Obesity PPT-Josh Flashcards Preview

BioScience II > Obesity PPT-Josh > Flashcards

Flashcards in Obesity PPT-Josh Deck (52):
1


what is the WHO definition of BMI categories for obesity

 

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

2


what is the BMI calculation


BMI= KG / height in meters2

3


how to calculate IBW

 

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

4

fat deposition:

what are the two man shapes?


apple

Pear

5


fat deposition:

which one are you?


j/k that sucks I think I am both

6


fat deposition:

other name for Pear shape


Gynecoid

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

7


fat deposition:

Another name for apple shape?


Android

(how to remember- Apples competition is the android)

8


fat deposition:

where is fat placed at w/ pear


hips more than waist

9


fat deposition:

where is fat placed for apple


waist more than hip

10


fat deposition:

which shape is considered better?

Pear

11


fat deposition:

the apple is often associated w/ what syndrome


Metabolic syndrome

12


Obesity:

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

 

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

13

what changes occur r/t to obesity to the Cranium


Benign Intracranial HTN

H/A dizziness

14


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

 

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

15


what changes occur r/t to obesity to GU system

 

 

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

16


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

 

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

17


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

 

  • Macular degeneration
  • Alzheimers
  • Depression

18


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

 

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

19


what changes occur r/t obesity to the GI system

  • Gallstones
  • Hiatus Hernia
  • Colon CA
  • Fatty liver (cirrhosis)

20


what changes occur r/t obesity to the respiratory system

 

  • Breathlessness
  • OSA
  • Hypoventilation
  •  

21


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

 

  • Breast Ca
  • Hirsuitism
  • Sweating
  • Sweat rashes

22


In what ways does obesity cause a potential problematic Airway

 

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

23

Obesity:

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


increased demand

Decreased supply

24

Obesity: Pulmonary

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

Increased demand

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

25


Obesity: Pulmonary

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

 

  • 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


what is another name for Obesity Hypoventilation Syndrome?


Pickwickian syndrome

27

Pickwickian Syndrome:

what the fuck is its characteristics

 

  • Hypercapnia
  • Hypoxia
  • Periodic breathing
  • Excessive daytime sleepiness
  • Snoring

28


Pickwickian Syndrome:

leads to strain on the hear that can cause what?

 

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

29


Pickwickian Syndrome:

what is the treatment

 

  • best is weight loss
  • next is CPAP

30


Obesity:

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

 

  • Ischemic heart disease
  • HTN
  • Cardiac failure

31


Obesity:

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


o.1L/min

32


Obesity:

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


NOPE

33


Obesity:

Preop

what questions should you ask for hx

 

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

34


Obesity:

PE

what do you wat to assess for

 

  • Orthopnea
  • Symptoms
  • Assess airway
  • ROM

35


Obesity:

Test

what test do you want preop on these fat assess

 

  • CBC
  • Urine
  • LFT
  • ECG
  • ECHO
  • ABG
  • X-ray
  •  

36


Obesity:Airway

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


men 17

Women 16

37


Obesity:Airway

what problems may you run into

 

  • 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


Obesity: Pharmacology

lipophilic drugs have what effect

 

  • 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


Obesity: Pharmacology

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


remifentanil

Digoxin

procainamide

 

40


Obesity: Pharmacology

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

Benzos

Barbs

Narcs

Fenanyl


IBW

41


Obesity: Pharmacology

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


IBW

42


Obesity: Pharmacology

how is Unfractionized heparin, enoxaprain, and vancomycin dosed


TBW

43


Obesity: Intraop

Monitors and getting ready.. what to you wanna do

 

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

44



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

 

  • LV dysfucntion
  • HTN
  • Increased pre-load/afterload
  • Increased PAP

45


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

  • 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



Obesity: Intraop management

what is the prefered mode of ventilation


controlled ventilation w/ LARGE Tv

47


Obesity: Intraop management

what is a big pro and con of PEEP with fatties

 

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

48


Obesity: Postop management

if extubating on table what position should you consider?

reverse trend (head up)

49


Obesity: Postop management

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


nasal

50


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


ofirmev

51


Obesity: Postop management

post intubation what is a good position for them


head up 30 degress and lateral decubitus

52


Thats it a special thanks goes out to Sam Tim


whatever were done,