Obesity PPT-Josh Flashcards

1
Q

what is the WHO definition of BMI categories for obesity

A
  • Overweight > or = 25
  • Obese > 30
  • Obese I : 30-34.9
  • Obese II: 35-39.9
  • Obese III: >40
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2
Q

what is the BMI calculation

A

BMI= KG / height in meters2

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3
Q

how to calculate IBW

A
  • Women
    • 100 + 5 lbs for each inch > 5 foot
    • Or Cm- 105
  • Men
    • 105 + 6 lbs for each inch > 5 foot
    • Or cm-100
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4
Q

fat deposition:

what are the two man shapes?

A

apple

Pear

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5
Q

fat deposition:

which one are you?

A

j/k that sucks I think I am both

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6
Q

fat deposition:

other name for Pear shape

A

Gynecoid

( how to remember-Think of a pear this is a divit (crease) in the bottom middle like a vagina AKA GYN)

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7
Q

fat deposition:

Another name for apple shape?

A

Android

(how to remember- Apples competition is the android)

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8
Q

fat deposition:

where is fat placed at w/ pear

A

hips more than waist

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9
Q

fat deposition:

where is fat placed for apple

A

waist more than hip

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10
Q

fat deposition:

which shape is considered better?

A

Pear

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11
Q

fat deposition:

the apple is often associated w/ what syndrome

A

Metabolic syndrome

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12
Q

Obesity:

Obesity can also be associated w/ certain d/o and conditions (besides just over eating) what are they?

A
  • Cushings Syndrome (release of cortisol)
  • Hypothyroid (underactive thyroid)
  • Neurological disturbances ( hypothalamus damage as it regulates appetite)
  • Drug induced (steroids, antipsychotics, antidepressants)
  • Psychological (emotional eating)
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13
Q

what changes occur r/t to obesity to the Cranium

A

Benign Intracranial HTN

H/A dizziness

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14
Q

what changes occur r/t to obesity to the locomoter system

A
  • weight related musculoskeletal d/o; arthritis
  • Trapped nerves
  • Gout
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15
Q

what changes occur r/t to obesity to GU system

A
  • Kidney disease
  • Uturine CA
  • Prostate CA
  • Pregnancy problems
  • Stress incontinence
  • Polycystic ovary disease
  • Infertility
  • ED
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16
Q

what changes occur r/t to obesity to the metabolic system

A
  • NIDDM
  • Dyslipidemia
  • Impaired glucose tolerance
  • raised uric acid (Gout)
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17
Q

what changes occur r/t to obesity to the neuropsychiatric system

A
  • Macular degeneration
  • Alzheimers
  • Depression
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18
Q

what changes occur r/t obesity to the Vascular and CV system

A
  • Stroke
  • HTN
  • CAD
  • thrombosis
  • HF
  • Varicose veins
  • Oedema
  • A-Fib
  • Arrhytmias
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19
Q

what changes occur r/t obesity to the GI system

A
  • Gallstones
  • Hiatus Hernia
  • Colon CA
  • Fatty liver (cirrhosis)
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20
Q

what changes occur r/t obesity to the respiratory system

A
  • Breathlessness
  • OSA
  • Hypoventilation
    *
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21
Q

what changes occur r/t obesity to other systems not previously mentioned

A
  • Breast Ca
  • Hirsuitism
  • Sweating
  • Sweat rashes
22
Q

In what ways does obesity cause a potential problematic Airway

A
  • IGD <3 cm
  • short TMD
  • limited head and neck extension
  • Poor Mallampati
  • Increased Body weight
  • Short, thick necks
23
Q

Obesity:

what are the 2 main complications in teh obese ot, r/t Oxygen

A

increased demand

Decreased supply

24
Q

Obesity: Pulmonary

the increased demand (metabolic demands of “fat organs”) results in what 3 events

A

Increased demand

  1. Increase O2 consumption
  2. Increased CO2 production
  3. Increased Alveolar ventilation
25
Q

Obesity: Pulmonary

the decreased supply of O2 (r/t abd and chest wall fat) causes what?

A
  • decreased chest wall compliance
  • decreased lung volumes
  • decreased FRC
  • premature airway closure
  • V/Q mismatch
  • Arterial Hypoxia
  • Increased work of breathing
  • decreased respiratory muscle efficiency
26
Q

what is another name for Obesity Hypoventilation Syndrome?

A

Pickwickian syndrome

27
Q

Pickwickian Syndrome:

what the fuck is its characteristics

A
  • Hypercapnia
  • Hypoxia
  • Periodic breathing
  • Excessive daytime sleepiness
  • Snoring
28
Q

Pickwickian Syndrome:

leads to strain on the hear that can cause what?

A
  • Biventricular enlargement ( RT>LT)
  • Dependent edema
  • Polycythemia
  • Pulmonary edema
  • Cor Pulmonale
29
Q

Pickwickian Syndrome:

what is the treatment

A
  • best is weight loss
  • next is CPAP
30
Q

Obesity:

Morbidity and mortality are predominantly due to CV diseases, what are the main 3

A
  • Ischemic heart disease
  • HTN
  • Cardiac failure
31
Q

Obesity:

there is an increased CO of ____L/min for each KG of fat acquired

A

o.1L/min

32
Q

Obesity:

is CHF associated w/ fatty infiltration of the myocardium due to obesity

A

NOPE

33
Q

Obesity:

Preop

what questions should you ask for hx

A
  • Duration of obesity
  • Past MI, HTN, or pVD
  • Excercise tolerance
  • Orthopnea
  • Paraxysmal nocturnal dyspnea
  • Current meds
  • Diet pills
34
Q

Obesity:

PE

what do you wat to assess for

A
  • Orthopnea
  • Symptoms
  • Assess airway
  • ROM
35
Q

Obesity:

Test

what test do you want preop on these fat assess

A
  • CBC
  • Urine
  • LFT
  • ECG
  • ECHO
  • ABG
  • X-ray
    *
36
Q

Obesity:Airway

a neck circumference of > than ____ inches in men or ____ inches in women may indicates undiagnosed OSA

A

men 17

Women 16

37
Q

Obesity:Airway

what problems may you run into

A
  • diff mask ventilation ( big cheeks, short neck, restrictions in mouth opening, Limited cervical and mandible movements)
  • ETT placement more difficult (excessive palatal and pharyngeal soft tissue
  • De-sat quick
  • Ventilatory depressent drugs cause faster de-sat
  • OHS (AKA OSA)
38
Q

Obesity: Pharmacology

lipophilic drugs have what effect

A
  • Larger Vd and thus longer elimination 1/2 life (hang around longer)

(i like to thinks of these drugs as black men.. They love fat, thus They marry our fat white chicks and HANG around them longer)

39
Q

Obesity: Pharmacology

Certain liphophilic drugs are exceptions and have normal Vd, what are a few of them

A

remifentanil

Digoxin

procainamide

40
Q

Obesity: Pharmacology

most routine anesthestic drugs listed require an initial bolus on TBW, but maintence dosing is based upon what?

Benzos

Barbs

Narcs

Fenanyl

A

IBW

41
Q

Obesity: Pharmacology

paralytics such as roc and vec are dosed according to what?

A

IBW

42
Q

Obesity: Pharmacology

how is Unfractionized heparin, enoxaprain, and vancomycin dosed

A

TBW

43
Q

Obesity: Intraop

Monitors and getting ready.. what to you wanna do

A
  • Standard monitors
  • Venous access (no shit)
  • PREOXYGENATE 3-5 min
  • Poss AFOI
  • Cricord pressure
44
Q

Obesity: Intraop

effects on CV

the degree of cardiac abnormality is correlated w/ the degree of obesity: what are usual CV symptoms we must be midfull of

A
  • LV dysfucntion
  • HTN
  • Increased pre-load/afterload
  • Increased PAP
45
Q

Obesity: Intraop

effects on Pulmonary

the degree of pulmonary abnormality is correlated w/ the degree of obesity: what are usual Pulmonary symptoms we must be midfull of

A
  • Increased O2 consuption and CO2 production
  • Increased Work of breathing
  • Decreased chest wall compliance
  • Anesthesia leads to a 50% decrease in FRC (in normal pt’s only leads to a 20% decrease)
46
Q

Obesity: Intraop management

what is the prefered mode of ventilation

A

controlled ventilation w/ LARGE Tv

47
Q

Obesity: Intraop management

what is a big pro and con of PEEP with fatties

A
  • May improve Oxygenation, but associated w/ decrease in CO
48
Q

Obesity: Postop management

if extubating on table what position should you consider?

A

reverse trend (head up)

49
Q

Obesity: Postop management

before the pt is “light” what type of airway is good to use

A

nasal

50
Q

Obesity: Postop management

during extubation adequate pain control is often accompied w/ fuller deeper breaths, but narcs can hinder this in fatties, what is a better choice

A

ofirmev

51
Q

Obesity: Postop management

post intubation what is a good position for them

A

head up 30 degress and lateral decubitus

52
Q

Thats it a special thanks goes out to Sam Tim

A

whatever were done,