111 - Obesity Flashcards
What is obesity
BMI >30kg/m2
Complications of obesity
Increased risk of hypertension, myocardial infarction, Cerebrovascular accident (stroke), T2DM, Obstructive sleep apnoea, cancer, OA, GORD, gallstones,
Metabolic syndrome is:
Central obesity plus 2 of: High triglycerdides High cholesterol High BP High glucose
Central obesity is
Determined by waist circumference, varies between ethnicities.
Lifestyle treatments for obesity
Diet and exercise
Pharmacological treatments fro obesity (classes not drugs)
Appetite suppressants
Lipase inhibitors
Anti-diabetic drugs
Surgical treatment for obesity indicated when
BMI >40/ >35+co-morbidity
18-55yrs
5yrs+obesity
No psych issues
Surgical options
Gastric banding
Sleeve gastrectomy
Gastric bypass
Bilo-pancreativ diversion +/- duodenal switch
How does Sibutramine work?
Appetite suppressant
Acts on Arcuate Nucleus
Inhibits serotonin reuptake - increase satiety
Inhibits noradrenaline reuptake - increases metabolism
How does Rimonabant work? Side effects?
Appetite suppressant
Blocks cannaboid receptors so decreases appetite. Withdrawn - side effects depression and suicide.
How does orlistat work? Side effects?
Pancreatic lipase inhibitor
Inhibits fat absorption
Side effects - steatorrhoea, faecal incontinence.
How does metformin work? Side effects?
Anti-diabetic - inhibits hepatic gluconeogenesis and increases insulin sensitivity.
Side effects - GI disturbance, lactic acidosis.
How does Rosiglitazone work?
Anti-diabetic drug, increases insulin sensitivity.
Why is gastric banding used?
Adjustable, reversible, less invasive, 50-60% of excess weight lost over 5yrs.
Downsides to gastric banding
Can slip
Pouch can enlarge
10% need revision
What is a sleeve gastrectomy?
Removal of greater curvature of stomach
Benefits of gastric bypass
Laproscopic, decreases gastric capacity by 95% - good results.
Role of leptin
Lowers appetite
Role of Ghrelin
Gets you hungry
What is dieting associated with?
Weight gain
What protects against BMI increase?
Body satisfaction
What can increase body dissatisfaction?
Thin ideal internalisation
Gut embryology - What does the foregut form?
Mouth to duodenum (bile duct entrance)
Gut embryology - What does the midgut form
Small intestine, caecum, appendix, ascending colon, 2/3 transverse colon.
Gut embryology - What does the hindgut form?
1/3 transverse colon, descending colon, sigmoid colon, rectum.
Describe the blood supply to gut
CSI
Coeliac trunk - foregut
Superior mesenteric - midgut
Inferior mesenteric - hindgut
