This document summarizes the surgical treatment of morbid obesity. It discusses the prevalence and health risks of obesity, indications for bariatric surgery, the evolution of different surgical procedures like gastric bypass and gastric banding, and results showing significant long-term weight loss and reduction in obesity-related health conditions with bariatric surgery. Laparoscopic bariatric surgery procedures like Roux-en-Y gastric bypass and adjustable gastric banding are now commonly performed and have been shown to be safe and effective options for treating morbid obesity.
Dr Pravin John and Dr John Thanakumar, Anurag Hospital, Coimbatore present the differences between metabolic and obesity surgery - dept of advanced laparoscopy and obesity
Dr Pravin John and Dr John Thanakumar, Anurag Hospital, Coimbatore present the differences between metabolic and obesity surgery - dept of advanced laparoscopy and obesity
Understant what is obesity and Bariatric Surgery, what are the risk factors and how to overcome on the it. For more information visit at http://gisurgery.info
Gastroesophageal reflux disease (GERD) is defined as the failure of the antireflux barrier, allowing abnormal reflux of gastric contents into the esophagus. It is a condition which develops when the reflux of stomach contents causes troublesome symptoms and complications.
Understant what is obesity and Bariatric Surgery, what are the risk factors and how to overcome on the it. For more information visit at http://gisurgery.info
Gastroesophageal reflux disease (GERD) is defined as the failure of the antireflux barrier, allowing abnormal reflux of gastric contents into the esophagus. It is a condition which develops when the reflux of stomach contents causes troublesome symptoms and complications.
Presentation by Prof. Francesco Rubino, Chair of Bariatric and Metabolic Surgery King's College London Consultant (Hon) Surgeon, King’s College Hospital during ECIPE Roundtable: Fighting the Burden of Obesity, Brussels 07/02/2017
Endocrine issues swirl around the Bariatric patient: Diabetes, thyroid conditions, and more. What do clinicians need to be aware of when caring for these patients pre or post surgery? What are the unique endocrinologic issues which explain the mechanism of success with bariatric surgery? Learn here.
Tharwat's Family
Tharwat's Family
O B E S I T Y A N D T H E D I G E S T I V E S Y S T E M
Diet and exercise in management of obesity and overweight
Kwong Ming Fock* and Joan Khoo†
Departments of *Gastroenterology and †Endocrinology, Changi General Hospital, Singapore
Keywords
BMI, diet, exercise, NAFLD, obesity.
Accepted for publication 30 September 2013.
Correspondence
Professor Kwong Ming Fock, Division of
Gastroenterology, Department of Medicine,
Changi General Hospital, 2 Simei Street 3,
Singapore 529889. Email:
[email protected]
Abstract
According to World Health Organization, in 2010 there were over 1 billion overweight
adults worldwide with 400 million adults who were obese. Obesity is a major risk factor for
diabetes, cardiovascular disease, musculoskeletal disorders, obstructive sleep apnea, and
cancers (prostate, colorectal, endometrial, and breast). Obese people may present to the
gastroenterologists with gastroesophageal reflux, non-alcoholic fatty liver, and gallstones.
It is important, therefore, to recognize and treat obesity.
The main cause of obesity is an imbalance between calories consumed and calories
expended, although in a small number of cases, genetics and diseases such as hypothy-
roidism, Cushing’s disease, depression, and use of medications such as antidepressants and
anticonvulsants are responsible for fat accumulation in the body.
The main treatment for obesity is dieting, augmented by physical exercise and supported
by cognitive behavioral therapy. Calorie-restriction strategies are one of the most common
dietary plans. Low-calorie diet refers to a diet with a total dietary calorie intake of
800–1500, while very low-calorie diet has less than 800 calories daily. These dietary
regimes need to be balanced in macronutrients, vitamins, and minerals. Fifty-five percent
of the dietary calories should come from carbohydrates, 10% from proteins, and 30% from
fats, of which 10% of total fat consist of saturated fats. After reaching the desired body
weight, the amount of dietary calories consumed can be increased gradually to maintain a
balance between calories consumed and calories expended. Regular physical exercise
enhances the efficiency of diet through increase in the satiating efficiency of a fixed meal,
and is useful for maintaining diet-induced weight loss. A meta-analysis by Franz found that
by calorie restriction and exercise, weight loss of 5–8.5 kg was observed 6 months after
intervention. After 48 months, a mean of 3–6 kg was maintained.
In conclusion, there is evidence that obesity is preventable and treatable. Dieting and
physical exercise can produce weight loss that can be maintained.
Introduction
Since 1980, obesity has more than doubled globally and is now
considered as a major health hazard and a global epidemic. This
review aims to evaluate the current management of obesity and
overweight employing a combination of dietary interventions,
exercise, and behavioral modification. For ...
PRESENTED BY: AYESHA KABEER
FROM: UNIVERSITY OF GUJRAT SIALKOT SUBCAMPUS
Obesity and Cardiovascular Diseases
1. Causes of Overweight and Obesity
2. Accessing Obesity
-Body Mass Index
3. Cardiovascular Diseases caused by Obesity
Similar to Surgical Treatment of Morbid Obesity (20)
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
23. Dr. Edward Mason University of Iowa 1967 Gastric Bypass with loop gastroenterostomy
24.
25. GASTRIC BYPASS WITH ROUX-en-Y LIMB SUBSEQUENTLY MODIFIED 50 mL POUCH WITH A ROUX LIMB TO MINIMIZE BILE REFLUX ROUX LIMB WAS LENGTHENED TO INCREASE MALABSORPTION AND IMPROVE WEIGHT LOSS COMBINED RESTRICTIVE AND MALABSORPTIVE
26. Nicola Scopinaro Biliopancreatic Diversion (BPD) Any procedure that diverts bile and pancreatic secretions Combined Restrictive and Malabsorptive surgery 1976 “ BPD”
Children watch on average ~4hrs of TV/Day which comes out to 2 months of non-stop TV/year Plus, video games, and web surfing……. Sedentary lifestyle
Shortcoming is that BMI does not take in to consideration lean body mass to fat body mass composition. Some athletes have low body fat, but high lean body mass and their BMI may be elevated.
Since 1985 obesity has been recognized as a chronic disease. It affects
Weight reduction may sometimes be achieved through medically-supervised dieting and intensive behavior modification, but when this fails, surgery is an option. Over the years, refinements in surgical procedures have led to reports of results superior to those seen with the earlier operations. In an effort to evaluate the objective evidence for these new technologies, the NIH held a consensus development conference on GI surgery for Severe obesity. A 13-member panel developed a consensus statement after hearing scientific presentations from many physicians, scientists, health care professionals, etc. The generally accepted criteria for surgical treatment developed at the 1991 National Institutes of Health Consensus Development Conference Panel [ 24 ] include BMI greater than 40 or BMI greater than 35 in combination with life-threatening cardiopulmonary problems or severe diabetes mellitus.
The first bariatric procedure to be presented to a recognized surgical society and published in a peer reviewed journal was that of Linner and Kremen in 1954. The case which they presented was of a jejuno-ileal bypass.(JIB). Jejuno-ileal bypass involved joining the upper small intestine to the lower part of the small intestine bypassing a large segment of the small bowel, which is thus taken out of the nutrient absorptive circuit. The premise of this bypass was that patients could eat large amounts of food and the excess would either be poorly digested or passed along too rapidly for the body to absorb. In addition, the procedure caused a temporary decrease in appetite which also resulted in weight loss. The procedure was very successful at producing weight loss, however patients developed chronic diarrhea, kidney stones, and liver disease. So a search for a better procedure followed.
As a consequence of all these complications, jejuno-ileal bypass is no longer a recommended Bariatric Surgical Procedure. Indeed, the current recommendation for anyone who has undergone JIB and still has the operation intact, is to strongly consider having it taken down and converted to one of the gastric restrictive procedures.
In 1967 the gastric bypass was devised and performed by Dr. Edward Mason at the University of Iowa. Dr. Mason noted that patients who underwent subtotal gastrectomy for peptic ulcer disease remained below normal weight and could not gain weight easily. His approach involved stapling most of the stomach, bypassing the duodenum, and allowing the undigested food to pass directly into the jejunum. Most of the early operations failed because the pouch eventually became enlarged.
The technique was modified to obtain a 50 mL pouch and a Roux-en-Y limb to minimize bile reflux from the loop gastrojejunostomy. The roux limb was lengthened to 100-150 cm in order to increase malabsorption and improve weight loss. The technique has been modified throughout the years with regard to the gastric pouch and retrocolic position of the roux limb. This procedure has stood the test of time, with one series of 500 patients followed for 14 years with patients maintaining 50% excess weight loss.
Biliopancreatic diversion (BPD) does NOT refer to a specific operation. It describes any anatomic arrangement within the GI tract that diverts bile and pancreatic secretions from their usual anatomic paths. The goal of BPD is maintaining protein digestion/absorption but decreasing fat digestion by delaying the interaction between fat and biliopancreatic secretions. In addition, when the upper jejunum is bypassed, beneficial entero-humeral effects on carbohydrate metabolism is gained. The morbidly obese seem to overproduce insulin. With changes in jejunal hormonal release, insulin production and resistance are decreased. Starch metabolism in beneficially altered. Scopinaro’s procedure= distal gastrectomy to reduce the incidence of peptic ulceration, an alimentary limb consisting of the terminal 250 cm of ileum, and a biliopancreatic limb consisting of the rest of the small bowel. The common channel is 50 cm beyond the biliopancreatic to alimentary anastomosis. This procedure has two components. A limited gastrectomy results in reduction of oral intake, inducing weight loss, especially during the first postoperative year. The second component of the operation, construction of a long limb Roux-en-Y anastomosis with a short common "alimentary" channel of 50 cms length. This creates a significant malabsorptive component which acts to maintain weight loss long term. Dr Scopinaro recently published long term results of this operation, reporting 72% excess body weight loss maintained for 18 years. These are the best results, in terms of weight loss and duration of weight loss, reported in the bariatric surgical literature to this date. Disadvantages of the procedure are the association with loose stools, stomal ulcers, offensive body odor and foul smelling stools and flatus. The most serious potential complication is protein malnutrition, which is associated with hypoalbuminemia, anemia, edema, asthenia, alopecia, generally requires hospitalization and 2 - 3 weeks hyperalimentation. BPD patients need to take supplemental calcium and vitamins, particularly Vitamin D, lifelong. Because of this potential for significant complications, BPD patients require lifelong follow-up. In BPD patients who have received 200 - 300 cm alimentary limbs because of protein malnutrition concerns, the incidence of protein malnutrition fell dramatically to range from 0.8% to 2.3%
Listing of complications of biliopancreatic diversion: Protein Malnutrition 15% Incisional hernia 10% Intestinal obstruction 1% Acute biliopancreatic limb obstruction Stomal Ulcer 3.0% Bone Demineralization: Pre-op 25%; at 1-2 yrs, 29%; at 3-5 yrs 53%; at 6-10 yrs 14%. Hemorrhoids 4.3% Acne 3.5% Night Blindness 3% Operative Mortality 0.4% - 0.8% (1122 subjects, 1984-1993)
This bariatric procedure separates the stomach into an upper pouch along the lesser curvature of the stomach about 5 cm long with a diameter of approximately 1.5 cm and a volume of 20 to 40 mL, into which ingested food enters. This small restricted pouch then empties into the rest of the stomach through an 11-mm diameter channel. This channel is wrapped or banded externally with a ring of nonexpandable prosthetic material to prevent the stoma from enlarging over time and counteracting the restriction of anatomy and the success of the operation. This gastric restrictive approach was attractive in theory because of its technical ease, low morbidity, and lack of any bypass of the intestinal tract. Although this operation works quite well in patients who maintain a bulky diet of meat and potatoes by preventing ingestion of large volumes, 50% of patients quickly recognize that high-calorie liquids (e.g., ice cream and milkshakes) rapidly slide through the stoma and do not lead to a rapid early satiety; such patients change their diet, and their weight increases, many times back to their preoperative weight. The authors evaluated results at the Mayo Clinic with vertical banded gastroplasty in 70 patients from 1985 through 1989. [ 23 ] Although morbidity and mortality were low, at 3 years postoperatively, only 38% of patients had lost and maintained at least 50% of their excess weight. Despite the unsatisfactory results, many groups throughout the United States continue to advocate this operation because of its safety and lack of significant metabolic side effects.
1988 Doug Hess of Ohio modified BPD, called Duodenal switch with sleeve gastric reduction. Dr. Marceau and colleagues in Quebec have pioneered this approach. The procedure is accomplished by transecting the duodenum 5 cm beyond the pylorus. 250 cm of distal ileum becomes the alimentary limb and is anastomosed to the proximal duodenal segment. The balance of the small intestine is the biliopancreatic limb. The common channel is 100 cm. Sleeve gastrectomy preserves the pylorus, all or most of the antrum, and a significant amount of duodenum. Marginal ulcers are prevented. Increased iron and calcium absorption occurs compared to gastric bypass. Stomach size is ~200-250cc. Antum preservation results in minimal B12 deficiency. Dumping is prevented with normal
Wittgrove and Clark from San Diego publish there series on 5 Cases of Laparoscopic Gastric Roux-en-Y gastric bypass, the first of which is performed in 1993
GUIDELINES- approved the lap VBG and lap gastric bypass Roux-en-Y