Case Study

Read the attached case study concerning the gastrointestinal system and answer the associated questions. Be sure to cite all references used.
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Chapter 23: The Digestive System
Case Story Summary
Chloe, a 28-year-old mother of two with a history of morbid obesity, high blood
pressure, diabetes, sleep apnea, and acid reflux disease has decided to opt for an
elective surgical procedure called gastric bypass. Gastric bypass surgery is also called
bariatric surgery. Her stomach is surgically reduced in size from 1 quart to 1 tablespoon
in volume. The purpose of this is to reduce food intake, and decrease the absorption of
calories. Chloe’s goal is to lose a substantial amount of weight. In addition to reducing
stomach size, the procedure should increase her feeling of fullness with smaller
amounts of food. Chloe’s doctor warns her, such a drastic procedure should not be
undertaken lightly, as it has a significant impact on the digestive process. Chloe must
closely monitor her nutrition for the rest of her life in order to avoid a host of potential
complications.
Diagnostic Information
Bariatric surgery is form of elective surgery usually considered for individuals with
severe morbid obesity (those with body mass indices greater than 40 kg/m 2. The
reasons for surgery are as varied as the patients who elect the procedure, but typically
the health concerns associated with obesity are often a primary consideration including
hypertension, hyperlipidemia, diabetes and heart disease. Unsuccessful weight
reduction using non-operative methods such as diet, exercise, and medications is
another indication for bariatric surgery. Bariatric surgery can be considered medically
necessary because it has been proven to be effective for long term weight control in the
morbidly obese. The procedure is not considered a cosmetic procedure because only
the digestive tract is altered, no fat is removed. The risks of surgical treatment include
post-operative wound infections, post-operative bleeding, improper wound healing, and
deep vein thrombosis.
Treatment Information
There are several options available for the obese patient. Chloe’s surgery as described
in the textbook is a stomach reduction surgery. In this type of surgery the stomach
volume is surgically reduced using staples, or some sort of restrictive ring or band. This
is a serious weight loss procedure, quite drastic in nature. Often less risky procedures
such as the Roux-en-Y gastric bypass are performed on patients. In the latter
procedure, the stomach is bypassed using a portion of the intestine rather than
surgically altering the stomach. Although the risks have been shown to be statistically
small for bariatric procedures, the surgeries that do not go well have serious
consequences. Obese patients are already at risk for cardiac, pulmonary and vascular
sequelae, therefore careful patient screening including the health of the patient and the
patients psychologic state are usually assessed prior to surgery.
Potential Alternate Hypotheses
Alternative procedures to explore might include liposuction, adjustable gastric banding,
vertical banded gastroplasty, jaw wiring, lap band wiring, stomach balloon surgery.
Chapter 23: The Digestive System
Answers to Case Questions
1. Which processes of digestion would be altered if Chloe’s had her mouth wired
shut?
2. Which serous membrane in Chloe’s abdomen most likely contains the greatest
amount of adipose tissue?
3. Would Chloe have deciduous teeth? .
4. What involuntary muscular process initiated by deglutition of water may cause
Chloe pain?
5. The lower part of Chloe’s stomach has been bypassed; what sphincter is no
longer part of her digestive tract?
6. Why might reduction of Chloe’s stomach reduce her acid reflux?
7. What vitamin may not be efficiently absorbed due to Chloe’s procedure?
8. How will protein digestion be affected by Chloe’s surgery?
9. Which pancreatic enzymes would Chloe not need if she was ingesting amino
acids and not proteins?
10. What pancreatic enzymes would Chloe need to break down the fats in her
nutrition drink?
11. Why would the pancreatic duct need to be rerouted during Chloe’s surgery?
12. Why might Chloe be at risk for gallstones (crystallized cholesterol which can
block the flow of bile from the gallbladder)?
13. Would absorption of nutrients be substantially altered in the small intestine
following Chloe’s gastric bypass surgery?
14. How would Chloe’s reduced stomach size and bypassed duodenum affect her
overall digestion in terms of neural feedback?
15. Why is vitamin B12 deficiency a serious concern?
16. With which complications should Chloe be concerned following the surgery?
17. Why is monitoring nutrition so important to Chloe now?
18. Chloe went on a liquid diet immediately following her surgery, based on what you
have learned about nutrition in this chapter, which substances would you include
in a liquid diet?

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