Power Review: Management of the Post-Bariatric Surgery Patient
Your next 3 patients…
#1: Gastric bypass pt with SIRS criteria
#2: Gastric bypass pt with psychiatric complaints
#3: Gastric bypass pt with nausea/vomiting
The Basics
-Morbid obesity continues to rise significantly (epidemic)
-Increasing # of weight-loss surgeries w/ physical/psych effects => increasing ED visits for postoperative complications
-Increased laparoscopic techniques; each surgical option w/ potential complications
-2 main strategies of surgery: gastric restriction (early satiety) => banding / gastroplasty; intestinal malabsorption (bypass parts of small intestine) => distal gastric bypass / biliopancreatic diversion +/- duodenal switch
-Hospital stays: 3-4 days
Clinical Pearls
–Challenging / unreliable abdominal exam => more extensive work-ups including CT abdo/pelv w/ oral + IV contrast (drink over several hours)
-May not fit into CT scan
–Often don’t manifest symptoms/signs of serious intra-abdominal pathology i.e. signs of peritonitis masked by large amount of intra-abdominal fat
-Lack cardiopulmonary physiologic reserve => quick deterioration; get surgery involved early
-Concern for band migration: need swallow study under fluoroscopy
-Roux-en-Y pts are tricky b/c part of small intestine is bypassed; signs/sxs not classic and abdo XR not reliable
–Fever + tachycardia + increasing abdominal / back pain in Roux-en-Y pt in 1st several weeks post-surgery, pursue anastomotic leak/intra-abdominal abscess; need UGI series vs surgical exploration
-Upper endoscopy has a role in diagnosing bleeding / stricture / stenosis
–Internal hernia: tough dx; many w/ normal labs / XR / UGI series / CT; surgical exploration needed […]
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