Postoperative Care & Long-term Monitoring Flashcards

A patient who has vomited often for 3 weeks after surgery develops confusion, ataxia and nystagmus. Which deficiency is most likely?

Answer: Thiamine (B1)

Thiamine stores run out within weeks of persistent vomiting, which can cause Wernicke encephalopathy.

Why are patients at risk of vitamin B12 deficiency after Roux-en-Y gastric bypass?

Answer: Less gastric acid and intrinsic factor in the pouch

The small pouch makes little acid and intrinsic factor, both of which are needed to release and absorb B12.

Which instruction best improves absorption of an oral iron supplement after bariatric surgery?

Answer: Take it with vitamin C and at least 2 hours apart from calcium

Vitamin C improves iron absorption, while calcium competes with it, so the two should be taken separately.

Why is calcium citrate preferred over calcium carbonate after gastric bypass?

Answer: It does not need stomach acid to be absorbed

Calcium citrate absorbs well in the low-acid setting of the gastric pouch, while carbonate needs acid.

What is the usual target serum 25-hydroxyvitamin D level for bariatric patients?

Answer: Above 30 ng/mL

Bariatric guidelines aim for 25(OH)D above 30 ng/mL to support calcium absorption and bone health.

Years after gastric bypass, a patient has anemia, neutropenia and gait problems, but B12 is normal. Which deficiency should be checked?

Answer: Copper

Copper deficiency can cause anemia, neutropenia and myeloneuropathy that look like B12 deficiency.

Which procedure carries the highest risk of fat-soluble vitamin (A, D, E, K) deficiency?

Answer: Biliopancreatic diversion with duodenal switch

BPD/DS causes the most fat malabsorption, so A, D, E and K deficiencies are most likely after it.