Chapter 23: The Digestive System Case Story Summary Chloe, a 28-year-old mother of two with a history of morbid
obesity, high blood pressure, diabetes, sleep apnea, and acid reflux disease has decided to opt for an elective surgical procedure called gastric bypass. Gastric bypass surgery is also called bariatric surgery. Her stomach is surgically reduced in size from 1 quart to 1 tablespoon in volume. The purpose of this is to reduce food intake, and decrease the absorption of calories. Chloe’s goal is to lose a substantial amount of weight. In addition to reducing stomach size, the procedure should increase her feeling of fullness with smaller amounts of food. Chloe’s doctor warns her, such a drastic procedure should not be undertaken lightly, as it has a significant impact on the digestive process. Chloe must closely monitor her nutrition for the rest of her life in order to avoid a host of potential complications. Diagnostic Information Bariatric surgery is form of elective surgery usually considered for individuals with severe morbid obesity (those with body mass indices greater than 40 kg/m 2. The reasons for surgery are as varied as the patients who elect the procedure, but typically the health concerns associated with obesity are often a primary consideration including hypertension, hyperlipidemia, diabetes and heart disease. Unsuccessful weight reduction using non-operative methods such as diet, exercise, and medications is another indication for bariatric surgery. Bariatric surgery can be considered medically necessary because it has been proven to be effective for long term weight control in the morbidly obese. The procedure is not considered a cosmetic procedure because only the digestive tract is altered, no fat is removed. The risks of surgical treatment include post-operative wound infections, post-operative bleeding, improper wound healing, and deep vein thrombosis. Treatment Information There are several options available for the obese patient. Chloe’s surgery as described in the textbook is a stomach reduction surgery. In this type of surgery the stomach volume is surgically reduced using staples, or some sort of restrictive ring or band. This is a serious weight loss procedure, quite drastic in nature. Often less risky procedures such as the Roux-en-Y gastric bypass are performed on patients. In the latter procedure, the stomach is bypassed using a portion of the intestine rather than surgically altering the stomach. Although the risks have been shown to be statistically small for bariatric procedures, the surgeries that do not go well have serious consequences. Obese patients are already at risk for cardiac, pulmonary and vascular sequelae, therefore careful patient screening including the health of the patient and the patients psychologic state are usually assessed prior to surgery. Potential Alternate Hypotheses Alternative procedures to explore might include liposuction, adjustable gastric banding, vertical banded gastroplasty, jaw wiring, lap band wiring, stomach balloon surgery. Chapter 23: The Digestive System Answers to Case Questions 1. Which processes of digestion would be altered if Chloe’s had her mouth wired shut? 2. Which serous membrane in Chloe’s abdomen most likely contains the greatest amount of adipose tissue? 3. Would Chloe have deciduous teeth? . 4. What involuntary muscular process initiated by deglutition of water may cause Chloe pain? 5. The lower part of Chloe’s stomach has been bypassed; what sphincter is no longer part of her digestive tract? 6. Why might reduction of Chloe’s stomach reduce her acid reflux? 7. What vitamin may not be efficiently absorbed due to Chloe’s procedure? 8. How will protein digestion be affected by Chloe’s surgery? 9. Which pancreatic enzymes would Chloe not need if she was ingesting amino acids and not proteins? 10. What pancreatic enzymes would Chloe need to break down the fats in her nutrition drink? 11. Why would the pancreatic duct need to be rerouted during Chloe’s surgery? 12. Why might Chloe be at risk for gallstones (crystallized cholesterol which can block the flow of bile from the gallbladder)? 13. Would absorption of nutrients be substantially altered in the small intestine following Chloe’s gastric bypass surgery? 14. How would Chloe’s reduced stomach size and bypassed duodenum affect her overall digestion in terms of neural feedback? 15. Why is vitamin B12 deficiency a serious concern? 16. With which complications should Chloe be concerned following the surgery? 17. Why is monitoring nutrition so important to Chloe now? 18. Chloe went on a liquid diet immediately following her surgery, based on what you have learned about nutrition in this chapter, which substances would you include in a liquid diet?
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