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APA 3 - Wolfe > Obesity > Flashcards

Obesity Flashcards

1
Q

What is the primary factor in the development of obesity?

A

Genotype

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2
Q

decreased activity, ease of increased caloric intake, socialization, age, sex, race and economic status are what factors in the development of obesity?

A

Environment

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3
Q

T/F: Adipose tissue is considered an organ

A

True

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4
Q

____ Leading Cause of preventable death
(10% - 50% greater chance of death from all causes)

Affects ___ of adults in America
35% have BMI > 30

A

2nd

3/4

More stats on slide 3

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5
Q

Calculation for BMI

A

Weight(kg)/height(m2)

(Weight[lbs}/Height[in2]) X 703

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6
Q

What are the BMI classes

A 
25-29.9 	Overweight
30-34.9	Obese Class I
35-39.9	Obese Class II 
40-44.9	Obese Class III/Morbidly Extreme Obese
>45	Obese Class IV/Severe Obesity
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7
Q

Calculation for ideal body weight (IBW)

A

Broca’s Index

Male = Height(cm) – 100
Female = Height(cm) – 105
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8
Q

Calculation for lean body weight

A

IBW x 1.3

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9
Q

Lean body weight is 30% higher than IBW, why?

A

due to extra muscle mass developed to carry extra weight

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10
Q

Adipose Tissue: Major physiologic function

Secretes

A

protein

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11
Q

Adipose Tissue: Major physiologic function

Endocrine organ -

A

readily convertible and usable energy

heat insulation

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12
Q

Adipose Tissue: Major physiologic function

Liver fat metabolism - why is this important?

A

because all cells contain some unsaturated fats synthesized by the liver

Degradation of fatty acids into usable units of energy
Synthesis of triglycerides from carbohydrates and proteins
Synthesis of other lipids from fatty acids (particularly cholesterol and phospholipids)

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13
Q

What is android distribution?

A

Central or abdominal visceral

Apple shaped

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14
Q

In the android distribution, waist/hip ratio is greater than ___ in men and ____ in women.

A

0.85 men
0.92 women
Correlated with higher risk of comorbidities

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15
Q

What is gynecoid distribution?

A

Gluteal femoral or peripheral

Pear shaped

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16
Q

Which type of obesity is associated with greater amount of comorbidities?

A

Android

heart disease, DM, HTN, dyslipidemia, death

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17
Q

What is gynecoid obesity associated with?

A

Varicose veins, joint disease

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18
Q

Cardiac pathophysiology:
Increased metabolic demand from..
Increased Cardiac Output of ___ for each kg of fat

A

fat organ

0.1 L/mi

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19
Q

Cardiac pathophysiology:
Increased ____ and increased ____
For every ____ of fat = 25 miles of neovascularization
Increase ____ + _____ = HTN

A

Vessels and volume

13.5 kg

Increase volume + RAA activation = HTN

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20
Q

Cardiac pathophysiology:

Increased workload to meet demand has what effects

A

Increased CO, O2 consumption, CO2 production

Cardiomegaly, atrial and biventricular dilatation and hypertrophy

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21
Q

Is CAD a dependent or indépendant factor with obesity?

A

independent

22
Q

Definition of HTN in obesity

A

SBP > 140, DBP > 90, or both

2 times risk in obesity

23
Q

Why is there a 2X risk of HTN in obesity?

A 
Increased blood viscosity
Hyperinsulinemia
Increased mineralocorticoids
Sodium reabsorption
Compression of kidneys
Impaired sodium excretion
RAA activation
24
Q

Respiratory pathophysiology

Why is there decreased compliance?

A

Pressure from abdominal, diaphragmatic , and thoracic fat

25
Q

What is the F/V loop pattern?

A

Restrictive

26
Q

Inhibited lung inflation leads to
Decreased:
Increased:
No change:

A

Decreased: FRC, ERV, VC, TLC
Increased: dead space
No change: RV, CC, FVC, FEV1

27
Q

Why is there a decreased FRC to < closing capacity?

A

Increased dead space, vq mismatch, shunting, hypoxemia

28
Q

What else does obesity lead to with respiratory?

A

Hypoventilation, hypercarbia, acidosis

29
Q

OSA rates are ____ portion to BMI

A

directly

30
Q

Risk factors for OSA in obesity

A

BMI > 30
abdominal fat distribution
large neck girth

31
Q

Definition of OSA

A

Excessive episodes of apnea (10 seconds) and hypopnea

Estimated that 80%-95% are undiagnosed

32
Q

How do episodes of apnea work in OSA

A

Obstruction –> hypoxia and hypercarbia –> surge of muscles to open airway –> period of hyperventilation –> reverses hypercarbia –> normal breathing –> start all over

33
Q

In OSA, > 5 episodes per hour or 30 per night

this will lead to what?

A

Hypoxia, hypercapnia, systemic and pulmonary hypertension, and cardiac arrythmias

34
Q

In pre-op, what questions should you ask about sleep apnea?

A

ask about sleeping patterns, snoring or apnea, arousals, diurnal sleepiness

35
Q

What is the gold standard test for OSA

A

polysomnography (PSG)

36
Q

STOP-BANG

A 
Snoring
Tiredness
Observed apnea
High BP
BMI (greater than 35)
Age (greater than 50)
Neck circumference (>40cm/15.75in)
Gender (male)
37
Q

Surgery centers should not do patients with a BMI >

A

45

38
Q

What is obese hypoventilation (pickwickian syndrome)?

A

Inappropriate and sudden somnolence, OSA, Hypoxia, Hypercapnia, arterial hypoxemia, cyanosis-induced polycythemia, respiratory acidosis, pulmonary hypertension, Right sided heart failure

39
Q

How does pickwickian lead to right sided heart failure

A

HPV –> pulmonary HTN –> cor pulmonale

40
Q

GI risks with obesity

A

GERD, gallstones, pancreatitis
Fatty liver disease – 3% develop cirrhosis
NAFLD (non-alcoholic fatty liver disease)

41
Q

DM risk with obesity

A

80% of NIDDM pts are obese

Risk linear to BMI

42
Q

Metabolic syndrome with obesity

A

Glucose intolerance, DM2, HTN, dyslipidemia, CVD

Cardiovascular risk 50%-60% above normal

43
Q

Ortho risk with obesity

A

Osteoarthritis from mechanical stress

44
Q

How much of pediatric population is considered obese?

A

16.9% age 2-19 considered obese
Weight for height ratio > 90%
BMI > 95%

45
Q

Complications with obesity and pregnancy correlate more with _____

A

pre-pregnancy obesity

Gestational DM, preeclampsia, preterm labor, c-section, postpartum hemorrhage, infection, PIH (pregnancy-induced hypertension), macrosomic infants

Double 1st 6 weeks miscarriage

46
Q

Is the complication risk in pregnancy increased or decreased after bariatric surgery?

A

increased

47
Q

What are the altered body compositions for pharmacology in obese patients?

A

Increased Vd
Increased blood volume
Decreased total body water
Alterations of protein binding & lipophilicity of drug

48
Q

Ideal Body Weight vs. Total Body Weight
Meds low lipophilicity =
Meds high lipophilicity =
inhaled anesthetic

A

IBW
TBW most of the time (digoxin, remifentanil, procainamide)

sevo and des

49
Q

Pharmacokinetic changes with obesity
Increased:
Decreased:

A

Increased: fat mass, C.O., blood volume, lean body weight, renal clearance, volume of distribution of lipid soluble drugs

Decreased:total body water, pulmonary function

Changes in plasma binding, abnormal liver function
(Pg 1007)

50
Q 
GA induction -
 \_\_\_% reduction in FRC
\_\_\_\_ achieves improvement in FRC and arterial O2 tension, may decrease CO and O2 delivery
\_\_\_\_ ml/kg IBW for volumes
Intermittent manual \_\_\_\_ may help FRC
A

50%
PEEP
6-10
“sighs”

51
Q

In obese patients, there is an increased ____ BUT proportionately decreased _____

A

total body volume

Estimated blood volume

52
Q

What EBV is used for obese patients

A

45-55 ml/kg

APA 3 - Wolfe (11 decks)

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