Question

Case Scenario: A young woman presents at the clinic six weeks after a gastric bypass surgery. She had more than 100 lbs. to lose and so far, has lost 40 lbs. She expected to gain some strength and begin exercising, but she is very weak. She states that at times she is too weak to even comb her hair. She eats small meals several times a day, but has watery diarrhea and is nauseated much of the time. She is losing her hair and is very discouraged.

2. Question: How are fats absorbed from the small intestine? How might this surgery affect this process? You will need to defend your answer using specific facts, data, and other information drawn from the textbook and at least one other supplemental source.

Answer 1

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ANSWER

Fat digestion starts in the mouth with the help of salivary lipase. The ingested fat will not break down until it reaches the small intestine. Once the fat reaches the stomach, chemical digestion with the help of gastric lipase and peristalsis will occur. Bile and pancreatic lipase from pancreas will breakdown the triglycerides in the small intestine along with mechanical digestion (peristalsis) until the fat becomes an individual fatty acid able to be absorbed by the small intestine epithelial cells. Pancreatic lipase hydrolysed the triglycerides in to free fatty acids and glycerol units. Once the triglycerides broke down into fatty acids, glycerol, it will aggregate into a structure called micelles along with cholesterol. Fatty acids and monoglycerides leave the micelles and diffuse across the membrane to enter the epithelial cells of the small intestine. In the cytosol of epithelial cells, the fatty acids and monoglycerides recombined to form triglycerides and these are packed to form a bigger particle called chylomicrons. Chylomicron will transport the digested fat. Chylomicrons transport through the bloodstream to enter the bloodstream and other tissues of the body.

The Small intestine has the absorptive capacity of 250m² and duodenum and jejunum are the major site of absorption and absorption is largely completed when the food reaches the mid jejunum. In gastric bypass surgery, the anatomy of the gastrointestinal tract is altered. and inducing malabsorption by surgically bypassing the region of the small intestine and diverting pancreatic biliary secretion, which limits the fat absorption. So the fat reaches in the intestine will not digested due to lack of enzymes and there by poor absorption of fat.