1.āPlease describe your body weight at present | Kg |
2.āPlease put a circle around the number below that fits your present postoperative whole amount of meal intake per day compared to your preoperative whole meal intake. | Ā |
āĀ Ā ā1) 20% | Ā |
āĀ Ā ā2) 40% | Ā |
āĀ Ā ā3) 60% | Ā |
āĀ Ā ā4) 80% | Ā |
āĀ Ā ā5) 100% | Ā |
āĀ Ā ā6) Other | % |
3.āPlease put a circle around the number below that fits your description of abdominal symptoms often occurring especially after meals at present. | Ā |
āĀ Ā ā1) Borborygmi | Ā |
āĀ Ā ā2) Abdominal pain | Ā |
āĀ Ā ā3) Diarrhea | Ā |
āĀ Ā ā4) Nausea, or Vomiting | Ā |
āĀ Ā ā5) Abdominal sensation of feeling full | Ā |
āĀ Ā ā6) Abdominal discomfort | Ā |
āĀ Ā ā7) Heart burn, or Reflux | Ā |
āĀ Ā ā8) No symptoms | Ā |