Exam (elaborations)
CSOWM METABOLIC AND BARIATRIC SURGERY
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CSOWM METABOLIC AND BARIATRIC SURGERY
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CSOWM METABOLIC AND BARIATRIC SURGERYBariatric & Metabolic Surgery Procedures - Answers-Group of surgical procedures that
impact the physiological regulation of body weight and improve morbidity and mortality
rates
Purely restrictive weight loss surgery - Answers-Laparoscopic adjustable gastric band
(LAGB)
Weight loss surgeries that are combination (Malabsorptive & restrictive) -Gastric
manipulation, causing some restriction & neural/hormonal) - Answers-Sleeve
gastrectomy (SG) & Roux-en-Y Gastric bypass (RYGBP)
Glucagon-like peptide 1 (GLP-1) - Answers-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) - Answers-Hormone secreted in the distal small I; Suppresses
appetite; There is a decrease in this hormone found in obese persons with weight loss
Insulin - Answers-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 - Answers-Hormone secreted from the adipocytes; Regulates energy balance &
suppresses appetite; Levels decrease during weight loss
Metabolic and bariatric surgery changes to gut hormones? - Answers-The opposite of
restrictive dieting
RYGB + SG changes in gut hormones - Answers-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 - Answers-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 - Answers-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 - Answers-Dysphagia, reflux/cough, regurgitation, maladaptive
eating
LAGB- Goal of fill (Saline fill) - Answers-Satiety, small meals satisfying
, LAGB- Needing a fill (saline fill) - Answers-Hungry, big meals, looking for food
LAGB downside - Answers-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 - Answers-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)
Bypass surgery that is combination of malabsorptive/restriction and of both
macronutrients & micronutrients - Answers-Biliopancreatic Diversion (BPD/DS)
Cholecystokinin (CCK) - Answers-Hormone secreted by the duodenum; suppresses
appetite and levels decrease during dieting and weight loss
Glucose-dependent insulinotropic polypeptide (GIP) - Answers-Hormone secreted by
the duodenum and jejunum; normal function for energy storage; Levels increase during
dieting and weight loss
Ghrelin - Answers-Hormone from the gastric fundus; Functions to stimulate appetite for
high fat, high sugar foods; Levels increase during diet and weight loss
These two procedures impact the physiological regulation of body weight with being
restrictive mainly in the 1st 3 post-op months - Answers-RYGB + SG
The largest endocrine organ in the body - Answers-The GI tract
Sleeve Gastrectomy procedure - Answers-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 - Answers-Gastric fundus
Advantages of SG - Answers-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 - Answers-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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