A patient presents for follow-up after obesity treatment, with a surgical image shown. Which procedure was pe… - INI-CET EXAM -2025

INI-CET EXAM -2025

Medical & Surgical Nursing

Medium

Appeared in: INI-CET EXAM -2025

Explanation

The surgical image shows the stomach has been divided to create a long, tubular pouch.
A loop of the small intestine (jejunum) is connected to this pouch with a single surgical connection (anastomosis).
This single-anastomosis loop configuration is the defining characteristic of a Mini-Gastric Bypass (MGB), also called a One-Anastomosis Gastric Bypass (OAGB).

Option A: A Roux-en-Y gastric bypass involves creating two anastomoses (connections): a gastrojejunostomy and a jejunojejunostomy. This creates a characteristic 'Y' shape in the intestine, which is not seen in the image.
Option C: A duodenal switch involves performing a sleeve gastrectomy and then connecting the distal part of the small intestine (ileum) to the first part of the small intestine (duodenum). The image shows the connection is to the stomach, not the duodenum.
Option D: Biliopancreatic diversion is a more complex malabsorptive procedure that typically involves a distal gastrectomy (removing the lower part of the stomach) and a long Roux-en-Y limb. The anatomy shown in the image does not match this configuration.

Visual 1: Diagram - A comparative illustration showing the anatomical differences between Mini-Gastric Bypass, Roux-en-Y Gastric Bypass, and Sleeve Gastrectomy. This helps visualize the single anastomosis of MGB versus the double anastomosis of RYGB.
Visual 2: Flowchart - A decision tree for identifying bariatric procedures based on key features like 'Number of Anastomoses' and 'Site of Intestinal Connection (Stomach vs. Duodenum)'.

Clinical Relevance

Nursing practice connection: Use the key finding related to Identification of bariatric surgical procedures based on anatomical diagrams to guide bedside assessment, documentation, and the next nursing action.
Nurses must be able to recognize different bariatric procedures to anticipate specific postoperative complications. For MGB, this includes monitoring for symptoms of bile reflux, such as persistent heartburn or regurgitation.
Patient education is critical. Nurses must teach patients about the lifelong need for vitamin and mineral supplements (especially iron, B12, calcium, and vitamin D) to prevent severe nutritional deficiencies, regardless of the type of bariatric surgery.
What if? - If a patient post-MGB presents with severe, persistent upper abdominal pain and vomiting, the nurse should have a high index of suspicion for complications like internal herniation or stomal stenosis, and escalate care promptly.

How to Approach the Question

First, carefully analyze the provided surgical diagram. Identify the organs involved (stomach, small intestine) and the nature of the surgical alteration.
Pay close attention to the number and location of the surgical connections (anastomoses). In this image, there is only one connection.
Note the configuration of the intestine. Is it a simple loop brought up to the stomach, or is it divided and re-routed into a 'Y' shape?
Compare your visual findings with the definitions of the surgical procedures listed in the options.
A single anastomosis between a gastric pouch and a loop of jejunum is the key identifier for a Mini-Gastric Bypass.
Eliminate other options based on their defining features: Roux-en-Y has two anastomoses, and a Duodenal Switch connects to the duodenum, not the stomach pouch.

Concept Tested & Keywords

Concept Tested: Identification of bariatric surgical procedures based on anatomical diagrams.
Stem keywords: obesity treatment, surgical image, procedure
Lead-in keywords: Which procedure

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