1/12. Managing the obese patient after bariatric surgery: a case report of severe malnutrition and review of the literature.Surgery is now considered to be the most effective treatment for reducing weight and maintaining weight loss in patients with clinically severe obesity. Although the jejuno-ileal bypass has been abandoned, the vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGB) operations are now commonly performed. A third operation, the bilio-pancreatic diversion (BPD), is performed less frequently. The RYGB and BPD procedures cause predictable selective micronutrient deficiencies that can be avoided by early supplementation. Surgical complications from all of these procedures may result in more severe forms of malnutrition. This article is intended to familiarize the nutrition support specialist with the anatomic and physiologic changes produced by these procedures, the resulting nutritional deficiencies and recommended supplementation, and the manifestations of severe malnutrition caused by complications. A case of severe malnutrition after RYGB surgery is reported for illustration.- - - - - - - - - - ranking = 1keywords = obesity (Clic here for more details about this article) |
2/12. malnutrition-induced myopathy following Roux-en-Y gastric bypass.A 42-year-old man developed a myopathy in the setting of malnutrition following Roux-en-Y gastric bypass for the treatment of morbid obesity. No specific vitamin or electrolyte deficiency was identified. Muscle biopsy revealed type II fiber atrophy. He recovered after the initiation of continuous enteral feeding. We suggest that malnutrition was the underlying cause of his myopathy.- - - - - - - - - - ranking = 1keywords = obesity (Clic here for more details about this article) |
3/12. Clinical nutrition in primary health care.Nutritional diagnosis and management are important aspects of general practice. This information, which is presented in two parts, offers the general practitioner a practical framework and an approach to nutritional advice. Part 1 outlines the clinical conditions and principles involved in nutritional diagnosis with a management approach to macrovascular disease and obesity. Part 2 covers protein malnutrition, eating disorders, osteoporosis, nutrient toxicity, cancer, inherited metabolic disorders, nutrient deficiency and diabetes mellitus. This material is based on a seminar organised by Kellogg (australia) Pty Ltd in Melbourne in 1989 and the material is reproduced with the kind permission of Kellogg (australia) Pty Ltd.- - - - - - - - - - ranking = 1keywords = obesity (Clic here for more details about this article) |
4/12. Home total parenteral nutrition in a pregnant diabetic after jejunoileal bypass for obesity.pregnancy after jejunoileal bypass (JIBP) for obesity is generally well tolerated without serious complications. A 24-yr-old diabetic patient who had previously had a JIBP procedure presented during pregnancy with severe malnutrition. She was treated successfully with home total parenteral nutrition. Previously published experience with pregnancy after JIBP and the use of parenteral nutrition during pregnancy is reviewed.- - - - - - - - - - ranking = 5keywords = obesity (Clic here for more details about this article) |
5/12. Morbid obesity, gastric plication and a severe neurological deficit.A 39-year-old man had protracted vomiting after gastric plication for morbid obesity. Within three months he lost 53 kg in weight and developed neuromuscular weakness, especially in the lower extremities. Clinical and laboratory studies suggested both radicular and peripheral neuropathy. One year later the condition was only marginally improved: he took only few steps unsupported. The apparent etiology is malnutrition but the primary cause remained unknown.- - - - - - - - - - ranking = 5keywords = obesity (Clic here for more details about this article) |
6/12. Neurologic complications of gastric partitioning.Six patients who had gastric reduction for morbid obesity suffered severe complex neurologic disturbances that included confusion and inappropriate behavior. All were profoundly weak or paraplegic, and recovery was delayed and incomplete. Encephalopathy was documented by EEG and neurologic examination. The cause is uncertain. Acute catabolism of lipid may predispose to damage of the nervous system, but relative vitamin deficiency is a more obvious and treatable explanation.- - - - - - - - - - ranking = 1keywords = obesity (Clic here for more details about this article) |
7/12. Feeding children with Down's syndrome.A retrospective chart review of forty-nine children with Down's syndrome between the ages of six months and six and a half years seen before 1970 showed that 80 per cent had problems related to food or feeding. An interdisciplinary intervention program utilizing group sessions introduced in 1970 is described. In twenty-one children, most of the nutritional, behavioral, and environmental problems surrounding food previously encountered in children with Down's syndrome were successfully prevented or remedied. The incidence of obesity in Down's syndrome was reduced but not eliminated. Except for parental susceptibility to food faddism, most professional concerns regarding food and eating were non-existent in sixteen of the children reevaluated in a follow-up six years after the intervention program.- - - - - - - - - - ranking = 1keywords = obesity (Clic here for more details about this article) |
8/12. Cutaneous anergy and marrow suppression as complications of gastroplasty for morbid obesity.Although serious morbidity from gastric restriction for morbid obesity is rare, outflow tract dilation after gastroplasty has become a well-recognized complication, and reoperation to decrease outflow tract size has become increasingly common. We report the case of a patient who developed outflow tract obstruction with subsequent malnutrition, recurrent infections, and marrow suppression. Extensive immunologic evaluation revealed impaired cutaneous reactivity to a battery of recall antigens. Other in vitro T cell functions, B cell functions, neutrophil respiration, and quantification of complements were within normal limits. The patient's immunodeficiency was attributed to protein-calorie malnutrition and was corrected with total parenteral nutrition. Recovery of immune function with renutriture was demonstrated, and coincident resolution of infection and marrow suppression also occurred. Because of the reversibility of the immunologic abnormality with appropriate nutritional therapy, it is important to consider and treat malnourishment in connection with any operation in which oral intake is severely limited.- - - - - - - - - - ranking = 5keywords = obesity (Clic here for more details about this article) |
9/12. Encephalopathy following jejunoileostomy.A neurological syndrome characterized by episodes of confusion, slurred speech, and unsteadiness is described in patients who have undergone jejunoileostomy for obesity. This syndrome has been noted in seven of 110 patients studied, although it may be more common. It appears to subside spontaneously or may respond to oral food restriction, with or without intravenous fluid plus vitamins and minerals. Episodes tend to recur in a given patient. Reversible changes in the EEG have been observed. Pertinent clinical and laboratory findings are described but no definite etiologic factor has been identified. The possible mechanisms involved in this syndrome of metabolic encephalopathy following jejunoileostomy are discussed.- - - - - - - - - - ranking = 1keywords = obesity (Clic here for more details about this article) |
10/12. Surgical syndromes of the hypothalamus.The clinical syndromes described with lesions of the hypothalamus are summarized in Table 9.5-9.7. The anterior hypothalamic syndrome consists of insomnia and loss of thirst regulatory mechanisms. In occasional larger lesions which interrupt the output from the supraoptic and paraventricular nuclei, diabetes insipidus has been noticed. In the tuberal region of the hypothalamus the most prominent findings are those that are caused by the disruption of the final common pathway to the pituitary. This results in endocrinopathy, most often the syndrome originally reported by Frohlich, with failure of sexual maturation and obesity. In the tuberal region, differences between lesions of the medial and lateral portions are quite marked. Medial lesions result in obesity while bilateral lesions result in anorexia and emaciation. The diencephalic syndrome of infancy with it's severe emaciation in young years and obesity in later years clearly indicates a different organizational pattern in the neonatal hypothalamus. Emotional disorders may be seen with lesions either in the medial or lateral hypothalamus at the tuberal level. Finally, in the posterior hypothalamic region, which includes the greatest effector apparatus, hypersomnia, apathy, and poikilothermia have been reported. Emotional disturbances and the Wernicke-korsakoff syndrome also seemed to be associated with lesions in this area. The hypothalamus remains the single most important integrator of vegetative and endocrinologic regulation of the body. Cushing said of the hypothalamus, "here in this hidden spot, almost to be covered with a thumb nail, lies the very main spring of primitive existence: vegetative, emotional and reproductive".- - - - - - - - - - ranking = 3keywords = obesity (Clic here for more details about this article) |
| | Next -> |