Question

Nutrition Care Questions As a dietitian/nutritionist working closely with Holly, address the following questions: 1. Patients considering bariatric surgical procedures may have several surgical options including the procedure that Holly underwent. Using a table format, including Roux-en Y procedure, discuss 2-3 other procedures that may be considered and briefly state the pros and cons associated with each one. 2. In addition to her planned meals, what would you recommend for her to do to meet the DRI for the micronutrients? Please provide specific and detailed information regarding these recommendations. 3. On the basis of the type of gastric bypass procedure that Holly has undergone, which micronutrients would you consider are of the greatest concern in regards to deficiency? List the micronutrient and possible clinical symptoms or condition of concern from the deficiency? 4. Holly is complaining of hair thinning and loss as well as fatigue? Which micronutrients could be directly related to these issues? What are major dietary sources of these nutrients? 5. As Holly continues to take the medications listed above, which other medical conditions would be of concern or risk after bariatric surgery? What would be the implications from these conditions on her micronutrient status? Pg. 2

Answer 1

1.

Procedure	Description	Pros	Cons
Roux-en Y procedure	a small portion of the stomach is made from the original stomach and it is sutured to the small intestine .The food consumed after reaching stomach reaches the small intestine	Controls weight more effectively Can reduce the comorbid disease like diabetes, hypertension and increase the fertility rate Gastric symptoms are greatly reduced	Nutritional deficiency ,dumping syndrome can occurs Cannot be reversed Risk of intestinal obstruction is greater
Sleeve gastrectomy	a portion of stomach is removed	Greatly reduces weight Can control diabetes Reduces the appetite Dumping syndrome is not experienced	This is not reversible Can lead to increased absorption of minerals and vitamins Feeling full very soon Infection Leaking Complications:bleeding, organ failure,death
Gastric banding	an adjustable band is fixed on the upper part of the stomach	Reversible	Infection Pulmonary embolism Internal hemorrhage

2.The following recommendations can be made

• Eat a small quantity of food ,this can prevent overloading
• Avoid foods containing sugar and fats ,fast eating to prevent dumping syndrome
• Water can be consumed before or after 30 minutes of meals to reduce the nausea and vomiting
• To prevent nutritional deficiency the vitamins and mineral supplements has to be taken
• Encourage to drink about 2 litres of fluids to prevent dehydration
• High protein diet can be encouraged

3.The common micronutrient deficiencies post surgery are

• Iron deficiency:can lead to anemia ,decreased amount of oxygen carrying RBC.This can make the patient very tired and fatigue
• Vitamin B12 deficiency can lead to neurological problems like tingling sensation, peripheral neuropathy,confusion,encephalopathy  macrocytic anemia
• Folate deficiency further aggrevating the anemia
• Vitamin A deficiency causes dryness of eyesmscarring in the cornea
• Vitamin C and D deficiency can lead to loss of bone mass
• Zinc deficiency leading to loss of hair,thinning and brittle hairs
• Copper deficiency leading to confusion and central nervous problems
• Deficiency of selenium(headache, nausea,abdominalpain), phosphorus(loss of bone mass,cavities,tooth decay), potassium (vomiting, diarrhea, extreme weight loss)

4.The main cause of hair thinning and loss is because of the deficiency of iron, zinc.The foods rich in this nutrient  are nuts,dairy products, shellfish, green leafy vegetables, fruits,whole grains ,meat ,etc.,