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Disease 3 > Bariatric > Flashcards

Bariatric Flashcards

1
Q

What is the definition of obesity?

A

A chronic, often progressive metabolic disease associated with increased morbidity and mortality

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2
Q

What is obesity a disorder of?

A

Body weight regulation

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2
Q

What subset of the population is least likely to be obese?

A

High income with the most education

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3
Q

What environmental factors can contribute to the prevalence of obesity?

A

Built environment - encourages or discourages physical activity
Food environment - encourages or discourages healthy eating

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4
Q

What health hazards are linked to obesity?

A

Type 2 diabetes mellitus
Heart disease
Stroke
Cancer
Osteoarthritis
Liver disease
Depression

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5
Q

What respiratory health hazards are linked to obesity?

A

Asthma
Obstructive sleep apnea
Obesity hypoventilation syndrome

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6
Q

Describe airway smooth muscle in lean people vs obese people

A

Lean = long and compliant
Obese = short and stiff

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7
Q

Which lung volume changes the most in the obese?

A

Expiratory reserve volume

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8
Q

How does obesity increase the work of breathing?

A

Chest wall is heavy and inhibits chest expansion

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9
Q

How is asthma in obese patients different in lean patients?

A

Asthma in obese patients is more difficult to treat
Patients with obesity have been shown to get decreased benefit from standard asthma treatment

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10
Q

Define obstructive sleep apnea

A

Repetitive episodes of apnea or reduced inspiratory airflow due to upper airway obstruction during sleep

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11
Q

What causes sleep apnea?

A

Loss of muscle tone with sleep

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12
Q

What are the characteristics of obstructive sleep apnea?

A

Loud snoring
Episodes of breathing cessation during sleep
Elbow sign
Abrupt awakenings accompanied by shortness of breath
Difficulty staying asleep
Frequent trips to the bathroom at night
Night sweats

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13
Q

What are some symptoms people with OSA may experience upon waking?

A

Dry mouth
Sore throat
Morning headache
Nausea
Excessive daytime sleepiness

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14
Q

What are the mental and psychological effects of sleep apnea?

A

Memory impairment
Difficulty concentrating
Moodiness or irritability
Intellectual and personality changes
Depression
Sexual impotence

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15
Q

What does OSA elevate the risk of?

A

Cardiovascular comorbidity and mortality

16
Q

What are the three types of sleep apnea?

A

Obstructive
Central
Mixed

17
Q

Define apnea

A

Cessation of airflow or aflow < 10% preevent baseline for duration of >10 seconds

18
Q

Define hypopnea

A

Airflow decreased >30% of pre-event baseline for a duration of >10 seconds accompanied by >3% decline in SpO2 from pre-event baseline

19
Q

What qualifies as mild, moderate and severe OSA?

A

Mild = 5-15 respiratory events per hour of sleep
Moderate = 15-30
Severe > 30

20
Q

What are the treatment options for OSA?

A

Behavior modification
Positive airway pressure
Oral appliances
Surgery
Implantable upper airway stimulator

21
Q

Describe obesity hypoventilation syndrome

A

An awake alveolar hypoventilation in an obese individual that cannot be attributed to other conditions associated with alveolar hypoventilation

22
Q

When should you expect a patient to have obesity hypoventilation syndrome

A

BMI > 30
Bicarb > 27
PaCO2 > 45 mmHg

23
Q

What other diseases are associated with obesity hypoventilation syndrome?

A

Pulmonary hypertension
Hypertension
Congestive heart failure
Insulin resistance

24
Q

What procedures are complicated by a patient who is obese?

A

Bag mask ventilation
Difficult airway to intubate
Aspiration risk

25
Q

What capacity is reduced in obese populations?

A

Functional reserve capacity

26
Q

What practices should be included when mechanically ventilating an obese patient?

A

Target Vt to PBW
Maintain lung protective strategies
Increase PEEP to offset the weight of the chest
Elevate head of bed
Consider early extubation to NIV

27
Q

Besides being difficult to intubate, what is another risk associated with intubating an obese patient?

A

They tend to desaturate faster

28
Q

What is the relationship between obesity and clot formation?

A

Obese patients have an increased risk of DVT
Increased risk for DVT increases risk of pulmonary embolism

29
Q

What are respiratory risks associated with surgical operations on obese patients?

A

Increased risk of V/Q mismatch
Increased risk of atelectasis
Delayed pulmonary recovery from surgery

30
Q

What support do patients require prior to bariatric surgery?

A

Nutrition
Psychological counseling
Lifestyle modifications
Realistic expectations
Knowledge of risks

31
Q

What are the 3 principles that must be considered for bariatric surgery?

A

Restriction
Malabsorption
Combination of restriction and malabsorption

32
Q

What are the options for restricting caloric intake by reducing the stomach capacity?

A

Resect
Bypass
Create a proximal gastric outlet
Absorption function of small intestine remains intact

33
Q

What are the options for limiting absorption?

A

Reduce the length of the functional small intestine
Bypass small bowel absorptive surface area

34
Q

What are the most common bariatric surgeries?

A

Sleeve gastrectomy
Roux en y

34
Q

What are the risks associated with malabsorption techniques?

A

Protein calorie malnutrition
Micronutrient deficiencies

35
Q

Describe a sleeve gastrectomy

A

Majority of bariatric surgeries
Removes curvature of the stomach
Creates a tubular stomach

36
Q

What are the hormonal effects of a sleeve gastrectomy?

A

Decrease hunger
Insulin resistance improves for better glycemic control

37
Q

Describe the roux en y procedure

A

Combination of restriction and malabsorption
Decreases size of stomach
Reduces length of small intestine

Disease 3 (9 decks)

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