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The Post Surgical Syndromes in Bariatrics

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by

Louie Hendricks

on 9 February 2013

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Transcript of The Post Surgical Syndromes in Bariatrics

Early Dumping Late Dumping Syndrome Hormonal Processes Roux Syndrome Arthritis Dermatitis Syndrome
(Bowel associated dermatitis, arthritis syndrome) Gallstones Gas bloat syndrome Anemias B12 requires intrinsic factor from the stomach to be
absorbed in the deuodenum.

Microcytic anemias also occur because of iron absorption
issues. Risk factors include age less than 50.

In one series patients being evaluated for anemia after
gastrectomy had a 79% incidence of B12 deficiency. 94% were iron deficient. Only 4% were folate deficient. This was a complication of changes in the
flora in limbs of bowel. With neither food nor
biliopancreatic secretions in the ileum, bacterial fermentation would result in the production of CO2 and ethanol and this led to the symptoms that give the syndrome its name. This was common after the jejunoileal bypass procedures.
It included flu like symptoms, myalgias, skin changes, and polyarticular arthritis. It usually manifests 3 months to 5 years after surgery.

Bacterial overgrowth in blind loops of bowel and the formation of circulating immunecomplexes are thought to cause BADAS. Antibiotics usually work as does reversal of the procedure. Again, many of procedures associated with weightloss
surgery and surgical oncology of the stomach can increase
the risk for gallstones.

-Dividing hepatic branches of the vagal trunk may be all that is necessary. This leads to stasis
- Ampullary dysfunction, changes in bile composition GI dysmotility syndrome with propulsive activity
toward pouch/or stomach. This probably occurs in
nearly all patients with gastrectomies but only a few
become symptomatic.

-bezoar formation
- dilation of roux limb will show on imaging
-may be a result of accidental vagotomy 15min-30min after ingestion

VIP (vasodilator, heart ionotroph, and GI secretion stimulation), CCK, , PPYY (anorexic secreated ileum and colon ), and renin-angiotensin-aldosterone.

Diaphoresis, weakness, light-headedness, tachycardia

tx: dietary changes and if persistent, octreotide. Classically, the Henley loop.
Theoretically, deuodenal switch for patients who had pyloroplasty Hyperinsulinemia
Hypoglycemia


diaphoresis, tachycardia, AMS

Nesideoblastosis?
Acarbose
Verapamil
DS The dumping syndrome is the result of pronounced
hormonal processes that are associated with hypertonic solutions. There are both cardiovascular and gastrointestinal phases. The Post Surgical Syndromes in Bariatrics The first Post gastrectomy syndrome was identified
by bilroth in 1885. It was epigastric pain with bilious
vomiting. Nutritional syndromes Zittel et al found that in a survey of patients who had underwent gastrectomy, 55% had vertebral fractures 5-20 years after the procedure. Copper deficiency mimmicks B12 deficiency with ataxia, myelopathy, and peripheral neuropathy. Like calcium, iron is absorbed in the upper bowel and requires an acidic environment. Dumping Syndromes Classical Complications The Dumping syndromes
Slushy
Ice Cream
Chicken Noodle Soup The End
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