Mr. McKinley has been obese his whole life, which puts him at an increased risk for type 2 diabetes, hyperlipidemia, hypertension, and osteoarthritis.
3. What are the standard adult criteria for consideration as a candidate for bariatric surgery? After reading Mr.
s medical record, determine the criteria that allow him to qualify for surgery.
The patient should be morbidly obese
...The patient should be obese with a BMI
35 and display a co-morbidity such as cardiovascular disease, sleep apnea, or diabetes.
Surgery is a resort used when the patient has failed to lose weight by other, less invasive means.
However, often times, physicians require that a patient lose some weight prior to the operation to demonstrate that he or she is willing to follow through with lifestyle changes relating to exercise and diet.
Mr. McKinley is a candidate for surgery because he is morbidly obese with a BMI of 59 (BMI >40) and he has several co-morbidities including: type 2 diabetes, hypertension, and hyperlipidemia.
4. By performing an Internet search or literature review, find one example of a bariatric surgery
Describe the information that is provided for the patient regarding qualification for surgery. Outline the personnel involved in the evaluation and care of the patient in this particular program.
Internet search information is taken from: http://www.obesityhelp.com/forums/vsg/about_vertical_sleeve_gastrectomy.htmlQualification information: for low-BMI individuals that should consider this procedure:
Those concerned by long-term complications of intestinal bypass
Those who are concerned about a lap-band, or inserting a foreign object into the abdomen
Those who have other medical problems that prevent them from having weight-loss surgery such as
prior surgery, severe asthma req
frequent steroid use, and other complex medical conditions
People who need to take anti-inflammatory medications; VSG presents a lower risk for development of ulcers after taking anti-inflammatory meds after surgery Personnel involved:
Laparoscopic Associates of San Francisco (LAPSF)
more than 700
there were no
no conversions to open and
Study showed that two-year weight-loss results from the vertical gastrectomy were similar to the roux-en- Y.
57% weight loss using the vertical gastrectomy compared to 41% for the lap-band procedure.
This case is associated with a team of several doctors from LAPSF.
5. Describe the following surgical procedures used for bariatric surgery including advantages, disadvantages, and potential complications.
a. Roux-en-Y gastric bypass
Most common restrictive-malabsorptive procedure.
A small pouch is created at the top of the stomach, which restricts food intake by increasing satiety. The jejunum is cut at the distal end and is attached to the small pouch at the top of the stomach, which bypasses the rest of the stomach, the duodenum, and the first part of the jejunum in order to restrict digestion and absorption.
The proximal end of the jejunum that is draining the stomach is surgically connected to the lower end of the jejunum, allowing for secretions from the liver, gallbladder and the pancreas to enter the jejunum to aid in digestion and absorption.
Medical Nutrition Therapy, 4th Edition eBook PDF Free Download
A Case Study Approach
Edited by Marcia Nahikian Nelms and Sara Long Roth
Building a bridge from classroom to clinical practice, this casebook is composed of 34 realistic case studies appropriate for introductory and advanced level courses in nutrition and diet therapy. Each case study uses the medical record as its structure. The student “solves the case” by using the information provided such as hospital admission data, laboratory test results, intake/output records, and the physician’s progress notes. The case is followed by a series of questions that focus on pathophysiology; assessment; clinical, nutritional and behavioral outcomes; interventions; and appropriate follow-up for the patient. This “real world” approach helps to prepare the student for the professional setting. Objectives for student learning within each case are built around the nutrition care process and competencies for dietetic education.