Medical Specialty:
Consult - History and Phy.

Sample Name: Gastric Bypass Discussion - 2

Description: Patient scheduled for laparoscopic gastric bypass.
(Medical Transcription Sample Report)

HISTORY: The patient is scheduled for laparoscopic gastric bypass. The patient has been earlier seen by Dr. X, her physician. She has been referred to us from Family Practice. In short, she is a 33-year-old lady with a BMI of 43, otherwise healthy with unsuccessful nonsurgical methods of weight loss.

She was on laparoscopic gastric bypass for weight loss.

She meets the National Institute of Health Criteria. She is very well educated and motivated and has no major medical contraindications for the procedure.

PHYSICAL EXAMINATION: On physical examination today, she weighs 216 pounds with a BMI of 43.5, pulse is 96, temperature is 97.6, blood pressure is 122/80. Lungs are clear. Abdomen is soft, nontender. There is stigmata for morbid obesity. She has cesarean section scars in the lower abdomen with no herniation.

DISCUSSION: I had a long talk with the patient about laparoscopic gastric bypass, possible open including risks, benefits, alternatives, need for long-term followup, need to adhere to dietary and exercise guidelines. I also explained to her complications including rare cases of death secondary to DVT, PE, leak , peritonitis, sepsis, shock, multisystem organ failure, need for re-operation including for leak or bleeding, gastrostomy or jejunostomy for feeding, rare case of respiratory failure requiring mechanical ventilation, etc., with myocardial infarction, pneumonia, atelectasis in the postoperative period were also discussed.

Short-term complications of gastric bypass including gastrojejunal stricture requiring endoscopic dilatation, marginal ulcer secondary to smoking or anti-inflammatory drug intake which can progress on to perforation or bleeding, small bowel obstruction secondary to internal hernia or adhesions, signs and symptoms of which were discussed. The patient would alert us for earlier intervention. Symptomatic gallstone formation secondary to rapid weight loss were also discussed. How to avoid it by taking ursodiol were also discussed. Long-term complications of gastric bypass including hair loss, excess skin, multivitamin and mineral deficiencies, protein-calorie malnutrition, weight regain, weight plateauing, need for major lifestyle and exercise and habit changes, avoiding pregnancy in the first two years, etc., were all stressed. The patient understands. She wants to go to surgery.

In preparation of surgery, she will undergo very low-calorie diet through Medifast to decrease the size of the liver to make laparoscopic approach more successful and also to optimize her cardiopulmonary and metabolic comorbidities. She will also see a psychologist, nutritionist, and exercise physiologist for a multidisciplinary effort for short and long-term success for weight loss surgery. I will see her two weeks before the plan of surgery for further discussion and any other questions at that point of time.

Keywords: consult - history and phy., medifast, laparoscopic gastric bypass, short-term complications, long-term complications, gastric bypass, complications of gastric bypass, weight loss,