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FAQs: Rapid Fire Answers to Pesky Clinical Questions – NGTs? Thiamine? PO Contrast? Nonsurgical Complications?

  • Erin LeimanEmail author
Chapter

Abstract

Bariatric patients encounter unique challenges. Blind placement of NG or OG tubes can be a risky procedure in those patients with altered anatomy. Clinicians should not place an NG tube blindly in those patients within 30 days of their surgery and consider fluoroscopic guidance when possible. Fluid intake, including oral contrast, should be limited to 6 oz (177 mL) for patients with stomach-altering bariatric surgeries, such as Roux-en-Y gastric bypass and sleeve gastrectomy, to accommodate the small gastric pouch. Nutritional deficiencies are common, and thiamine deficiency can lead to Wernicke’s encephalopathy in bariatric surgery patients. Venous thromboembolism and anastomotic leaks are both associated with significant morbidity and mortality in this population.

Keywords

Bariatric surgery Nasogastric tube Thiamine deficiency Oral contrast Pulmonary embolism 

References

  1. 1.
    Van Dinter TG, Lijo J, Guileyard JM, Fordtran JS. Intestinal perforation caused by insertion of a nasogastric tube later after gastric bypass. Proc Bayl Univ Med Cent. 2013;26(1):11–5.CrossRefGoogle Scholar
  2. 2.
    McNally EF, Kelly JE, Ingelfinger FJ. Mechanism of belching: effects of gastric distention with air. Gastroenterology. 1964;46:254–9.PubMedGoogle Scholar
  3. 3.
    Alva S, Eisenberg D, Duffy A, Roberts K, Israel G, Bell R. Virtual three dimensional computed tomography assessment of the gastric pouch following laparoscopic Roux-Y gastric bypass. Obes Surg. 2008;18(4):364–6.CrossRefGoogle Scholar
  4. 4.
    American Society for Metabolic and Bariatric Surgery. (n.d.). Retrieved from https://asmbs.org/.
  5. 5.
    Byrne TK. Complications of surgery for obesity. Surg Clin North Am. 2001;81:1181–93.CrossRefGoogle Scholar
  6. 6.
    Steele K, Schweitzer M, et al. The long term risk of venous thromboembolism following bariatric surgery. Obes Surg. 2011;21:1371–6.CrossRefGoogle Scholar
  7. 7.
    Goldenberg L, Pomp A. Management of nutritional complications. In: Nguyen N, Blackstone R, Morton J, Ponce J, Rosenthal R, editors. The ASMBS textbook of bariatric surgery. New York: Springer; 2015.Google Scholar
  8. 8.
    Toy S, Zarshenas N, Jorgensen J. Prevalence of nutrient deficiencies in bariatric patients. Nutrition. 2009;25(11–12):1150–6.Google Scholar
  9. 9.
    Sugarman HJ, Brewer WH, Shiffman ML, et al. Multicenter, placebo-controlled, randomized, double-blind, prospective trial of prophylactic ursodiol for the prevention of gallstone formation following gastric-bypass-induced rapid weight loss. Am J Surg. 1995;169:91–6.CrossRefGoogle Scholar
  10. 10.
    Chandler RC, Srinivas G, Chintapalli KN, Schwesinger WH, Prasad SR. Imaging in bariatric surgery: a guide to postsurgical anatomy and common complications. AJR. 2008;190:122–35.CrossRefGoogle Scholar
  11. 11.
    Carucci LR, Turner MA. Imaging after bariatric surgery for morbid obesity: Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding. Semin Roentgenol. 2009;44(4):283–96.CrossRefGoogle Scholar
  12. 12.
    Levine MS, Carucci LR. Imaging of bariatric surgery: normal anatomy and postoperative complications. Radiology. 2014;270:327–41.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Emergency Medicine, Department of SurgeryDuke University Medical CenterDurhamUSA

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