Bariatric and metabolic surgery

All are indications of bariatric surgery except

A. Anyone with a BMI ≥40
B. People with a BMI ≥35 with onset of type 2 diabetes in the past 10 years
C. People with a BMI of >35 with active substance abuse
D. Persons with BMI 30-35 with type 2 diabetes

Not true of Roux-en-Y Gastric Bypass surgery is

A. Leads to changes in food preferences
B. Reduces eating at least temporarily
C. The most commonly performed bariatric operation
D. Reduces lean body mass considerably

All are true of sleeve gastrectomy except

A. Increases the patient’s satiety and decreases meal portion size
B. Decreases serum levels of ghrelin
C. Increases plasma high sensitivity C-reactive protein (hs-CRP)
D. Improvement in non-alcoholic fatty liver disease (NAFLD)

Not true of Biliopancreatic diversion with duodenal switch operation

A. Produces the most significant weight loss in comparison to other bariatric surgeries
B. It involves a partial proximal gastrectomy
C. Transection of the small bowel between the ligament of Treitz and the ileocecal valve
D. A vertical sleeve gastrectomy is combined with a duodenoenterostomy

Advantages of implantation of Devices for weight loss includes all except

A. Adjustable gastric band is placed about the proximal stomach to constrict the size of the gastric pouch and outlet
B. Weight loss occurs by reduction of appetite when leads are placed about the vagal trunks at the diaphragm to produce intermittent vagal blockade
C. Pain or dyspepsia can not be appreciated in intermittent vagal blockade
D. Early satiety is the mechanism of weight loss in intermittent vagal blockade

In short

  • Reduced appetite and early satiety are common features that are potentially explained by changes in levels of gut hormones, such as PYY and GLP-1 after bariatric surgery.

  • Protein/calorie malabsorption is common after Biliopancreatic diversion with duodenal switch operation.

  • Gastro-oesophageal reflux is more common after Sleeve gastrectomy.

  • Nutritional and micronutrient supplements after bariatric surgery include: Multivitamin and mineral supplement, thiamine if vomiting, vitaminD, iron, selenium, copper, zinc, folic acid, vitamins B12,A, E, K.

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