CBR AM flashcards

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NIH bariatric eligibility criteria

BMI ≥40, or BMI ≥35 with an obesity-related comorbidity, plus documented failed nonsurgical weight management and acceptable operative risk.

Contraindications to bariatric surgery

Uncontrolled severe psychiatric illness, active substance use disorder, inability to comply with lifelong follow-up, and lack of understanding of risks.

Preoperative very-low-calorie diet

An 800-1000 kcal/day diet for 2-4 weeks before surgery that reduces liver volume and left liver lobe size, improving laparoscopic exposure.

STOP-BANG screening

A screening tool for obstructive sleep apnea; a score of 3 or more warrants further evaluation and treatment before surgery.

Sleeve gastrectomy anatomy

Removal of about 75-80% of the stomach along the greater curvature, leaving a tubular conduit of roughly 60-100 mL with neurohormonal effects.

Roux-en-Y gastric bypass

A 15-30 mL gastric pouch connected to a Roux limb, combining restriction with malabsorption and dumping physiology.

Adjustable gastric banding

A purely restrictive procedure with the highest long-term reoperation rate among common bariatric operations; now used infrequently.

Duodenal switch

A malabsorptive procedure giving the greatest durable weight loss but the highest risk of protein-calorie and fat-soluble vitamin deficiency.

Sleeve leak location

After sleeve gastrectomy, leaks most often occur at the proximal staple line near the angle of His.

Protein target after surgery

Aim for 60-80 g/day, sometimes up to 1.0-1.5 g/kg ideal body weight, to preserve lean mass.

Dumping syndrome triggers

High-sugar, high-osmolar foods cause rapid emptying symptoms; management is low-sugar, high-protein meals with fluids between meals.

Lifelong micronutrients

Multivitamin with minerals, vitamin B12, vitamin D with calcium citrate, and iron are required indefinitely after bariatric surgery.

Thiamine deficiency risk

Persistent vomiting after surgery raises thiamine (B1) deficiency risk; untreated Wernicke encephalopathy is a neurologic emergency requiring immediate parenteral thiamine.

Postoperative leak signs

Tachycardia, often above 120 beats per minute, is the earliest and most sensitive sign, along with fever, pain, or respiratory distress.

Anastomotic stricture

Progressive dysphagia and vomiting of solid food after gastric bypass, treated with endoscopic balloon dilation.

Marginal ulcer

Epigastric pain typically 1-3 months after bypass, associated with NSAIDs, smoking, and H. pylori; treated with proton pump inhibitors.

Early versus late dumping

Early dumping occurs 10-30 minutes after eating from osmotic fluid shifts; late dumping occurs 1-3 hours later from reactive hypoglycemia.

Preoperative psychological evaluation

Screens for active psychiatric illness, eating disorders such as binge-eating disorder, substance use, and capacity to consent.

Binge-eating disorder

Recurrent loss-of-control eating without purging; common in bariatric candidates and associated with poorer weight loss; treated with cognitive behavioral therapy.

Alcohol risk after surgery

Altered pharmacokinetics raise blood alcohol peaks, and the risk of alcohol use disorder and transfer addiction increases; screen with AUDIT-C.

Depression screening

Use the PHQ-9 at intervals after surgery because depression and anxiety may persist or worsen; refer for treatment when identified.

Diabetes medication adjustment

Insulin and sulfonylurea doses must be reduced or stopped early after surgery to prevent hypoglycemia as weight and insulin resistance fall.

Extended-release drug absorption

After gastric bypass, extended-release and enteric-coated formulations may be poorly absorbed; prefer immediate-release alternatives where possible.

NSAID risk after bypass

NSAIDs increase marginal ulcer risk; avoid or use with caution and gastroprotection after gastric bypass.

Levothyroxine monitoring

Absorption may change after bypass; recheck TSH 6-8 weeks after surgery and after any dose change.

Expected weight loss

Sleeve and bypass typically achieve 25-35% total weight loss at 1-2 years, with some regain common after 2-5 years.

Weight regain evaluation

Assess dietary patterns, portion size, grazing, alcohol use, mental health, and anatomical causes such as pouch dilation or fistula.

Long-term laboratory monitoring

CBC, CMP, iron studies, B12, folate, 25-OH vitamin D, calcium, PTH, and lipids should be checked at scheduled intervals.

Pregnancy timing after surgery

Delay pregnancy 12-18 months after surgery and monitor iron, folate, B12, and vitamin D with additional supplementation.

Accreditation requirements

Programs such as MBSAQIP require a multidisciplinary team, defined pathways, data collection, and quality reporting.

Enhanced recovery pathway

Standardized perioperative protocols including early ambulation, opioid-sparing analgesia, and early oral intake reduce length of stay and complications.

Quality metrics tracked

Thirty-day readmission, reoperation, leak rate, VTE, mortality, and nutritional deficiency rates should be tracked and reported regularly.