Restrictive
- Malabsorptive
Assessment:
- Specific lifestyle changes
- eating habits
- bowel habits
-
Contraindications to major abdominal surgery
previous attempts at weight loss
screened for behavioral disorders
-
Patients w/ obesity:
- OSA
- GERD
- Heart disease
- nonalcoholic fatty liver disease
- diabetes
-Vitamin/mineral deficiencies
Types:
- Roux-en-y Gastric Bypass (RYGB)
- gastric banding
- sleeve gastrectomy
- biliopancreatic diversion w/ duodenal switch (most weight loss: indicated for pts with very high BMIs)
-
Potential complications:
Fluid balance:
- IV flluids 1st hours postop
- small volumes orally: stimulate GI peristalsis/ perfusion / gastric reflux
- 30 ml of fluids q 15 mins stop if nauseated or full
Strain= hemorrhage or anastomotic leak!!!!
Preventing infection/ Anastomotic Leak
- pts tend to be older, male, greater body mass: disruption of site
- more with Open than laparoscopic procedures
S&S:
- fever, abdominal pain, tachycardia, & leukocytosis --> sepsis then--> septic shock.
If suspected anastomotic leak
- CT scann w/ contrast (leaking contrast)
Less severe in later postop: CT-guided drainage
Early or severe leak: Immediate open surgical intervention for repair
Dietary deficiencies:
Malabsorption of organic iron- oral/parenteral iron and low serum Vit. B12
IM injections: Vit B12: prevent pernicious anemia.
Diarrhea more common than constipation (prevent: high fiber)
- steatorrhea: rapid gastric emptying (unable to mix pancreatic & biliary secretions)
persistent (diarrhea or steatorrhea): upper Endoscopy/colonoscopy: rule out Celiac or CDiff
-
Bowel & gastric outlet obstruction:
NG tube contraindicated in bariatric pts (even if they have gastric outlet obstruction) may cause anastomotic leak or hemorrhage
- alternative: endoscopic procedures (balloon dilation or surgical revisions.
-
2 most common: (better outcome than gastric banding)
-
-
-