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Category: RNY

Neuromuscular Disease After Weight Loss Surgery

June 08, 2015 11:30 am

Weight loss surgical procedures may result in varying degrees of nutritional deficiencies. Some of these nutritional deficiencies may cause neuromuscular disease if left untreated, these include vitamins, minerals, and protein. The long-term effect of these deficiencies may presents as neuromuscular conditions including, weakness, numbness, confusion and all others if not-diagnosed and untreated. It is important to note that all weight loss surgical procedures require lifetime vitamin, mineral supplements and protein monitoring and possible supplements.

The table below outlines some of the specific neurological and neuromuscular disease complications following bariatric surgery. The most common deficiencies seen with the duodenal switch operation are fat soluble vitamin deficiencies. These include, Vitamin A, D, E and K. Duodenal Switch patients need oral supplements of Dry “Water Miscible” type of Vitamin A, D, E, and K based on their laboratory studies and needs.

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The neurological deficiencies are manifested much more frequently with the Gastric Bypass than the duodenal switch operation. The most common nutritional deficients are that of B1, B12, Folate deficiencies that are common in Gastric Bypass. A list of possible neurologic deficiencies and there associated symptoms were summarized by Becker (2012). Another article with Nutritional Neuropathies.

Nutritional deficiencies are seen in a number of illnesses including weight loss surgery patients.

Dental Issues after Weight Loss Surgery

October 13, 2014 10:53 pm

Please click the link to view the webinar on Dental Issues after Weight Loss Surgery.  A special thank you to Armen Mardirossian, DDS, MS Diplomate for his contributions to this article.

Update for Feb. 2017 Dental Resources here.

Dental Issues after Weight Loss Surgery Webinar here.

alveolar-bone
Anatomy of a Tooth
Dental Issues after Weight Loss Surgery
Factors that contribute to Dental Issues

This is a review of data regarding weight loss surgery and dental health.  I am not a Dentist so please follow up with your Dental Health Care Providers if you are having any issues.  Always keep your health care providers informed of your overall health status.

Bowel Obstruction After DS

August 20, 2014 12:47 am

One of the potential complications of any abdominal surgery is Bowel Obstruction.  If the treating physician (usually the primary care, or the emergency room doctor) is not absolutely clear of the anatomy of a patent post duodenal Switch or the Gastric bypass  surgeries this will pose a diagnostic dilemma. In intact anatomy the GI tract start at the mouth and ends up at the rectum as a long tube. After the Duodenal Switch the small bowel has two parallel limbs, the alimentary limb brings the food down from the stomach, and the biliopancreatic limb brings down the biliopancreatic secretions. These two limbs join and form the common channel.

In normal anatomy, bowel obstruction may present with nausea, vomiting, abdominal cramps, inability to pass gas, and/or have bowel movements. In this case, the X-ray will also show dilated loops of bowel and if oral contrast is given with the X-ray, there will be no contrast past the obstruction. Think of it as a garden hose that has been kinked and no water is going thru.

Bowel Obstruction After DS
Bowel Obstruction After DS

In this upper GI- the contrast travels down the small bowel and the entire small bowel is the same caliber. This is normal study with no evidence of obstruction. In a patient with the DS, the patient my have the biliopancreaitc limb obstruction, with an identical X-ray as above, since the oral contrast given will never get to the biliopancreatic limb and it will not show if it is dilated or not. 

In duodenal switch operation, a patient may have complete obstruction of the alimentary limb, with nausea, vomiting and abdominal pain, and yet have bowel movements because the content of the biliopancreatic limb is getting to the common channel. Similarly, a patient with biliopancreatic limb may have nausea, but no vomiting, because the obstructed biliopancreatic limb is not connected to the stomach and the content can’t not be expelled from the stomach.

Bowel Obstruction After DS
Bowel Obstruction After DS

It is critical to make sure that a patient with a suspected bowel obstruction after the DS, is evaluated with the understanding that the common signs and symptoms, and the diagnostic workup will not provide an accurate picture. A patient with the DS or RNY, can have bowel obstruction and still have bowel movement, and no vomiting.

Bowel Obstruction After DS
Bowel Obstruction After DS

A patient with suspected bowel obstruction should have CT scan of the Abdomen with oral and IV contrast. The cardinal findings will be “dilated loops of bowel with no contrast within the lumen of the bowel”. This is highly suspicious for bowel obstruction after DS, where the regular x ray will not pick this up. Additionally, abnormal liver function test may suggest biliopancreatic limb obstruction.

Bowel Obstruction After Duodenal Switch

August 19, 2014 4:47 pm

One of the potential complications of any abdominal surgery is Bowel Obstruction.  If the treating physician (usually the primary care, or the emergency room doctor) is not absolutely clear of the anatomy of a patent post duodenal Switch or the Gastric bypass  surgeries this will pose a diagnostic dilemma. In intact anatomy the GI tract start at the mouth and ends up at the rectum as a long tube. After the Duodenal Switch the small bowel has two parallel limbs, the alimentary limb brings the food down from the stomach, and the biliopancreatic limb brings down the biliopancreatic secretions. These two limbs join and form the common channel.

In normal anatomy, bowel obstruction may present with nausea, vomiting, abdominal cramps, inability to pass gas, and/or have bowel movements. In this case, the X-ray will also show dilated loops of bowel and if oral contrast is given with the X-ray, there will be no contrast past the obstruction. Think of it as a garden hose that has been kinked and no water is going thru.

Bowel Obstruction After DS
Bowel Obstruction After DS

In this upper GI- the contrast travels down the small bowel and the entire small bowel is the same caliber. This is normal study with no evidence of obstruction. In a patient with the DS, the patient my have the biliopancreaitc limb obstruction, with an identical X-ray as above, since the oral contrast given will never get to the biliopancreatic limb and it will not show if it is dilated or not.

In duodenal switch operation, a patient may have complete obstruction of the alimentary limb, with nausea, vomiting and abdominal pain, and yet have bowel movements because the content of the biliopancreatic limb is getting to the common channel. Similarly, a patient with biliopancreatic limb may have nausea, but no vomiting, because the obstructed biliopancreatic limb is not connected to the stomach and the content can’t not be expelled from the stomach.

Bowel Obstruction After DS
Bowel Obstruction After DS

The images of fluid filled loops of bowel are highly suspicious.

Bowel Obstruction After DS
Bowel Obstruction After DS

It is critical to make sure that a patient with a suspected bowel obstruction after the DS, is evaluated with the understanding that the common signs and symptoms, and the diagnostic workup will not provide an accurate picture. A patient with the DS or RNY, can have bowel obstruction and still have bowel movement, and no vomiting.

A patient with suspected bowel obstruction should have CT scan of the Abdomen with oral and IV contrast. The cardinal findings will be “dilated loops of bowel with no contrast within the lumen of the bowel”. This is highly suspicious for bowel obstruction after DS, where the regular x ray will not pick this up. Additionally, abnormal liver function test may suggest biliopancreatic limb obstruction.