CSOWM METABOLIC AND BARIATRIC SURGERY QUESTIONS WITH CORRECT ANSWERS

CSOWM METABOLIC AND BARIATRIC v v v




SURGERYQUESTIONSWITHCORRECT
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ANSWERS 2025 v v




Bariatric & Metabolic Surgery Procedures - CORRECT ANSWER -
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Group of surgical procedures that impact the physiological regulation of body weight and improve mor
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bidity and mortality rates
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Purely restrictive weight loss surgery - CORRECT ANSWER -Laparoscopic adjustable gastric band (LAGB)
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Weight loss surgeries that are combination (Malabsorptive & restrictive) -
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Gastric manipulation, causing some restriction & neural/hormonal) - CORRECT ANSWER - Sleeve
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gastrectomy (SG) & Roux-en-Y Gastric bypass (RYGBP)
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Bypass surgery that is combination of malabsorptive/restriction and of both macronutrients & micronu trients -
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CORRECT ANSWER -Biliopancreatic Diversion (BPD/DS)
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Cholecystokinin (CCK) - CORRECT ANSWER - v v v v v




Hormone secreted by the duodenum; suppresses appetite and levels decrease during dieting and weig ht
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loss
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Glucose-dependent insulinotropic polypeptide (GIP) - CORRECT ANSWER - v v v v v v v




Hormone secreted by the duodenum and jejunum; normal function for energy storage; Levels increase during
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dieting and weight loss
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Ghrelin - CORRECT ANSWER - v v v v




Hormone from the gastric fundus; Functions to stimulate appetite for high fat, high sugar foods; Levels increase
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during diet and weight loss
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Glucagon-like peptide 1 (GLP-1) - CORRECT ANSWER - v v v v v v v




Hormone secreted in the ileum of the small I; Functions to suppress appetite and increase satiety; Lev els
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have a decreased functionality with diet and weight loss
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,Peptide YY (PYY) - CORRECT ANSWER - v v v v v v




Hormone secreted in the distal small I; Suppresses appetite; There is a decrease in this hormone found in
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obese persons with weight loss
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Insulin - CORRECT ANSWER - v v v v




Hormone secreted from the beta cells of the pancreas; Functions to regulate energy balance and signa l
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satiety in the brain; There is resistance to this hormone in obese persons; Levels decrease after dietin g
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Leptin - CORRECT ANSWER - v v v v




Hormone secreted from the adipocytes; Regulates energy balance & suppresses appetite; Levels decre ase
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during weight loss
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Metabolic and bariatric surgery changes to gut hormones? - CORRECT ANSWER - The
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opposite of restrictive dieting
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RYGB + SG changes in gut hormones - CORRECT ANSWER -
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They don't see a decrease in RMR; decrease in appetite and hunger; increase in satiety; decrease in gh relin,
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increase in GLP-1, PYY, CCK, and amylin
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Amylin - CORRECT ANSWER -co- v v v v




secreted with insulin by beta cells in response to nutrient stimuli. Delays nutrient uptake and suppress es
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glucagon secretion after meals. Satiating effect.
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LAGB + Hunger hormones - CORRECT ANSWER -Studies show an increase in ghrelin 6-
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12 months s/p procedure; may be why decrease in wt loss with this Adjustments and food choices ess ential
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for wt loss and maintenance
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LAGB - Too tight fitting - CORRECT ANSWER -Dysphagia, reflux/cough, regurgitation, maladaptive eating
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LAGB- Goal of fill (Saline fill) - CORRECT ANSWER -Satiety, small meals satisfying
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LAGB- Needing a fill (saline fill) - CORRECT ANSWER -Hungry, big meals, looking for food
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, LAGB downside - CORRECT ANSWER -
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Soft meals still go in easy, which can still allow for increase in calorie intakes to weight gain (Ex: increas e in
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refined, icecream, etc)
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LAGB history - CORRECT ANSWER -First approved in 2001 in US; Lost <25-
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30% of excess weight in up to 40% of patients; Many complications found: Band erosion, infection, int
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olerance to band symptoms, slippage of band, difficulty swallowing, GERD, Pouch dilation, port infectio n
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(Most now having removed than put in)
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These two procedures impact the physiological regulation of body weight with being restrictive mainly in
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the 1st 3 post-op months - CORRECT ANSWER -RYGB + SG
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The largest endocrine organ in the body - CORRECT ANSWER -The GI tract
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Sleeve Gastrectomy procedure - CORRECT ANSWER -
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Laparoscopically (~6 small inserts) ; ~80% of the gastric fundus removed; Food will empty into the duo denum v v v v v v v v v v v v v v v v v




normally through gastric sphincter; ghrelin still produced in GI
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The primary place where ghrelin is produced - CORRECT ANSWER -Gastric fundus
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Advantages of SG - CORRECT ANSWER - v v v v v v




Performed more quickly, decrease in complications and micronutrient deficiencies; decreased risk of lo
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ngterm complications (Intestinal obstructions, ulcers, dumping syndromes, severe hypoglycemia, other
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dysfunctional glycemic syndromes); Allows access to both biliary and pancreatic ducts; Can be revised or
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converted to a variety of other procedures (Bypass or BPD)
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Disadvantages of SG - CORRECT ANSWER - v v v v v v




May exacerbate GERD; contraindicated in pts with severe GERD, lower esophageal-
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sphincter incompetence; Barrett's esophagus; There is a lack in longterm data (>10 years) of the durabi lity
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of this weight loss or changes in comorbidities (Studies currently being published)
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Roux-en-Y gastric bypass procedure - CORRECT ANSWER - v v v v v v v




Done Laparoscopically (6 insertion sites); Nothing taken out during procedure, duodenum re-
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connected to the lower intestine; Bile + pancreatic enzymes reconnect with food at lower end of small
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I. The proximal jejunum is where the food then first empties to from the newly created stomach.
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