1/9. Managing the obese patient after bariatric surgery: a case report of severe malnutrition and review of the literature.Surgery is now considered to be the most effective treatment for reducing weight and maintaining weight loss in patients with clinically severe obesity. Although the jejuno-ileal bypass has been abandoned, the vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGB) operations are now commonly performed. A third operation, the bilio-pancreatic diversion (BPD), is performed less frequently. The RYGB and BPD procedures cause predictable selective micronutrient deficiencies that can be avoided by early supplementation. Surgical complications from all of these procedures may result in more severe forms of malnutrition. This article is intended to familiarize the nutrition support specialist with the anatomic and physiologic changes produced by these procedures, the resulting nutritional deficiencies and recommended supplementation, and the manifestations of severe malnutrition caused by complications. A case of severe malnutrition after RYGB surgery is reported for illustration.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
2/9. A personal perspective on the needs of the weight loss surgery patient.weight loss surgery (WLS) patients, such as those undergoing bileopancreatic diversions and other Roux-en-Y gastric bypass procedures, present a relatively new population for the health care system. WLS creates special needs for this population that health care providers may not be fully aware of. The author, a former WLS patient and health care quality assurance professional, presents observations from his unique personal perspective. He feels that WLS patients, and post-WLS patients receiving other health care services, can be inadvertently jeopardized by the lack of awareness of their special needs. These needs are the result of the permanent postsurgical malnutrition and malabsorption syndrome occurring after the Roux-en-Y gastric bypass. These needs include nutrition, management of electrolytes during surgery, and pain management. Additionally, the morbidly obese patients may possess low self-esteem to the degree that they may not actively and appropriately participate in their own care. The author also offers personal observations concerning his belief that there is discrimination against morbidly obese patients in the health care setting. The author presents a personal case study as a tool for better understanding of the WLS patient by caregivers.- - - - - - - - - - ranking = 0.14285714285714keywords = malnutrition (Clic here for more details about this article) |
3/9. stroke and seizure following a recent laparoscopic Roux-en-Y gastric bypass.Laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been an available operation for weight loss for the past decade, and bariatric surgery is increasing in the united states. Careful patient screening and follow-up have been the cornerstone for success against the complexities of morbid obesity. Neurologic complications have occurred, such as polyneuropathy and Wernicke-korsakoff syndrome. We report an 18-year-old female with morbid obesity, steatohepatitis, tobacco, recreational drug, and oral contraceptive use who at 4 months after LRYGBP experienced a generalized seizure and stroke. She was diagnosed with an acute ischemic stroke, possibly venous infarction. Her postoperative course had been complicated by malnutrition and dehydration, apparently related to nausea from chronic cholecystitis. She had a possible protein-S deficiency. Rare neurologic complications emphasize the importance of postoperative surveillance in these patients.- - - - - - - - - - ranking = 0.14285714285714keywords = malnutrition (Clic here for more details about this article) |
4/9. fatigue, weakness, and sexual dysfunction after bariatic surgery - not an unusual case but an unusual cause.BACKGROUND: Malabsorptive bariatic surgery for morbid obesity has been very effective in producing weight loss. However, patients may experience some degree of malnutrition, which may lead to various clinical symptoms, such as fatigue and weakness. Morbid obesity is often associated with impaired reproductive function, and weight loss generally improves sexual function in both sexes. However, women with extreme weight loss may experience secondary amenorrhea. In men, zinc deficiency may lead to impaired testosterone synthesis resulting in hypogonadism and impotency. Case Report: A 43-year-old male 5 years after jejunoileal bypass for morbid obesity performed in a foreign institution presented with a recent history of progressive fatigue, general weakness, and declining libido and potency. Unexpectedly, his symptoms were not related to the operation or to his weight loss but rather to a structural cause. Endocrine and radiologic evaluations revealed a cystic tumor in the sella turcica causing partial hypopituitarism and secondary hypogonadism. CONCLUSION: Long-term follow-up is mandatory in patients after bariatic surgery. Non-specific symptoms and findings should be further investigated. A loss of sexual activity and performance may have causes other than the previous bariatic operation.- - - - - - - - - - ranking = 0.14285714285714keywords = malnutrition (Clic here for more details about this article) |
5/9. Wernicke's encephalopathy after gastric bypass that masqueraded as acute psychosis: a case report.Wernicke's encephalopathy was originally described more than a decade ago. It has been reported after many causes of malnutrition. This case presents a patient with thiamine deficiency after gastric bypass, although unusual in itself, further complicating the case was the initial diagnosis of acute psychosis that was scheduled for electroconvulsive therapy. After recognition and intervention, the patient was successfully treated with thiamine replacement and parenteral nutrition.- - - - - - - - - - ranking = 0.14285714285714keywords = malnutrition (Clic here for more details about this article) |
6/9. methamphetamine use following bariatric surgery in an adolescent.bariatric surgery is increasingly popular as a therapeutic strategy for morbidly obese adolescents. Adolescence represents a sensitive period of psychosocial development, and children with considerable weight loss may experience greater peer acceptance, accompanied by both positive and negative influences. Substance abuse exists as one of these negative influences. We present the case of an adolescent bariatric surgical patient who abused methamphetamines in the postoperative period, with consequent nutritional instability. A concerted effort must be made in the preoperative assessment of adolescent bariatric patients to delineate a history of illicit drug use, including abuse of diet pills and stimulants. Excessive postoperative weight loss or micronutrient supplementation non-compliance should raise a suspicion of stimulant use and appropriate screening tests should be performed. The consequent appetite suppression may manifest with signs of malnutrition such as bradycardia, hypotension, and weakness. Inpatient nutritional rehabilitation and psychiatric assessment should be considered.- - - - - - - - - - ranking = 0.14285714285714keywords = malnutrition (Clic here for more details about this article) |
7/9. Home total parenteral nutrition in a pregnant diabetic after jejunoileal bypass for obesity.pregnancy after jejunoileal bypass (JIBP) for obesity is generally well tolerated without serious complications. A 24-yr-old diabetic patient who had previously had a JIBP procedure presented during pregnancy with severe malnutrition. She was treated successfully with home total parenteral nutrition. Previously published experience with pregnancy after JIBP and the use of parenteral nutrition during pregnancy is reviewed.- - - - - - - - - - ranking = 0.14285714285714keywords = malnutrition (Clic here for more details about this article) |
8/9. starvation injury after gastric reduction for obesity.Gastric reduction operations are designed to control body weight by establishing a small, meal-size juxtaesophageal, gastric pouch that empties into the jejunum (gastric bypass) or the larger portion of the stomach (gastroplasty). If the outlet of the pouch is too small, a patient may be limited to ingesting clear liquids. vomiting then occurs if heavier liquids or normal foods are taken. An occasional patient has difficulty eating properly and vomits even though the pouch volume and outlet are of optimum size. For a patient who reports vomiting, a distinction must be made between episodic improper eating and uncontrolled starvation. Three types of starvation injury are described: (1) sudden death from protein malnutrition; (2) refeeding syndrome; and (3) Wernicke-korsakoff syndrome. The mechanisms of the development, manifestations, prevention, and treatment of these complications are explained. Surgeons who treat severe obesity should be aware of these complications and be prepared to manage patients who have uncontrolled vomiting so that such complications either do not develop or are recognized and treated as early as possible before serious and irreversible injury occurs.- - - - - - - - - - ranking = 0.14285714285714keywords = malnutrition (Clic here for more details about this article) |
9/9. Conversion of proximal to distal gastric bypass for failed gastric bypass for superobesity.The purpose of this study was to analyze outcome following malabsorptive distal gastric bypass (D-GBP) in superobese patients who were reoperated for recurrent obesity comorbidity after a failed standard gastric bypass (S-GBP). Twenty-seven formerly superobese patients with a failed S-GBP converted to a D-GBP were studied. The small bowel was anastomosed 250 cm from the ileocecal valve to the disconnected Roux limb; the bypassed small intestine was connected to the ileum 50 cm from the ileocecal valve in five patients between 1985 and 1986 and 150 cm from the ileocecal valve in 22 patients thereafter. comorbidity was reassessed yearly following conversion to D-GBP. malnutrition occurred in all five patients with a 50 cm "common tract"; all required further revision and two died of hepatic failure. Three of 22 patients with a 150 cm common tract were reoperated with bowel lengthening because of malnutrition. Initial body mass index was 57 /-2 kg/m2 and fell from 46 /-2 kg/m2 before revision to 37 /-2 kg/m2 at 1 year and 32 /-2 kg/m2 at 5 years after revision; the percentage of excess weight lost went from 30 /-4% to 61 /-4% at 1 year and 69 /-5% at 5 years after revision. Preoperative comorbidity in patients undergoing revision included 14 with insulin-dependent type II diabetes mellitus, 11 with sleep apnea, 14 with hypoventilation, 13 with hypertension, and two with venous stasis ulcers. obesity comorbidity was corrected within 1 year in all but two patients with hypertension and remained stable in all patients followed for 5 years. Revision of a failed S-GBP to a 150 cm common tract D-GBP corrects failed weight loss and severe obesity comorbidity but requires nutritional support to prevent protein-calorie malnutrition, iron and fat-soluble vitamin deficiencies, and further revision in some patients to correct malnutrition. A 50 cm common tract has an unacceptable morbidity and mortality.- - - - - - - - - - ranking = 0.42857142857143keywords = malnutrition (Clic here for more details about this article) |