Kwashiorkor Following Roux-En-Y Gastric Bypass (Rygb) Managed Conservative by A Multidisciplinary Team

In the UK, about 22% of adults are clinically obese. This has brought with it increased incidence of diabetes, hypertension, and ischaemic heart disease. Assessment of degree of obesity and health risk needs to be defined. Effective management then involves a multidisciplinary team. Lifestyle interventions, pharmaceutical management, and the principles of bariatric surgery are covered in this chapter, including gastric band, gastric bypass, vertical banded gastroplasty, and biliopancreatic diversion.

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SURGICAL TREATMENT OF SEVERE OBESITY IN TEENS: LATE RESULTS

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-6720201500s10004 ◽

2015 ◽

Vol 28 (suppl 1) ◽

pp. 7-10

Author(s):

Álvaro Antônio Bandeira FERRAZ ◽

Luciana Teixeira de SIQUEIRA ◽

Clarissa Guedes NORONHA ◽

Danilo Belem Rodrigues de HOLANDA ◽

José Guido Corrêa de ARAÚJO-JÚNIOR ◽

...

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Multidisciplinary Team ◽

Severe Obesity ◽

Developed Countries ◽

Late Results ◽

Overweight And Obesity ◽

Drug Discontinuation ◽

Average Weight

Background : In children is estimated that the prevalence of overweight and obesity has increased up to five times in developed countries and up to four in developing countries. In Brazil, the proportion of children and adolescents who are overweight also increased from approximately 4.1% to 13.9%. Aim : To evaluate the surgical results of severe obesity in adolescents. Methods : Retrospective descriptive study of 2737 patients with severe obesity that underwent Roux-en-Y gastric bypass selecting from the total 44 patients with mean age of 18.1 years, 14 males and 30 females, most (37) operated by laparotomy. There was follow-up of 20 patients (45.45%). All were followed preoperatively by a multidisciplinary team and had indication confirmed for surgical unanimous approval of all team members. Results : Among the 20 adolescent, 14 were female. From five teenagers using anti-hypertension or hypoglycemic drugs before surgery, four (80%) had drug discontinuation and one (20%) reduced the dose in 50% postoperatively. The average weight loss was 45.4 kg after a mean follow up of 60 months. There were no deaths or severe postoperative complications. Among those who underwent postoperative follow-up with a multidisciplinary team, 18 were with BMI<30. Conclusions : Adolescents undergoing Roux-en-Y gastric bypass has good response in relation to weight loss and improvement of comorbidities. There was a low rate of complications and no deaths. All patients were satisfied with their personal results.

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Much Ado About Fried Chicken: Abetting Aspiration or Respecting Autonomy?

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-18-0207 ◽

2019 ◽

Vol 28 (3) ◽

pp. 1356-1362

Author(s):

Laurence Tan Lean Chin ◽

Yu Jun Lim ◽

Wan Ling Choo

Keyword(s):

Palliative Care ◽

End Of Life ◽

Multidisciplinary Team ◽

Biopsychosocial Model ◽

Family Members ◽

Clinical Decisions ◽

Goals Of Care ◽

Complex Needs ◽

Aspiration Risk ◽

Patient Centric

Purpose Palliative care is a philosophy of care that encompasses holistic, patient-centric care involving patients and their family members and loved ones. Palliative care patients often have complex needs. A common challenge in managing patients near their end of life is the complexity of navigating clinical decisions and finding achievable and realistic goals of care that are in line with the values and wishes of patients. This often results in differing opinions and conflicts within the multidisciplinary team. Conclusion This article describes a tool derived from the biopsychosocial model and the 4-quadrant ethical model. The authors describe the use of this tool in managing a patient who wishes to have fried chicken despite aspiration risk and how this tool was used to encourage discussions and reduce conflict and distress within the multidisciplinary team.

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Food for Thought

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd21.2.68 ◽

2012 ◽

Vol 21 (2) ◽

pp. 68-72 ◽

Cited By ~ 7

Author(s):

Caryn Easterling

Keyword(s):

Multidisciplinary Team ◽

Clinical History ◽

Team Members ◽

Speech Language Pathologist ◽

Expected Outcome

Our professional American Speech-Language-Hearing Association (ASHA) guidelines state, if a speech-language pathologist suspects on the basis of the clinical history that there may be an esophageal disorder contributing to the patient's dysphagia, then “An esophageal screening can be incorporated into most [videofluoroscopic swallowing studies, or] VFSS” (ASHA, 2004). However, the esophageal screen has not been defined by ASHA or by the American College of Radiology. This “Food for Thought” column suggests deglutologists work together to determine the procedure and expected outcome for the esophageal screen so that there is acceptance and consensus among the multidisciplinary team members who evaluate patients with dysphagia.

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