Bariatric Patients Flashcards
what BMI constitutes obese and overweight?
obese BMI greater than 30
overweight BMI 25-30
What conditions are associated with increased morbidity as people become more obese?
T2D, coronary heart disease, chronic kidney disease, obstructive sleep apnoea, asthma, cancers
What cardiovascular changes occur in obese paitents?
Increased cardiac workload
increased CO and blood volume
Cardiac remodelling, cardiomyopathy, heart failure
Arrhythmias, may be precipitated by hypoxia, cardiac remodelling, electrolyte imbalances - increased AF
what airway changes may happen in obese patients?
Increased upper airway resistance
extra adipose tissue weight on chest wall
redundant supraglottic tissue, large thick tongue, distorted neck anatomy - short neck and redundant adipose tissue
what is Obstructive sleep aponea?
periodic reduction/cessation of breathing due to narrowing of upper airways during sleep
what is the strongest risk factor for OSA?
58% moderate to severe obesity
what is the impact of severe OSA?
increased risk of cardiovascular disease, atrial fibrillation and stroke
what are the respiratory changes in obese patients?
Impaired chest expansion- hypoventilation and relative hypocapnia
Reduced functional residua capacity- rapid oxygen desaturation
difficult chest auscultation
what is the difference in asthma between obese and non obese patients
twice as likely to have asthma
because - decreased airway calibre, increased airway responsiveness and chronic inflammatory response
why is there an increased risk of pulmonary hypertension in obese paitents?
due to left sided heart failure/reduction in functionality which cause blood to back up in pulmonary circulation
what changes in relation to insulin happen in obese patients?
Insulin resistance with hyperinsulinemia - present before onset of hyperglycaemia. Pts 7 times more likely to develop T2D
what effects on the endocrine/liver can obesity have?
non-alcoholic fatty liver disease
metabolic syndrome where there is fatty iniltration in the liver. can cause cirrhosis and portal hypertension.
what things may need to be considered in obese patients in regards to pharmacology?
drug clearance correlates with lean weight mostly. adipose tissue is slow to clear drugs
lipophilic drugs may be stored in excess adipose tissue and have longer effects/plasma concerntration levels may be reduced
what are the different medical interventions that may be recommended for obese patients?
lifestyle changes
oral medications
subcutaneous injections
surgery
what is an anastomotic leak?
anastomotic leak- 3/7 days after operation acute surgery complication
significant compilation increased overall morbidity to 61% and mortality to 15%
presentation HR>120, dyspnoea, fever, abdominal paint
