Symptoms of Peutz Jeghers syndrome This autosomal dominant trait is often heralded by the presence of melanin spots on the lips and buccal mucosa. Hamartomas are almost always present on the small intestine and occasionally on the stomach and colon. Previously considered a benign process, patients with PJS are at increased risk for multiple cancers: breast …
Which intestinal polyposis syndromes are associated with hamartomatous polyps? Peutz-Jeghers syndrome (PJS) Juvenile polyposis (familial or generalized) Cronkhite-Canada syndrome (hamartomatous polyps with alopecia, cutaneous pigmentation, and toenail and fingernail atrophy) Intestinal ganglioneuromatosis (isolated or with von Recklinghausen disease or multiple endocrine neoplasia type 2) Ruvalcaba-Myhre-Smith syndrome (polyps of colon and tongue, macrocephaly, retardation, unique facies, …
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What does preoperative surgical counseling entail with any procedure? All patients undergo extensive preoperative education and counseling and must attend a required nutritional class and pass a psychological evaluation. Although this is practice dependent, all patients should be thoroughly educated that these procedures are just tools—the most effective tools for weight loss to date—and for …
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Is malnutrition seen with biliopancreatic diversion? Yes. Protein has only 200 to 300 cm of ileum to be absorbed. Up to 30% of patients end up with protein-calorie malnutrition requiring hospitalization and TPN or surgical revision. A high-protein, lower-carbohydrate diet is required to avoid inducing a state of starvation mimicking kwashiorkor disease. Are there other …
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How does the biliopancreatic diversion work? Biliopancreatic diversion creates a fixed amount of malabsorption whereby all fat and most starch can only be absorbed in 50 to 100 cm of terminal ileum.
Location and treatment of leak and obstruction after sleeve Leaks are most often near gastroesophageal junction at the angle of His, and are usually treated conservatively unless the patient is unstable. This includes percutaneous drainage and covered stent. Obstruction usually occurs at the incisura angularis and is treated with endoscopic dilation or laparoscopic myotomy. Rarely …
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What are the risks associated with the sleeve gastrectomy? Risks are mortality (0.3%), anastomotic leak (1%), obstruction (1%), new GERD (20%), and vitamin B 12 and calcium deficiency.