Mrs. Gutierrez: Twelve Years After Bariatric Surgery

Abstract

OPEN ACCESSJanuary 19, 2014Mrs. Gutierrez: Twelve Years After Bariatric Surgery Carla Lupi, MD, Anthony Oliva, Ansley Splinter Carla Lupi, MD Florida International University Herbert Wertheim College of Medicine Google Scholar More articles by this author , Anthony Oliva Florida International University Herbert Wertheim College of Medicine Google Scholar More articles by this author , Ansley Splinter Florida International University Herbert Wertheim College of Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9666 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstract Introduction: This interdisciplinary problem-based learning case for third-year and advanced second-year students describes a woman urgently referred from her primary care provider to a neurologist several years after bariatric surgery. Learners will move through the unfolding diagnostic reasoning of a rare condition that presents identically to a common one, considering the importance of monitoring response to therapy as a means of confirming the original diagnosis, and the use of non-response to therapy as a trigger for reevaluation of that diagnosis. Methods: This case provides the opportunity for students to “take the history” from the facilitator rather than simply receive predetermined information. It also invites students to review emerging guidelines on the long-term care of this growing population of patients, consider occupational exposures, and the use of the history to determine the likelihood of heavy menses as the cause of anemia in a woman. Advanced learners may also consider issues of cost-effectiveness of the diagnostic work-up, the communication challenge of explaining highly uncertain prognosis, ethical issues in the ongoing care of patients who lose insurance coverage, and best practices for the education and follow-up of these patients. Results: We have formally surveyed 39 third-year students immediately after the session. All 39 students agreed or strongly agreed that this case improved their understanding of basic science concepts related to nutrition. Thirty-seven students agreed or strongly agreed that this case improved their understanding of the effects of different types of bariatric surgery on nutritional needs. All 39 students agreed or strongly agreed that the case was believable. Discussion: We have used this case with students on the neurology clerkship at our institution for a cross-clerkship curriculum designed to help students integrate basic science into their rapidly-expanding clinical learning. Other curricular needs prompting us to write this case were in the areas of nutrition, reflection on diagnostic reasoning, and the care of the rapidly growing postbariatric surgery population. Educational Objectives By the end of this resource, learners will be able to: Develop a differential diagnosis for anemia in a woman using the kinetic approach (production, hemolysis, and blood loss) and/or the morphologic approach (microcytic, normocytic, and macrocytic).Interpret the laboratory tests used in the work-up of anemia, including the variations in correlation of B12 and folate levels with clinical symptoms.Develop and reason a differential diagnosis for combined vestibular and sensory abnormalities.Describe the types of bariatric surgery and their risks for nutritional deficiencies.Review the current recommendations for management of nutrition and supplementation in the postbariatric patient.Describe the central and peripheral demyelinating disorders as well as clinical manifestations for the disruption of sensory and motor pathways.Explain the specific biochemical roles of vitamins and minerals in hematopoiesis.Describe the absorption of vitamins and minerals important in hematopoiesis and nerve function as well as the mechanisms of their deficiencies in the postbariatric patient.Explain the mechanism of nephrolithiasis in the postbariatric surgery patient. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Instructor's Guide.pdf Facilitator Version.pdf Student Version.pdf Student Learning Survey.pdf PBL Rubric.pdf To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2014 Lupi et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsMyelopathySpinal Cord DiseasesCopperMultiple SclerosisDiagnostic ReasoningVitamin B 12NutritionFolateBariatric SurgeryWomen's Health CareGuidelinesAnemiaFolic AcidOccupational Diseases Disclosures None to report. Funding/Support None to report. Loading ...