A 40-year-old female is scheduled for a cholecystectomy and you wish to estimate her risk for postoperative bleeding.
Which one of the following provides the most sensitive method for identifying her risk?
Correct Answer D: Bleeding time, activated partial thromboplastin (aPTT), and prothrombin time (PT) are relatively poor predictors of bleeding risk. Studies have shown that baseline coagulation assays do not predict postoperative bleeding in patients undergoing general or vascular surgery who have no history that suggests a bleeding disorder. Obtaining a history for evidence of prior bleeding problems is the most sensitive and accurate method of determining a patient’s risk.
Surgery for obesity would be most appropriate for which one of the following?
Correct Answer C: Obesity surgery should be considered for patients with a BMI > 35 and medical Comorbidities, as well as for patients with a BMI > 40 or 100% over ideal weight without any medical problems. When dietary weight loss relieves medical symptoms it should be continued, rather than recommending surgery. Alcohol abuse is a contraindication to surgery.
Bariatric surgery for obese patients with type 2 diabetes mellitus often results in:
Correct Answer D: Following bariatric surgery for obesity, up to 75% of patients with diabetes experience complete resolution of their disease. Mortality rates are 3-4 times higher in diabetics treated with oral hypoglycemia agents alone compared to surgery. Hyperlipidemia also resolves.
A 42-year-old white male who has been obese for many years seeks your advice about bariatric surgery. He has controlled hypertension and his body mass index (BMI) is 46 kg/m2 .
Which one of the following would you tell him is the leading cause of death from this surgery?
Correct Answer B: According to the International Bariatric Surgery Registry, the leading cause of death following surgery is pulmonary embolism. Indications for bariatric surgery include a BMI of 40 kg/m2 or higher, or a BMI of 35 kg/m2 with serious comorbid factors such as diabetes mellitus, obstructive sleep apnea, or coronary artery disease.
Which one of the following is the leading cause of death following bariatric surgery?
Correct Answer A: Pulmonary Emboli, anastomotic leaks, and respiratory failure are responsible for 80% of deaths in the 30 days following bariatric surgery, with death from pulmonary embolism being the most frequent cause. Wound infections and marginal ulcers are not uncommon complications of this type of surgery.
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