Question

Registered Nurse One Month after Gastric Bypass Surgery

Ginny Baca is a 46-year-old nurse who recently had gastric bypass surgery. She is 65 inches tall and weighed 302 pounds prior to surgery. She has lost 15 pounds in the month following her surgery and has advanced her post-surgery diet from clear liquids to solid foods. At her post-surgery visit, she is excited about her weight loss but also worried that she is not able to drink fluids like she used to. She has had two episodes of dumping after drinking soda with meals. She reports feeling bloated at times, even when she eats very small amounts of food.

1.  What characteristics in the history above made Ginny a good candidate for bariatric surgery? What other characteristics would you expect to find in her medical history?

2.  What routine supplements will Ginny most likely need to take for the rest of her life? Explain why this is important.

3.  Based on her ideal body weight of 125 pounds, calculate Ginny’s current daily protein needs

Answer 1

Gastric bypass surgery refers to a surgical process in which the stomach is divided into a small upper pouch and a much larger lower "remnant" pouch and then the small intestine is rearranged to connect to both. Surgeons have developed several different ways to reconnect the intestine, thus leading to several different gastric bypass procedures (GBP). Any GBP leads to a marked reduction in the functional volume of the stomach, accompanied by an altered physiological and physical response to food.

The operation is prescribed to treat morbid obesity (defined as a body mass index greater than 40), type 2 diabetes, hypertension, sleep apnea, and other comorbid conditions. Bariatric surgery is the term encompassing all of the surgical treatments for morbid obesity, not just gastric bypasses, which make up only one class of such operations. The resulting weight loss, typically dramatic, markedly reduces comorbidities.

Q.1 What characteristics in the history above made Ginny a good candidate for bariatric surgery? What other characteristics would you expect to find in her medical history?

The Consensus Panel of the National Institutes of Health (NIH) recommended the following criteria for consideration of bariatric surgery, including gastric bypass procedures:

• people who have a BMI of 40 or higher
• people with a BMI of 35 or higher with one or more related comorbid conditions

So Ginny baca a registered nurse who is weighing 302 pound 65 inch.her calculated BMI is 83.01 so she is an ideal candidate for gastric bypass.other charecteristics expected from Ginny is obesity associated type 2 DM which is not mentioned in the history.

2.  What routine supplements will Ginny most likely need to take for the rest of her life? Explain why this is important.

• Secondary hyperparathyroidism due to inadequate absorption of calcium may occur for GBP patients. Calcium is primarily absorbed in the duodenum, which is bypassed by the surgery. Most patients can achieve adequate calcium absorption by supplementation with vitamin D and calcium citrate
• Iron frequently is seriously deficient, particularly in menstruating females, and must be supplemented. Again, it is normally absorbed in the duodenum. Ferrous sulfate can cause considerable GI distress in normal doses; alternatives include ferrous fumarate, or a chelated form of iron. Occasionally, a female patient develops severe anemia, even with supplements, and must be treated with parenteral iron.
• Signs and symptoms of zinc deficiency may also occur such as: acne, eczema, white spots on the nails, hair loss, depression, amnesia, and lethargy.[journal 11]
• Deficiency of thiamine (also known as vitamin B1) brings the risk of permanent neurological damage (i.e. Wernicke's encephalopathy or polyneuropathy). Signs of thiamin deficiency are heart failure, memory loss, numbness of the hands, constipation, and loss of appetite.
• Vitamin B12 requires intrinsic factor from the gastric mucosa to be absorbed. In patients with a small gastric pouch, it may not be absorbed, even if supplemented orally, and deficiencies can result in pernicious anemia and neuropathies. Vitamin B12 deficiency is quite common after gastric bypass surgery with reported rates of 30% in some clinical trials. Sublingual B12 (cyanocobalamin) appears to be adequately absorbed. In cases where sublingual B12 does not provide sufficient amounts, injections may be needed.
• Protein malnutrition is a real risk. Some patients suffer troublesome vomiting after surgery, until their GI tract adjusts to the changes, and cannot eat adequate amounts even with 6 meals a day. Many patients require protein supplementation during the early phases of rapid weight loss to prevent excessive loss of muscle mass. Hair loss is also a risk of protein malnutrition
• Folate deficiency is also a common occurrence in gastric bypass surgery patients.

3.  Based on her ideal body weight of 125 pounds, calculate Ginny’s current daily protein needs

The current weight of Ginny is 287 pound that is 130.18 kg.

Proteins are essential food substances, contained in foods such as vegetables, fruits, legumes, nuts, meat, fish, poultry, dairy products and eggs. With reduced ability to eat a large volume of food, gastric bypass patients must focus on eating their protein requirements first, and with each meal. In some cases, surgeons may recommend use of a liquid protein supplement. Powdered protein supplements added to smoothies or any food can be an important part of the post-op diet.

The amount of protein that the human body requires daily is dependent on many conditions including overall energy intake, growth of the individual, and physical activity level. It is often estimated based on body weight, as a percentage of total caloric intake (10-35%), or based on age alone. 0.8g/kg of body weight is a commonly cited recommended dietary allowance (RDA). This value is the minimum recommended value to maintain basic nutritional requirements, but consuming more protein, up to a certain point, may be beneficial, depending on the sources of the protein.

so for Ginny the daily protein requirement is 104 grams per day