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â–º Med Misc 44 > Obesity > Flashcards

Flashcards in Obesity Deck (109)
1

what is defined as an increase in body weight above a standard related to height?

 

Overweight

 

2

what is defined as being characterized by an abnormally high percentage of body weight as fat of sufficient magnitude to impair health

obesity

3

what is a concept defines by life insurance companies- is the weight associated with the lowest mortality rate for a given height and gender?

Ideal body weight (IBW)

4

IBW:

what is IBW for a female

height (cm) - 105

5

IBW:

what is IBW for Males

height (cm) - 100

6

is lean body weight (LBW) synonymous with IBW

no

7

LBW:

how is it calculated or what is it defined as

the TBW minus the adipose tissue weight

8

LBW:

formula

IBW + (20 to 40%)

9

what is the formula for BMI

BMI = kg / m^2

10

BMI:

Underweight

11

BMI:

normal

18.5-24.9

12

BMI:

Overweight

25-29.9

13

BMI:

Obese (I)

30-34.9

14

BMI:

Obese (II)

35-39.9

15

BMI:

Morbid obesity (III)

>/= 40

16

BMI:

Superobese

>/= 50

17

BMI:

Super-superobese

>/= 60

18

Distribution of Body fat:

what are the 2 types of body fat?

Android (apple) 

Gynecoid (pear)

19

Distribution of Body fat:

Apple or Pear

Apple

20

Distribution of Body fat:

Apple or pear

pear

21

Distribution of Body fat: Android (apple)

fat is predominetly located where?

upper body

22

Distribution of Body fat:​ Android (apple)

associated with increased consumption of what?

O2

23

Distribution of Body fat:​ Android (apple)

have an increaced incidence of CV disease particulary what?

LV dysfunction

24

Distribution of Body fat:​ Gynecoid (pear)

fat is usually where

hips

butt

thighs

25

Distribution of Body fat:​ Gynecoid (pear)​

why is there a decreases risk of CV disease in these pt's

less metabolically active fat

26

what is the newly est standard used as a marker for abdominal obesity?

waist circumference

27

A waist circunference greater than what in men denotes an increased risk for certain diseases and conditions including DM, Heart dz, HTN, dyslipidemia, and death?

102 cm (40.2 inches)

28

A waist circunference greater than what in women denotes an increased risk for certain diseases and conditions including DM, Heart dz, HTN, dyslipidemia, and death?

 

58cm (34.6 inches)

 

29

Respiratory:

what happens to lung voumes

decrease

30

Respiratory:

what happes to work of breathing

increases

31

Respiratory:

what are some of the airway changes

decreased pharyngeal area

excessive hypopharyngeal tissue

posterior displaced hyoid bone

 

32

Respiratory:

fat accumulation on the thorax and abdomen decress chest wall and lung compliance by about how much

35%

33

Respiratory:

what happens to TLC, ERV and FRC

 

decreased

 

34

Respiratory:

what happens to TV, residual voume, and closing capacity

nothing, usually no changes

 

35

Respiratory:

the reduction in FRC is explained primarily d/t what?

reduced ERV

FRC = RV + ERV

36

Respiratory:

when CC > FRC what occurs

V/Q mismatch

37

Respiratory:

Once CC > FRC and the V/Q mismatch arises what occurs?

CO2 retention (acidosis)

right to left shunting 

arterial hypoxemia

38

Respiratory:

In response to the CO2 retention and arteial hypoxia what are their respiration usually like 

 

rapid and shallow

 

39

 Respiratory:

they develop what type of respiratory disease pattern

restrictive

40

Respiratory: anesthesia concerns

the obese pt has a decrease in FRC of how much compared to the 20% decrease if the non-obese

50%

41

Respiratory:

obesity increases ____ and _____ even at rest

oxygen consumption and CO2 production

42

Respiratory:

bc of the increased O2 consuption and CO2 production combined with the decreased FRC and V/Q mismatch the obese pt usually develops chronic what?

arterial hypoxia

43

Respiratory:

the chronic arterial hypoxia leads to what CV problems

Pulm HTN and Cor Pulmonale

Aka right heart failure

44

OSA:

what is a milder precuror to OSA and is defined as partial decreased airflow (>50% reduction), lasting 10 seconds, occuring >15/hr of sleep, and accompied by at least a 4% reduction in arterial oxygenation.

OSH

obstructie sleep hypopnea

45

OSA:

risk factors obese

male

middle aged

BMI > 30

evening ETOH consumption

46

 OSA:

risk factor for non-obese

 crainofacial dytoses

cartilaginous abnormalities

Chronic nasal obstruction

tonsilar hypertrophy

trisomy 21

47

OSA:

what are the hallmark signs of OSA

Snoring

daytime sleepiness

impaired concentration

memory problems

morning headaches

48

OSA:

apnea is defined as what?

cessation of airflow > 10 sec

=/> 5 times per hour of sleep

dispite continued ventilatory effort against clossed glottis

in combination with at least 4% decrease in arterial oxygenation

49

OSA:

what follows period of apnea and why?

hyperventilation

to compensate for hypercarbia

50

 OSA: Physical Alteration

what happens to arterial O2

Arterial Hypoxemia

51

OSA: Physical Alteration

what happens to CO2

Hypercarbia

52

OSA: Physical Alteration

what happens to pulmonary and systemic vasculature

Vasoconstriction

53

OSA: Physical Alteration

what happens to blood components

polycythemia

54

OSA:

the definative diagnosis for of OSA is made how?

polysomnography in sleep lab

55

OSA:

what is an assessment questionmaire you may use in the preop period

STOP BANG

56

OSA:

explain the STOP BANG questionnaire

  • do you SNORE loudly
  • do you feel TIRED during the daytime most everyday
  • has anyone see you STOP breathing during sleep
  • so you have a high blood PRESSURE
  • is BMI > 35
  • is AGE greater then 50
  • is NECK circumference greater then 40cm
  • in GENDER male

57

OSA:

with the STOP BANG your at high risk for OSA if you score what?

> 3 are yes

58

OSA:

you are at low risk for OSA if your score is what on the STOP BANG?

59

OSA:

definative treatment of OSA is what?

Positive airway pressure in the forms of IPAP. EPAP, and CPAP

60

OSA: Anesthestic concerns

they are exquisitely sensitive to all CNS depressants, so what should we use sparingly in the preop phase

Benzo

Opioids

61

what is a disorder like OSA but more severe?

Obesity Hypoventilation Syndrome (OHS)

62

Obesity Hypoventilation Syndrome (OHS)

is also called what?

Pickwickian Syndrome

63

Obesity Hypoventilation Syndrome (OHS)

is a complication of extreme obesity, characterized by what

 

OSA

Hypercapnia

Daytime Hypersolmnolence

arterial hypoxemia

Cyanosis-induced polycythemia

respiratory acidosis

Pulm HTN

right sided heart failure

 

 

64

Obesity Hypoventilation Syndrome (OHS)

can lead to central apnea, what is that?

 

Apnea without resp effort

 

65

what is the main difference b/t Obesity Hypoventilation Syndrome (OHS) and OSA?

Obesity Hypoventilation Syndrome (OHS)- can lead to central apnea which is apnea without respiratory effort

66

Obesity Hypoventilation Syndrome (OHS)

what are the 3 main diagnostic critera to define it

BMI > 30

Awake PCO2 > 45mmHg

sleep disordered breathing

67

the prevalence of Obesity Hypoventilation Syndrome (OHS) in pts with OSA is what?

small 4-20%

68

the prevelance of OSA with Obesity Hypoventilation Syndrome (OHS) is what?

high- 90%

 

69

basically pts with Obesity Hypoventilation Syndrome (OHS) almost always have OSA

but pt's with OSA usually don't have Obesity Hypoventilation Syndrome (OHS)

70

CV and Hematologic:

CO increases how much for each kg of excess body fat?

20-30 mL/kg

(about 100mL/min per kg)

71

CV and Hematologic:

total blood volume is increased in the obese BUT on a volume to weight basis it is ______ than in the non-obese

less

72

CV and Hematologic:

EBV calculation for  Obese

50mL/kg

(vs 60mL/kg female non-obese and 70mL/kg male)

73

CV and Hematologic:

the expanded blood volume places a greater demand on what?

the myocardium

74

CV and Hematologic:

the expanded blood volume places a greater demand on the myocardium, specifically increased what?

LV wall stress

75

CV and Hematologic:

the expanded blood volume places a greater demand on the myocardium, specifically increased LV wall stress. According to the LAw of Laplace the LV will do what in attempt to reduce wall stress

Hypertrophy

76

CV and Hematologic:

LV hyertrophy leads to what complications

Hypertrophy

reduced LV wall stress

impaired diastolic filling

elevated LV pressures

Pulmonary edema

Systolic dysfunction

Biventricular failure

77

CV and Hematologic:

adipose tissues releases a number of bioactive mediators (cytokines, chemokines, hormones) that promote a chronic, sub-clinical inflammatory state. This can contribute to what complications?

CV disease

Insulin resistance

coagulopathies

78

CV and Hematologic:

obese people have a 2xs higher risk of developing what coag disorder

DVT

79

CV and Hematologic:

high Factor ____ levels are associated w/ increased CV mortality

VIII

80

Gastrointestinal:

what happens to gastric volume and acidity

increased

81

Gastrointestinal:

why do they develop delayed gastric emptying?

increased abd mas

82

Gastrointestinal:

what liver abnormalities are associated with obesity

NAFLD

inflammation

focal necrosis

Cirrhosis (1.5-2.5 x greater)

83

Gastrointestinal:

both males and females who are obese have an increased risk for what cancer

esophageal and colorectal

84

Endocrine and Metabolic:

the risk of what is linear with BMI

DMII

85

Endocrine and Metabolic:

obese people have a higher incidence of what metobolic d/o (not DM)

Metabolic syndome

86

Endocrine and Metabolic:

what is metabolic syndrome

constellation of metabolic abnormalities including

Abdominal obesity

glucose intolerance

HTN

dyslipidemia

87

Endocrine and Metabolic:

diagnosis of metabolic syndrome requires what?

Android obesity

with at least 2 of the following

  • high triglycerides
  • reduced HDL
  • HTN
  • elevated fasting serum glucose

88

Genitourinary:

what happens to Renal blood flow and GFR

increased

89

Genitourinary:​

why does GFR and Renal blood flow increase in the obese

d/t the increased CO and Increased MAP

90

Bariatric Surgery:

what are the 2 categories of sx

gastric restrictive

combo gastric restrictive and malabsortion

91

Bariatric Surgery: Restrictive

what is the goal of this category

reduce and limt the pts capacity for food intake

92

Bariatric Surgery:​ Restrictive

what are 3 procedures

Vertical band Gastroplasty (VBG)

Laparoscopic gastric band (LGB)

laparoscopic sleeve gastrectomy (LSG)

93

Bariatric Surgery:​ Combined Restrictive & Malabsorption:

what is an example

Roux-en-Y gastric bypass (RYGB)

94

Bariatric Surgery:​ Combined Restrictive & Malabsorption:

what is the biggest risk with the surgery

Anastomosis leak and peritonitis

95

 Pharmacology:

2 pharmacokinetics principles should be kept in mind when determining drug doses for obese pt's what are they?

 

volume of distribution

clearance

96

Pharmacology:

what is general rule to give drugs

 

IBW (induction) then titrate to effect

 

97

Pharmacology:

most drugs we give should be given based off what weight (except for NDMR)

TBW

98

Pharmacology:

how should NDMR be dosed

LBW (IBW)

99

Anesthestic Management: Preop

what should we look for to evaluate for LEft and right ventricular failure

 

Elevated Jugular venous pressures

added heart sounds

Pulmonary crackles

Hepatomegaly

peripheral edema

 

100

Anesthestic Management: Preop

what on the echo will inticate to us the pt has pulm htn

tricuspid regurg

101

Anesthestic Management: Preop

what should we ask about r/t respiratory

Smoke

Exercise tolerance

somnolence

OSA

102

Anesthestic Management: Preop

what do we wanna look for during airway evaluation

limited movement of Alantoaxial joint (fat pads)

Limited movent of cervical (fat pads)

Short thick neck

excessive tissue (neck folds)

very thick submental fat

103

Anesthestic Management: Preop

Airway- is difficult airway closely correlated with BMI?

No

104

Anesthestic Management: Preop

since difficult airway is not corralated with BMI what is it correlated with

Increased age

Male

TMJ

MALAMPATTI II or IV

abnormal upper teeth

OSA

Neck circumference

 

105

Anesthestic Management:

what position provides the longest safe apnea period during induction of general anesthesia

Head up

Reverse trend

fowlers

106

what are the the 3 axis to line up prior to intibation

 

oral axis

Pharyngal axis

laryngeal axis

107

what is the only ventilatory parameter to show improved respiratory fxn in the obese

PEEP

108

what happens to LA needs in the obese

may decrease by 20%

109

at the end of sx goin from supine to sitting increases FRC by how much in the obese

30%

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