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Medicine Year 1 > Week 111 - Obesity > Flashcards

Week 111 - Obesity Flashcards

1
Q

What risk are women at from having a high BMI, more so than men?

A

Type II diabetes

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2
Q

What BMI is required to be considered for bariatric surgery in Wales?

A

50+

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3
Q

what type of collagen provides mechanical strength?

A

fibrillar - type 1

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4
Q

Define catabolism

A

breaking down complex nutrients into simple molecules

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5
Q

What is the main risk of having a high BMI?

A

CVD

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6
Q

What are the restrictive surgical options for morbid obesity?

A

laparoscopic gastric banding (LGB) laparoscopic sleeve gastectomy (LSG)

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7
Q

What type of collagen forms tendons primarily?

A

type 1

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8
Q

Define anabolism

A

building up of complex molecules required for life

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9
Q

What is classed as clinically obese?

A

30+ BMI

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10
Q

What are the malabsorptive surgical options for morbid obesity?

A

laparoscopic biliopancreatic diversion with duodenal switch (BPD with DS)

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11
Q

What is the function of fibril-associated collagen?

A

link fibrillar collagens together

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12
Q

What molecules is energy stored in?

A

ATP and NAD+

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13
Q

What does a BMI chart not take into account?

A

Age or gender

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14
Q

How does gastric banding and sleeve gastrectomy generally work?

A

decrease food intake by decreasing stomach size

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15
Q

What do sheet-forming and anchoring collagens function as?

A

Form 2D networks in basal laminae and connect it to skin/underlying connective tissue

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16
Q

What does NAD+ act as?

A

An electron carrier

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17
Q

Why is using a BMI chart not good for women?

A

Have a higher % body fat which increases with age

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18
Q

How does BPD with DS generally work?

A

decreases calorie consumption absorbed by GI tract

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19
Q

What do transmembrane collagens act as?

A

adhesive receptors

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20
Q

What does NAD+ become once it has been reduced?

A

NADH + H+

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21
Q

What is the best way to measure obesity?

A

Waist circumference

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22
Q

What are the combined surgical options for morbid obesity?

A

laparoscopic gastric bypass

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23
Q

What amino acids are the polypeptide chains of collagen primarily made up of?

A

Proline and glycine

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24
Q

NAD+ carries electrons associated with what process?

A

catabolism of O2 during respiration

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25
Q

What is the first line of treatment in obese patients?

A

Diet and physical activity

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26
Q

How does gastric bypass generally work?

A

Combines decreasing stomach size with decreasing calorie consumption

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27
Q

What arrangement do fibrillar collagens have?

A

Quarter stagger arrangement

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28
Q

What does NADP+ function as?

A

Electron donator

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29
Q

Why were drugs like Rimonabant removed?

A

Increased risk of depression and suicide

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30
Q

What are the problems of gastric bands?

A

misplacement of band band erosion half of patients will require further surgery

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31
Q

What is quarter stagger packing?

A

Molecules are displaced 1/4 of their length

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32
Q

NADP+ donates electrons in what processes?

A

Anabolic processes

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33
Q

What else is sibutramine used for?

A

antidepressant

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34
Q

What is done in sleeve gastrectomy surgery?

A

Subtotal gastrectomy (removes most of stomach) so becomes a tube

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35
Q

What cells compose tendons?

A

tenocytes and fibroblasts

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36
Q

Define the respiratory exchange ratio

A

CO2 produced / O2 used

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37
Q

How did Rimonabant work?

A

Mimiced effect of endocannabinoids in brain

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38
Q

What are the benefits to LSG?

A

reduced portion size reduced transit time - arrives faster to SI so GLP-1 released quicker

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39
Q

What are the function of tendons?

A

transmit muscle forces with minimal elongation

40
Q

What fuel do red blood cells use?

A

glucose

41
Q

What effect does GLP-1 have in humans?

A

decreases appetite by maintaining blood glucose levels and slows gastric emptying

42
Q

What are the problems associated with LSG?

A

Reflux Stenosis Dilatation

43
Q

What fuel do white blood cells use?

A

glucose

44
Q

What is the mechanism of GLP-1?

A

decreases glucagon secretion by alpha cells in pancreas

45
Q

What is done in biliopancreatic diversion with duodenal switch (BPD with DS) surgery?

A

Sleeve gastrectomy performed (70% stomach removed), and two pathways are created from small intestine with one common channel.

46
Q

What fuel does the liver use?

A

fatty acids

47
Q

When do levels of GLP-1 increase?

A

After ingestion of food

48
Q

What is the aim of having two pathways in the small intestine with one common channel before entering the large intestine?

A

Reduce the amount of time the body has in absorbing calories from the diet in the small intestine and selectively limit the digestion of fat by forcing bile to travel down the longer pathway

49
Q

What fuel does the brain use?

A

Glucose (or ketone bodies in starvation)

50
Q

How is the digestion of fat selectively limited in a BPD with DS?

A

The longer pathway (biliopancreatic loop) carries bile from the liver to the common channel and the shorter pathway takes food straight to the common channel - so chance that they meet and fat is digested is lowered

51
Q

State the process of B-oxidation in the liver

A

fatty acids –> 2 acetyl CoA + energy

52
Q

What are the advantages of BPD with DS?

A

Can eat normal portion sizes Excellent comorbdity resolution 90% EWL at 2 yrs

53
Q

Statet the process of ketogenesis in the liver

A

2 acetyl CoA –> 4 ketone bodies

54
Q

What are the disadvantages of BPD with DS?

A

Very demanding operation hospital stay Lifetime high protein diet 0.5% mortality

55
Q

What fuel does the heart use?

A

Ketone bodies

56
Q

What is done in laparoscopic gastric bypass?

A

Bypasses most of the stomach and small intestine via food channel to avoid digestion

57
Q

What fuel does the kidney cortext use?

A

Fatty acids and Ketone bodies

58
Q

What are the problems with LRYGB?

A

Dumping syndrome Hospital stay

59
Q

When are there high levels of ketone bodies

A

Starvation

60
Q

What are the benefits of LRYGB?

A

75% EWL at 2 years Type II diabetes mellitus resolution rates 85%

61
Q

How long does it take for fat to be liberated from deposits to enter the bloodstream?

A

15-20minutes exercise or after 24 hours starvation

62
Q

What are the problems with obese patients undergoing surgery?

A

Intubation/ventilation problems

63
Q

What happens during the first 24 hours of starvation?

A

Glycogenolysis Glycogen –> glucose

64
Q

Give the equation for BMR

A

weight (kg) x 24kcal / day

65
Q

What conditions increase a persons BMR?

A

hyperthyroidism exposure to cold regular exercise fever

66
Q

What conditions decrease a persons BMR?

A

hypothyroidism starvation hypothermia sustained idleness

67
Q

what four marcromolecules form extra cellular matrix (ECM)? cartilage

A

collagen elastin proteoglycans glycoproteins

68
Q

Define metabolism

A

chemical transformations made by cells and tissues during life

69
Q

How does orlistat work

A

prevents the digestion and absorption of fat by binding to GI lipases

70
Q

What ethnicity is predisposed to a higher risk of obesity?

A

Pima indians

71
Q

What drug used to obesity acts as a cannabinoid receptor 1 agonist?

A

Rimonabant

72
Q

What drugs are used to decrease glucagon secretion thus hepatic glucose output, and decrease gastric emptying?

A

GLP-1 analogues

73
Q

What is drug required to be tested before being considered for bariatric surgery?

A

Orlistat

74
Q

What BMI is required to be considered for bariatric surgery in England?

A

40+ or 35+ with comorbidities

75
Q

what type of cartilage is pressure tolerant?

A

articular cartilage

76
Q

What % water is the body made up of?

A

55%

77
Q

What is the function of protein in the body?

A

form structural proteins, enzymes, transport/binding proteins found in membranes/cytoplasm and blood

78
Q

What is the only drug that can be prescribed to obese patients?

A

Orlistat

79
Q

Name the obesity related comorbidity

A

T2DM Hypertension Obstructive sleep apnoea OA Depression Subfertility Increased rates of CV disease/cancer

80
Q

What drug used to treat obesity acts as a pancreatic lipase inhibitor?

A

Orlistat

81
Q

what do ligaments do?

A

link bone to bone

82
Q

What firstline drug is prescribed to obese patients to treat diabetes type II?

A

Metformin

83
Q

What drug used to treat obesity acts as a reuptake inhibitor of serotonin?

A

Sibutramine

84
Q

What do tendons do?

A

link muscle to bone

85
Q

What % protein is the body made up of?

A

19%

86
Q

What % lipid is the body made up of?

A

19%

87
Q

What is the function of water in the body?

A

provides medium for the rapid transport and metabolism of metabolites

88
Q

How does Metformin work?

A

Suppresses glucose production by liver

89
Q

What are the main environmental causes of obesity?

A

High food intake+Lack of physical activity

90
Q

what type of joint is the knee?

A

synovial hinge

91
Q

How in theory would an SNRI work as an appitite supressant?

A

Blocking seratonin reuptake in GUT - increased Satiety Blocking noadrenaline reuptake - increased sympathetic tone (AP firing rate) -> increased metabolism

92
Q

How does Orlistat work?

A

Pancreatic lipase inhibitorInhibits fat absorbtion in the gut

93
Q

Name some of the conditions you are at risk of by being obese?

A
  • hypertension - stroke - type 2 diabeties - mycardial infarction (heart attack) minors: - sleep apnea - GORD - gallstones - cancer - osteoarteritis
94
Q

What is the definition of Metabolic syndrome?

A

Someone who is- Centerally Obese (measured via waist circumfrence) - diabetic - hypertensive

95
Q

What BMI is classes as obese?

A

> 30

Medicine Year 1 (39 decks)

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