ROUX en Gastric Bypass

Considered the gold standard in bariatric surgery, a Roux-en-Y gastric bypass is what is known as a combined restrictive and malabsorptive procedure. It is restrictive because the stomach is reduced to a small pouch that can only hold a very small amount of food at a time. It is malabsorptive because a portion of the small intestine is bypassed, reducing the body’s ability to absorb the full amount of calories that are consumed. These two factors, working together, make this procedure extremely effective at helping patients shed large amounts of excess weight. We perform laparoscopic gastric bypass at our practice serving Fort Worth, Arlington, and the entire Dallas region so that patients can enjoy the benefits of bariatric procedures without the discomfort of open surgery.

• Laparoscopic Roux-en-Y Gastric Bypass
• Benefits
• Risks

Laparoscopic Roux-en-Y Gastric Bypass

Roux-en-Y gastric bypass involves the separation of the stomach into two sections. The small upper portion can collect and digest food, but only in very small quantities. This small stomach pouch is then connected to the middle portion of the small intestine. The remainder of the stomach and upper segment of the small intestine are left in place, but bypassed. These bypassed segments are responsible for producing certain necessary digestive acids and proteins, which they will continue to do, even though food will no longer pass through them.

Traditionally, Roux-en-Y has been performed as an open procedure, involving a significant amount of pain, a long recovery time, and substantial surgical risk. Using laparoscopic techniques, we can perform the same gastric bypass procedure at our Dallas, Arlington, and Fort Worth-area practice while using only five small incisions. This results in a much shorter and easier recovery and virtually no noticeable scarring.

Benefits

There are many reasons why this procedure has become the leader in the field of bariatrics. First and foremost, it is extremely effective for the majority of patients. It does not involve the use of any implanted device, like gastric banding, and because nothing is removed, it is technically reversible, although this is strongly advised against.

People who have undergone gastric bypass surgery have experienced reduction or resolution of such conditions as type 2 diabetes and acid reflux disease, even before a significant amount of weight is lost. As the weight comes off, additional benefits include decreased hypertension, increased energy, reduced pressure on the joints, and improved confidence.

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Risks

Gastric bypass surgery, like all surgery, carries an inherent amount of risk. Although patients who are obese present with a more complicated medical history, bariatric surgery is actually statistically safer than many of the common surgical procedures performed every day in the United States. At Minimally Invasive Bariatrics, we thoroughly discuss all of the potential risks with each patient prior to surgery.

After the surgery is complete, some side effects associated with Roux-en-Y gastric bypass could still occur. Due to the malabsorptive aspect of the procedure, some patients experience vitamin or nutrient deficiencies. This can be avoided by carefully following the dietary guidelines provided by our practice and taking the recommended vitamin supplements. Many patients have also experienced an extremely uncomfortable side effect known as “dumping syndrome,” which is caused by the stomach emptying food into the intestine too quickly. This is most often triggered by the consumption of high-fat or sugary foods, so once again, following a proper Post-bariatric diet will minimize the chances of this condition appearing.

Minimally Invasive Bariatrics is committed to providing our patients with the best care possible. As part of this commitment, we offer a wide range of procedures, which we perform using only the most advanced minimally invasive methods available.

The sleeve gastrectomy is a relatively new form of bariatric surgery offered at Minimally Invasive Bariatrics in Arlington, Dallas, and the Fort Worth area. It involves reducing the size of the stomach as well as the stomach's ability to produce certain appetite-inducing hormones. Read more about sleeve gastrectomy.

StomaphyX™ allows surgeons to access the stomach through the esophagus, eliminating the need for incisions altogether. This results in significantly shorter healing times and no visible scars whatsoever. Learn more about StomaphyX™ and whether this remarkable technology might be right for you.

Lung cancer strikes 900,000 men and 330,000 women yearly. Among men, smoking causes more than 80 per centof lung cancer cases. In women,smoking is the cause of 45 per cent of all lung cancer worldwide, but more than 70 per cent in North America and Northern Europe.In both men and women, the incidence of lung cancer is low before age 40,and increases up to age 70 or 75.
The rise in female smoking prevalence is a major public health concern. In the US, more women die from smoking-induced lung cancer than from breast cancer and in some Nordic countries,including Iceland and Denmark, female lung cancer deaths have begun tooutnumber male tobacco victims. Considering that in several European countries up to 50 per cent of young women are now regular smokers, this will cause a disease burden that significantly reduces women’s health in decades to come.

Cancer prevention:

Epidemiological studies indicate that the frequent consumption
carcinomas of the pharynx, larynx, lung, oesophagus, stomach,
Prospective Investigation into Cancer and Nutrition (EPIC
of fruits and vegetables can decrease incidence of cancers
The report also says that given the multi-faceted
consumption of locally produced vegetables,
Western style dietary habits. IARC says that such actions
would have health benefits beyond cancer,
notably cardiovascular disease and diabetes,
Early detection – the best strategy second to
cancer remains the avoidance of exposure to
(eg tobacco, industrial carcinogens, etc).
There is sound evidence that the recent decline in cancer mortality
extent due to early detection. Responsible for
(mammography, magnetic resonance (MR) and
but also a higher degree of disease awareness and

Most successful so far has been the early detection
of cervical cancer by cytology and of breast cancer by mammography.
A recent analysis by an IARC Working Group
screening may reduce breast cancer mortality

There is also emerging evidence that prostate
result in lower mortality rates but management
colonoscopy is considered the gold standard although

early and treated adequately infections that may cause canceracco,

It is one of the commonest cause of death in



many developed countries in middle aged women.



risk factors:



1)age:

1) it is most common in beetween age of 35 and 50 and



uncommon below the age of 35.



2)family history



1)the risk is high in those with a positive family history of breast cancer.



3)socio-economic status



it is common in higher socio-economic group.



4)others



1)early menarcheand late menopause



2)using oral contraceptives



3)elevated levels of estrogen and progesterone.



prevention



1)primary prevension:

1)eliminate the risk factors



2)promation of cancer education .



3)the average age at menarche can be increased through



a reduction in childhood obesity and increase in strenuous physical activity



2)secondary prevention



1)breast screening leads to early diagnosis of breast cancer.



2)after confermation start treament



3)detect recurrence as early as possible.

SEIZURE

Caused by transient, paroxymal and synchronous discharge

of groups of Neurons in the brain


Clinical manifestations depends on the location and number

of neurons involved, in the seizure discharge and its duration.

May be

1.Transient or

2.Permanent (Epilepsy)

Classification of Epileptic seizures

• Partial

• Generalized

• Unclassified

PARTIAL

-Simple partial seizures (consciousness not impaired)

- Complex partial seizures (consciousness impaired)

- Partial seizures evolving to generalized seizures (Tonic, clonic or tonic-clonic)


GENERALIZED SEIZURES
(Convulsive or non convulsive)

•Absence seizures

•Myoclonic seizures

•Clonic seizures

•Tonic seizures

•Clonic tonic seizures

•Atomic seizures.


DRUGS USED IN DIFFERENT DISORDERS

Partial Seizures

- Carbamazepine

- Phenyotin and

- valproate

Generalized seizures

- Carbamazepine

- Phenyotin
- Valproate

- Barbiturates

- Gabapentin or

- Lamotrigine

Generalized non seizures

- Ethosuximide (or)

- Valproate

SIDE EFFECTS

Depression of cerebral function with symptoms of sedation

- Diploma

- Persistent or fluctuation ataxia

Dyskinesias of the tongue, face and limbs

- Mild sensory neuropathy

- Altered peripheral nerve function

•Hepatic failure

• Pancreatitis

• Mild anaemia to aplastic anaemia

• Depress circulating platelets

• Skin rashes

• SLE

• Seroderma and

• Sjogrens syndrome

• Steven johnsons syndrome

STATUS EPILEPTICUS

Def : Continuous seizure activity or two or more seizures

occurring in sequence without recovery of consciousness between the seizures

PHARMACOLOGIC MANAGEMENT OF STATUS EPILEPTICUS

1.Lorazepam / Diazepam – 0.1 mg / kg I.V at 2 mg/ min

2.Phenytoin – 20mg / kg I.V at 50mg / min or fosphenytoin 20mg/kg IV at 150mg/min

3.Phenyotin or fosphenytoin additional 5-10 mg/kg

4.Phenobarbitol 20mg/kg I.V at 50-75 mg/min

5.Phenobarbitol – additional 5-10mg/kg

6.Anaesthesia with propofol or midazolam

OTHER AREAS OF TREATMENT

•Exclude hypoglycemia

•Tracheal intubation

•ABG

•Hyperthermic management

Management of Anaesthesia for seizure disorders

Consider impact of drugs on organ function

- Coagulation

- Response to anaesthetic drugs.

TYPES:

ACUTE

Sub acute

Chronic

ACCUTE TONSILITIS:

It is the acute inflammation of the tonsil.

CLASSIFICATION

1)Acute catarrhal / superficial

2)Acute follicular

3)Acute parenchymatous

4)Acute membranous

AETIOLOGY:

CAUSATIVE ORGANISMS :

Haemolytic streptococcus- most common

Staphylococci

Pneumococci

H.infuenzae

Diptheriods

SYMPTOMS:

Sore throat.

Difficulty in swallowing

Fever.

Otalgia

Foul breath

Constitutional symptoms:

Headache

General body aches

Malaise

Constipation

Thick & muffled voice

SIGNS:

Foetid breath & coasted tongue.

Hyperaemia of pillars, soft palate& uvula

Follicular: Red & swollen tonsils with yellowish purulent material at crypts

Membranous: Whitish membrane on the medial surface can be wiped off

Parenchymatous: Enlarged & congested tonsils with oedema of uvula & soft palate.

Tender & enlarged jugulodigastric lymph nodes.

PHYSIOLOGY OF TASTE


.Taste is one of the special senses,

sensed by tongue through taste buds.

.There are 4 primary taste sensations

SALT,SWEET,BITTER,SOUR and umami

.Taste buds are present on papillae

Circumvallate papillae present


on the posterior part of the tongue

Foliate papillae present on the lateral

surface of the tongue and Filiform

papillae on the anterior surface of the tongue
.

THE NASAL SEPTUM IS THAT PART OF

THE NOSE WHICH SEPARATES THE TWO

AIRWAYS&NOSTRILS. A DEVIATED NASAL

SEPTUM IS WHEN THERE THE SHIFT FROM

THE MIDDLE OR CENTRAL POSITION

AETIOLOGY:

1) TRAUMA: USUALLY IN CHILDHOOD , MAY EVEN BE DURING DELIVERY.

2) CONGENITAL DISORDERS 3) HEREDITARY DISORDERS

4) RACIAL PREDISPOSITION

TYPES OF DNS:

1) ANTERIOR DISLOCATION 2) C-SHAPED DEFORMITY 3) SPURS

4) SEPTALTHICKENING 5) S-SHAPED DEFORMITY

CLINICAL FEATURES:

1) NASAL OBSTRUCTION 2) COTTLE'S TEST 3) MUCOSAL CHANGES

4) NEUROLOGICAL CHANGES

SYMPTOMS:

THE SYMPTOMS CAUSED BY SEPTAL DEVIATIONS AREENTIRELY RESULTS OF THEIR

EFFECTS ON NASALFUNCTION. THE DOMINANT EFFECT BEING NASAL

OBSTRUCTION,BUT THIS IS RARELY SEVERE ENOUGH TO CAUSE ANOSMIA

. SIGNS:

1)HEADACHE 2) SINUSITIS 3) BLEEDING FROM THE NOSE 4) EXTERNAL DE FORMITY

5) MIDDLE EAR INFECTION 6) NOISY BREATHING DURING SLEEP

COTTLE'S CLASSIFICATION:

1) SIMPLE DEVIATION 2) OBSTRUCTION 3) IMPACTION

TREATMENT :

MEDICAL MANAGEMENT
1) ANTIBIOTICS 2) ANTIHISTAMINS 3)ANTI INFLAMMATORY DRUG

4) NASAL DECONGEST DROPS

SURGICAL MANAGEMENT :

1)SEPTOPLASTY 2) SUBMUCOUS RESECTION(SMR)

HOW TO AVOID DNS :
1) USE APPROPRIATE SAFETY EQUIPMENT DURING SPORTS .

2)USE A HELMET WHEN RIDING A BIKE OR ROLLER SKATING

3) FASTEN UR SEAT BELT WHEN DRIVING