ThinnerTimes

[Gr. anastom M sis opening, outlet]    a connection between two parts of the intestinal tract or between two vessel. See gastrojejunostomy and jejunojejunostomy.

distant,  remote; farther from any point of reference; opposed to proximal.

In the normal person sugary foods are released slowly from the stomach into the small intestine.  After gastric bypass these sugars pass quickly into the jejunum and sometimes cause "dumping syndrome".  Symptoms include bloating, cramps, sensation of lightheadedness, fast heart rate, sweating, and sometimes hypotension.  These symptoms last 10 to 45 minutes. Patients will often want to take a nap and "sleep it off". Dumping affects about 75% at first, but most patients find that the syndrome gradually resolves over the first six months. Very few patients have significant long term symptoms.  Very sweet and carbohydrate rich foods most often cause dumping. These could be sodas, candy, sweet fruits, milk shakes, cereals.  

The physiology of dumping includes release of vasoactive substances from the small intestine into the blood stream in response to hyperosmolar foods such as sugars and starches and an inrush of fluid into the small bowel that dilutes the sugars and causes lowered blood pressure. Some of the vasoactive substances include serotonin, bradykinin, substance P, pancreatic polypeptide, insulin, glucagon, neurotensin, and enteroglucagon. This is a complex syndrome that is incompletely understood.

[gastro- + jejunostomy]    surgical creation of an anastomosis between the stomach and jejunum; also, the anastomosis so established.

the operative formation of an anastomosis between two portions of the jejunum; also, the anastomosis so formed.

1. incisional (ventral) Area in a surgical incision that weakens over time allowing a bulge to form. Treated by surgery often at the time of tummy tuck by bringing the solid edges of the hernia together. 2. internal  an abnormal opening within the abdominal cavity through which a loop of bowel can protrude. In gastic bypass, may occur under the roux limb, along side the roux limb, or through the jejeunojejunostomy mesentary. Generally prevented by careful suture closure of these potential pathways.

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Predetermination of medical necessity: Does the insurance company or its reviewing agency consider that the proposed obesity operation is medically necessary?

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Iron is an essential constituent of hemoglobin, cytochrome, and other components of respiratory enzyme systems; its chief functions are in the transport of oxygen to tissues (in hemoglobin) and in cellular oxidation mechanisms. Dietary sources include muscle meats, eggs, grains, and certain vegetables and fruits. Depletion of iron stores may result in iron-deficiency anemia . Excessive consumption of iron causes iron poisoning (see under poisoning).

Iron is absorbed by the duodenum as well as the lower small bowel.  When a gastric bypass is performed, the duodenum is bypassed as well.  Therefore iron is not absorbed as well after bypass.  Women who are menstruating lose blood and therefore iron with each period. These women can't get enough iron in the diet and should take a daily iron supplement.  Women who don't menstruate and men will generally get enough iron in the diet to prevent deficiency. These patients should take a multivitamin with iron, but generally don't require a specific iron supplement.

Learn more in our section on Iron Deficiency.