Obesity

Question 1

What are the two gut homes that are involved in weight control?

Answer 1

Gherlin
Glucagon-like peptide (GLP-1)

Question 2

Where is Gherlin found? What does it do?

Answer 2

Fundus of the stomach
ONLY KNOWN CIRCULATING OREXIGEN or APPETITE STIMULANT

Also increases secretion of growth hormone, cortisol and epinephrine

Question 3

When do you see gherkin suppression with gastric bypass surgery?

Answer 3

because it involves removal of the funds of the stomach, where it is made

Question 4

What does Glucagon-like Peptide 1 do?

Answer 4

Enhances insulin release
Improves beta cell function
Inhibits glucagon secretion
delays gastric emptying
Decreases food intake

Question 5

Where is GLP 1 found?

Answer 5

distal ileum and colon

Question 6

How does GLP1 improve DM?

Answer 6

through effects on Glucagon, insulin, food intake and weight loss from anorexic effects of bariatric surgery

Question 7

What are some CV effects of obesity?

Answer 7

Increase in circulating blood volume, plasma volume and CO
Increase blood volume –> increased preload & after load
All can lead to BiVent failure
HTN

Question 8

___ L/Min increase in CO for every ____ of body fat

Answer 8

0.1 ; 1kg

Question 9

What are some respiratory effects of obesity?

Answer 9

Increased demand and decreased supplyH

Question 10

How does Obesity increase O2 demand?

Answer 10

increased oxygen consumption and CO2 production
Leads to increased alveolar ventilation

Question 11

How does obesity decrease supply?

Answer 11

Decreased Chest wall compliance –> decreasing lung volume
Decreased FRC and EVR
Premature airway closure due to an increase in closing volume and capacity

Question 12

What is closing volume

Answer 12

volume of gas in the lungs in excess of the RV at a time when the small airways close during maximum exhalation

Question 13

What odes increased closing volume lead to?

Answer 13

Atelectasis and shunting of blood

Question 14

Why is WOB increased in obese pts?

Answer 14

elevation of the diaphragm from fat layers on chest wall and abdomen

Question 15

What three factors predict a return to DM after bariatric surgery?

Answer 15

long duration of DM
poor blood sugar control preop
required insulin therapy

Question 16

WHAT IS METABOLIC SYNROME?

Answer 16

Truncal obesity + at least two of the following;
Hypertriglyceridemia
HTN
Hyperglycemia (fasting BG> 100)
Low LDL

Question 17

What are the classifications for truncal obesity

Answer 17

Men >40 in and women >35 in

Question 18

What are some risk factors for metabolic syndrome?

Answer 18

Age
Race
BMI 25
Hx of DM 2 in th family or women with GD

Question 19

What is OHS?

Answer 19

Obesity hypoventilation syndrome
Also called pickwickian syndrome

Hypoventilation, leads to respiratory alkalosis, hypoxemia and polycythemia

Question 20

What can OHS lead to

Answer 20

pHTN
Right axis deviation
RV hypertension
PE
Cor pulmonae
PNA
Conversion to hypoxic drive, hypersomnolence or difficult airway

Question 21

What is malignant OHS?

Answer 21

Essentially OHS with multi system organ failure related to obesti

Question 22

What is the major criteria for Malignant OHS?

Answer 22

BMI >40
Awake hypercarbia
HCO2 > 28
Metabolic syndrome
Restrictive lung disease

Question 23

What is the minor criteria for OHS?

Answer 23

Multiple hospital admissions for respiratory failure
chronic renal insufficiency
Sleep apnea
NASH
Eccentric LVH
Vit D Deficiency
Diastolic LV dysfunction
Elevated CRP
PHTN
RV Volume overload
Systemic HTN