CSOWM METABOLIC AND BARIATRIC
SURGERY QUESTIONS WITH CORRECT
ANSWERS 2026
Bariatric & Metabolic Surgery Procedures - CORRECT ANSWER - - Group of surgical procedures that
impact the physiological regulation of body weight and improve mor bidity and mortality rates
Purely restrictive weight loss surgery - CORRECT ANSWER - -Laparoscopic adjustable gastric band (LAGB)
Weight loss surgeries that are combination (Malabsorptive & restrictive) -
Gastric manipulation, causing some restriction & neural/hormonal) - CORRECT ANSWER - -
Sleeve gastrectomy (SG) & Roux-en-Y Gastric bypass (RYGBP)
Bypass surgery that is combination of malabsorptive/restriction and of both macronutrients & micronu
trients - CORRECT ANSWER - -Biliopancreatic Diversion (BPD/DS)
Cholecystokinin (CCK) - CORRECT ANSWER - -Hormone secreted by the duodenum; suppresses
appetite and levels decrease during dieting and weig ht loss
Glucose-dependent insulinotropic polypeptide (GIP) - CORRECT ANSWER - -Hormone secreted by the
duodenum and jejunum; normal function for energy storage; Levels increase during dieting and weight loss
Ghrelin - CORRECT ANSWER - -Hormone from the gastric fundus; Functions to stimulate appetite for
high fat, high sugar foods; Levels increase during diet and weight loss
Glucagon-like peptide 1 (GLP-1) - CORRECT ANSWER - -Hormone secreted in the ileum of the small
I; Functions to suppress appetite and increase satiety; Lev els have a decreased functionality with diet
and weight loss
,Peptide YY (PYY) - CORRECT ANSWER - -Hormone secreted in the distal small I; Suppresses appetite;
There is a decrease in this hormone found in obese persons with weight loss
Insulin - CORRECT ANSWER - -Hormone secreted from the beta cells of the pancreas; Functions to
regulate energy balance and signa l satiety in the brain; There is resistance to this hormone in obese
persons; Levels decrease after dietin g
Leptin - CORRECT ANSWER - -Hormone secreted from the adipocytes; Regulates energy balance &
suppresses appetite; Levels decre ase during weight loss
Metabolic and bariatric surgery changes to gut hormones? - CORRECT ANSWER -
- The opposite of restrictive dieting
RYGB + SG changes in gut hormones - CORRECT ANSWER - - They don't see a decrease in RMR;
decrease in appetite and hunger; increase in satiety; decrease in gh relin, increase in GLP-1, PYY, CCK,
and amylin
Amylin - CORRECT ANSWER - -co-
secreted with insulin by beta cells in response to nutrient stimuli. Delays nutrient uptake and suppress
es glucagon secretion after meals. Satiating effect.
LAGB + Hunger hormones - CORRECT ANSWER - -Studies show an increase in ghrelin 6-
12 months s/p procedure; may be why decrease in wt loss with this Adjustments and food choices ess
ential for wt loss and maintenance
LAGB - Too tight fitting - CORRECT ANSWER - -Dysphagia, reflux/cough, regurgitation, maladaptive eating
LAGB- Goal of fill (Saline fill) - CORRECT ANSWER - -Satiety, small meals satisfying
LAGB- Needing a fill (saline fill) - CORRECT ANSWER - -Hungry, big meals, looking for food
, LAGB downside - CORRECT ANSWER - - Soft meals still go in easy, which can still allow for increase
in calorie intakes to weight gain (Ex: increas e in refined, icecream, etc)
LAGB history - CORRECT ANSWER - -First approved in 2001 in US; Lost <25-
30% of excess weight in up to 40% of patients; Many complications found: Band erosion, infection, int
olerance to band symptoms, slippage of band, difficulty swallowing, GERD, Pouch dilation, port infectio
n (Most now having removed than put in)
These two procedures impact the physiological regulation of body weight with being restrictive mainly
in the 1st 3 post-op months - CORRECT ANSWER - -RYGB + SG
The largest endocrine organ in the body - CORRECT ANSWER - -The GI tract
Sleeve Gastrectomy procedure - CORRECT ANSWER - -Laparoscopically (~6 small inserts) ; ~80% of the
gastric fundus removed; Food will empty into the duo denum normally through gastric sphincter; ghrelin still
produced in GI
The primary place where ghrelin is produced - CORRECT ANSWER - -Gastric fundus
Advantages of SG - CORRECT ANSWER - -Performed more quickly, decrease in complications and
micronutrient deficiencies; decreased risk of lo ngterm complications (Intestinal obstructions, ulcers,
dumping syndromes, severe hypoglycemia, other dysfunctional glycemic syndromes); Allows access to
both biliary and pancreatic ducts; Can be revised or converted to a variety of other procedures (Bypass
or BPD)
Disadvantages of SG - CORRECT ANSWER - -May exacerbate GERD; contraindicated in pts with severe
GERD, lower esophageal-
sphincter incompetence; Barrett's esophagus; There is a lack in longterm data (>10 years) of the durabi
lity of this weight loss or changes in comorbidities (Studies currently being published)
Roux-en-Y gastric bypass procedure - CORRECT ANSWER - -Done Laparoscopically (6 insertion sites);
Nothing taken out during procedure, duodenum re-
connected to the lower intestine; Bile + pancreatic enzymes reconnect with food at lower end of small
I. The proximal jejunum is where the food then first empties to from the newly created stomach.
SURGERY QUESTIONS WITH CORRECT
ANSWERS 2026
Bariatric & Metabolic Surgery Procedures - CORRECT ANSWER - - Group of surgical procedures that
impact the physiological regulation of body weight and improve mor bidity and mortality rates
Purely restrictive weight loss surgery - CORRECT ANSWER - -Laparoscopic adjustable gastric band (LAGB)
Weight loss surgeries that are combination (Malabsorptive & restrictive) -
Gastric manipulation, causing some restriction & neural/hormonal) - CORRECT ANSWER - -
Sleeve gastrectomy (SG) & Roux-en-Y Gastric bypass (RYGBP)
Bypass surgery that is combination of malabsorptive/restriction and of both macronutrients & micronu
trients - CORRECT ANSWER - -Biliopancreatic Diversion (BPD/DS)
Cholecystokinin (CCK) - CORRECT ANSWER - -Hormone secreted by the duodenum; suppresses
appetite and levels decrease during dieting and weig ht loss
Glucose-dependent insulinotropic polypeptide (GIP) - CORRECT ANSWER - -Hormone secreted by the
duodenum and jejunum; normal function for energy storage; Levels increase during dieting and weight loss
Ghrelin - CORRECT ANSWER - -Hormone from the gastric fundus; Functions to stimulate appetite for
high fat, high sugar foods; Levels increase during diet and weight loss
Glucagon-like peptide 1 (GLP-1) - CORRECT ANSWER - -Hormone secreted in the ileum of the small
I; Functions to suppress appetite and increase satiety; Lev els have a decreased functionality with diet
and weight loss
,Peptide YY (PYY) - CORRECT ANSWER - -Hormone secreted in the distal small I; Suppresses appetite;
There is a decrease in this hormone found in obese persons with weight loss
Insulin - CORRECT ANSWER - -Hormone secreted from the beta cells of the pancreas; Functions to
regulate energy balance and signa l satiety in the brain; There is resistance to this hormone in obese
persons; Levels decrease after dietin g
Leptin - CORRECT ANSWER - -Hormone secreted from the adipocytes; Regulates energy balance &
suppresses appetite; Levels decre ase during weight loss
Metabolic and bariatric surgery changes to gut hormones? - CORRECT ANSWER -
- The opposite of restrictive dieting
RYGB + SG changes in gut hormones - CORRECT ANSWER - - They don't see a decrease in RMR;
decrease in appetite and hunger; increase in satiety; decrease in gh relin, increase in GLP-1, PYY, CCK,
and amylin
Amylin - CORRECT ANSWER - -co-
secreted with insulin by beta cells in response to nutrient stimuli. Delays nutrient uptake and suppress
es glucagon secretion after meals. Satiating effect.
LAGB + Hunger hormones - CORRECT ANSWER - -Studies show an increase in ghrelin 6-
12 months s/p procedure; may be why decrease in wt loss with this Adjustments and food choices ess
ential for wt loss and maintenance
LAGB - Too tight fitting - CORRECT ANSWER - -Dysphagia, reflux/cough, regurgitation, maladaptive eating
LAGB- Goal of fill (Saline fill) - CORRECT ANSWER - -Satiety, small meals satisfying
LAGB- Needing a fill (saline fill) - CORRECT ANSWER - -Hungry, big meals, looking for food
, LAGB downside - CORRECT ANSWER - - Soft meals still go in easy, which can still allow for increase
in calorie intakes to weight gain (Ex: increas e in refined, icecream, etc)
LAGB history - CORRECT ANSWER - -First approved in 2001 in US; Lost <25-
30% of excess weight in up to 40% of patients; Many complications found: Band erosion, infection, int
olerance to band symptoms, slippage of band, difficulty swallowing, GERD, Pouch dilation, port infectio
n (Most now having removed than put in)
These two procedures impact the physiological regulation of body weight with being restrictive mainly
in the 1st 3 post-op months - CORRECT ANSWER - -RYGB + SG
The largest endocrine organ in the body - CORRECT ANSWER - -The GI tract
Sleeve Gastrectomy procedure - CORRECT ANSWER - -Laparoscopically (~6 small inserts) ; ~80% of the
gastric fundus removed; Food will empty into the duo denum normally through gastric sphincter; ghrelin still
produced in GI
The primary place where ghrelin is produced - CORRECT ANSWER - -Gastric fundus
Advantages of SG - CORRECT ANSWER - -Performed more quickly, decrease in complications and
micronutrient deficiencies; decreased risk of lo ngterm complications (Intestinal obstructions, ulcers,
dumping syndromes, severe hypoglycemia, other dysfunctional glycemic syndromes); Allows access to
both biliary and pancreatic ducts; Can be revised or converted to a variety of other procedures (Bypass
or BPD)
Disadvantages of SG - CORRECT ANSWER - -May exacerbate GERD; contraindicated in pts with severe
GERD, lower esophageal-
sphincter incompetence; Barrett's esophagus; There is a lack in longterm data (>10 years) of the durabi
lity of this weight loss or changes in comorbidities (Studies currently being published)
Roux-en-Y gastric bypass procedure - CORRECT ANSWER - -Done Laparoscopically (6 insertion sites);
Nothing taken out during procedure, duodenum re-
connected to the lower intestine; Bile + pancreatic enzymes reconnect with food at lower end of small
I. The proximal jejunum is where the food then first empties to from the newly created stomach.
