Most important notes in Bariatric surgery 📝
🔴Indications for surgery
▪️BMI >40
▪️BMI >35 + co-morbidities ( 2 O ( osteoarthritis-OSA) / 3D (DM 2 -Disk prolapse -Dyslipidemia )/ HTN)
🔴 Ursodiol➡️ minimize gallstone development
🔴Sleeve gastrectomy ➡️ no metabolic malabsorption
🔴Interval between gastric bypass & plastic surgery procedure ➡️ 12-18 M
🔴DVT is a common risk after barriatric surgery
🔴M.C vitamin deficiency ➡️ Vit B12 ➡️ present by subacute cord degeneration
🔴In GERD ➡️ it is preferred to do Bypass procedure as Sleeve ⬆️ GERD Incidence

Notes on obesity in Endocrine 📝
🔴M.C cause of obesity ➡️simple obesity
🔴 genetic abnormalities in obesity ➡️ laurence Moon / Bradet-Beidl / prader-willi/ Frolich’s
🔴 drugs that lead to obesity ➡️ 3C ( Contraceptive pills - Carbamazepine - Corticosteroids) / ( insulin - TZD) / 2S ( Sulphonyl urea -Sertonin antagonist)
🔴Lateral Nuclei ➡️ Feeding centre
🔴Ventromedial Nuclei ➡️ Satiety centre
🔴Skin fold thickness ➡️ Normal values
F ➡️ 30 mm
M ➡️ 20 mm
🔴Waist circumference ➡️ Normal values
F➡️<80 cm
M➡️< 94 cm
🔴 Waist / Hip ratio
F➡️ <0.75
M➡️<0.85
🔴 Best tool for fat distribution evaluation ➡️CT & MRI
Co-morbidities of obesity
🔴HTN
🔴Atherothrombosis ➡️ obesity is considered a pro-thrombotic state
🔴 restrictive lung disease
🔴 obstructive sleep apnoea
🔴 hypoventilation syndrome➡️ cyanosis
🔴DM
🔴 Hyperuricaemia
🔴 Hyperlipidaemia
🔴NASH
🔴 gallbladder stone
🔴GERD
🔴 F ➡️ irregular menses , amenorrhea and infertility
🔴M ➡️ delayed puperty and hypogonadal manifestation( ⬆️aromatase activity)
🔴 osteoarthritis
🔴Cancer
M ➡️ colorectal + prostte
F➡️ ( breast-ovaries-uterus ) +GB
🔴 idiopathic intracranial hypertension ➡️ headache , tinnitus & vision disorders
🔴 to lose 1 kg , you must burn 🔥 7500 kcal

زيادات ال integrated فى ال obesity
🔴Drugs
1) 1st line ➡️ GLP 1 agonist ( semaglutide)
2) Orlistat
3) phenterimine

🔴Endoscopic management
1ry management ( before surgery)
▪️ Restriction
✅ Intra-gastric ballon
Indications :⬆️ neck circumference
Contra-indications: previouse GIT surgery - pregnancy- large hiatal hernia

✅Tranpyloric shuttle ( كأنها GOO)

✅Transoral gastroplasty (كأننا بندبسها)

▪️Malabsorption
✅implants

▪️Delay emptying
✅Botilinium injection

2ry management (after surgery)

▪️Rx complications
✅Dumping $ ➡️ narrow stomach
✅Widened sleeved stomach ➡️ narrow it


🔴 Surgery
✅ Mini Gastric bypass= Omega loop bypass ➡️ Modification of sleeve gastrectomy

اي حد هيمتحن oncology او head and neck لازم يحفظهم
Levels of cervical LN
L1 A Submental
L1 B sub mandibler
L2 equal (upper deep cervical) from base of skull till hyoid bone divided by spinal acessery nerve to
A inf
B sup
L3 eqal (middle deep cervical) From hyoid to circoid.. between it and L4 omohyoid muscle
So... Supra omohyoid dissection we remove level 1 2 3 only MCQ✅
L4 (lower deep cervical) from circoid to clavicle equal supraclavicler LN MCQ✅
L5 equal post triangle LN
جاتلي في امتحان الروند head and neck MCQ. كان عايز level 5 ده ايه
L6 prelarngal LN=Delphine LN
جاتلي في امتحان روند الoncology كان عايزه مين هي الDelphine LN
L7 mediastinum LN

SURGERY OF integrated

so surgery in CD:
- ileal resection (limited right hemicolectomy)
- Internal bypass (
- External bypass (ileostomy)
- stricturoplasty (NOT IN: colon/ short segment/ near area to be resected/ inflammation/ hypoalbuminemia till corrected)


surgery in UC:
- fulminant colitis
- Toxic megacolon
- dysplasia or cancer
- no response to medical treatment
- severe extraintestinal maifestations
-failure to grow in children
- uncontrolled bleeding
- perforation

ربّ اشرح لي صدري، ويسر لي أمري، واحلل عقدةً من لساني، يفقهوا قولي. اللهم أخرجنا من ظلمات الوهم، وأكرمنا اللهم بنور الفهم، وافتح علينا بمعرفة العلم، وحسن أخلاقنا بالحلم. وسهل لنا أبواب فضلك، وانشر علينـا مـن خـزائن رحمتـك، يا أرحم الراحمين.