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Medcon Rehab IV > Bariatric Sx and PT Implications > Flashcards

Bariatric Sx and PT Implications Flashcards

1
Q

Obesity is a ___________

A

Pandemic!!!!

*NOTE: affects >300 million people worldwide!!!

2nd leading cause of preventable death in the USA***

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2
Q

Obesity is a _________ Disease

A

Multifactorial

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3
Q

Obesity is Multifactorial

More facts:

A
  • Complex, multifactorial**
  • Affects multiple body systems**
  • Genetics + Environment
  • Factors:
    • Physical, social, cultural, genetic, behavioral
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4
Q

GOLD STANDARD measurement for Obesity (but shouldn’t be)

A

Body Mass Index (BMI)

  • BW (kg)/Ht (m2)
  • Challenges to BMI:
    • Most accurate measurement=> BF%
    • Healthy, muscular= fall into overWT category
    • Persons w/ decd mm mass may fall into normal
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5
Q

BMI Lvls: all then broken down

A
  • UNDERweight→ <18.5
  • Normal wt→ 18.5-24.9
  • OVERweight→ 25-29.9
  • Obesity→ 30+
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6
Q

BMI Lvls:

UNDERwt.

A

<18.5

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7
Q

BMI Lvls:

Normal Weight

A

18.5-24.9

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8
Q

BMI Lvls:

OVERwt.

A

25-29.9

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9
Q

BMI Lvls:

Obese

A

30+

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10
Q

Obesity Subcategories:

Classes 1-3

A
  • Class 1: BMI 30 to <35
  • Class 2: BMI 35 to <40
  • Class 3: BMI of 40+
    • extreme, severe, morbid obesity
    • “Bariatric”
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11
Q

Independent predictor of MI

A

Waist to Hip ratio

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12
Q

Waist (above iliac crest) to Hip (widest part hips) Ratio

FACTS

A
  • Considers diff’s in body type distributions
  • Waist circumference: above iliac crest→ fat around abdomen/organs
    • >40 in (males)
    • >35 in (females)
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13
Q

Waist to Hip Ratio

Obese #s Men vs Women

A

Men: >0.9= obese

Women: >0.85= obese

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14
Q

Sequelae of being overweight or obese

A

see pics but NOTE the following:

  • Type 2 DM: insulin resistance in indivs w/ high lvls visceral fat (around abdomen)
  • Most Cx’s related to endocrine
  • Widespread systemic inflammation (not on list)
  • *Cx outcomes are poorer for obese indivs than normal wt indiv’s
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15
Q

Pathophysiology of Obesity

Physiology of adipose tissue in obesity: Adipocytes

What do they do?

A
  • Adipocytes (fat cells)→ Release PROs (adipokines or adipocytokines) that act locally on tissues or systemically thru bloodstream
    • ROLE(S) of Adipokines:
      • Energy balance, Angiogenesis
      • Inflammation, Vasoconstriction
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16
Q

What are the PROs called that Adipocytes (fat cells) RELEASE?

A

Adipokines or adipocytokines

Energy balance, Angiogenesis

Inflammation, Vasoconstriction

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17
Q

Pathophysiology of Obesity

Physiology of adipose tissue in obesity:

Brown Fat

A
  • Role→ Thermoregulation
  • Infants have HIGH amts
  • DECd amts in adults***
  • Regulated by SNS
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18
Q

Pathophysiology of Obesity

Physiology of adipose tissue in obesity:

White Fat

2 Roles:

A
  1. Storage of triglycerols for long-term energy reservoir
  2. Secrete PROs
    1. BAD→ all PRO-inflammatory
      1. TNF, IL-6, IL-8, resistin, acylation-stimulation PRO
    2. GOOD
      1. Leptin→ inflammation, immune function
      2. Adiponectin→ incs insulin sensitivity, anti-inflammatory
19
Q

Pathophysiology of Obesity

Physiology of adipocytes in obesity:

More on White Fat

Secreted PROs from White fat help regulate other body processes:

A
  • Fat metabolism, Energy balance, Feeding (hunger, app. suppress.), Hemostasis/vascular tone, Insulin sensitivity
20
Q

Pathophysiology of Obesity

Physiology of adipose tissue in obesity:

White Fat

Role #2: Secrete PROs

Talk about “Good” vs “Bad” again

A
  • BAD: PRO-inflammatory
    • TNF, IL-6, IL-8, resistin, acylation-stimulation PRO
  • GOOD:
    • Leptin→ inflammation, immune function
    • Adiponectin→ INC insulin sensitivity, ANTI-inflammatory
21
Q

Pathophysiology of Obesity

Physiology of adipose tissue in obesity:

Leptin and Hunger

A
  • Acts on hypothalamus to alter hunger
  • INCd leptin lvls act to depress hunger
  • In obese indivs→ HIGH lvls leptin exist→ BUT target receptors for leptin are LESS sensitive (do not recognize leptin) → don’t get “full” so keep eating****
22
Q

Benefits of Tx:

Strong evidence that Wt loss reduces risk factors for DM and CV disease

Explain the cascade of events WHY

A
  • Ex. of physiology
    • W/ Wt loss→ DECd # macrophages in adipose tissue→ DECd in local inflamm (may see clinical improvement in CVD, DM bc of improved action by adipocytes’ secreted PROs)
23
Q

GENERAL goals of Wt loss/Mgmt

A
  • Initial goal→ 10% reduction in bw OR if that is not possible, NO inc in wt.
  • Reasonable time frame→ 6mos
  • Wt maintenance should include diet, phys act, behavior tx
24
Q

Medical Intervention for Obesity

5:

A
  1. Dietary counseling
  2. Pharmacologic approaches
  3. Behavioral approaches
  4. Exercise***
  5. Bariatric Sx
25
Bariatric Sx: ## Footnote **3 mentioned in lecture to KNOW:**
* Adjustable gastric band OR Vertical banded gastroplasty * Pancreatobiliary bypass or Duodenal switch * Gastric Bypass
26
Bariatric Sx: ## Footnote **Adjustable gastric band OR Vertical banded gastroplasty** **What does it do?**
**Restricts** stomach **volume** by creating a **smaller stomach pouch**. \***Stomach left _INtact_**
27
Bariatric Sx: ## Footnote **Pancreatobiliary bypass or Duodenal switch** **What does it do?**
**Malabsorptive procedure** **\*Removes _portion_ of stomach**
28
Bariatric Sx: ## Footnote **Gastric Bypass procedure** **What does it do?**
**_Restricts_** stomach **volume** by **_bypassing the stomach_** w/ a **gastrojejunostomy**
29
Gastric Banding Procedures ## Footnote **2:**
1. Adjustable gastric banding procedure 2. Vertical banding gastroplasty
30
Bariatric Sx: ## Footnote **Malabsorptive Procedures** **2:**
1. Biliopancreatic Diversion (BPD) 2. BPD w/ Duodenal Switch
31
Gastric Bypass Procedure aka **Roux-en-Y stomach bypass** ## Footnote **the “Y” Connection one**
Gastric Bypass
32
Gastric Bypass procedure aka
**Roux-en-Y procedure**
33
PT Considerations: ## Footnote **Post-op Bariatric Sx** **BIG ONES TO KNOW!!!! then all in another card**
* **Tachycardia\*** * **HR \>110bpm** * **Fever\*** * **Drainage\*** * Color (green, red) * Smell * **Persistent Pain\*** * **L shoulder** * **Epigastric** * **DECd Urine output\***
34
Post-op bariatric sx PT Considerations ## Footnote **Persistent Pain** **Where?**
L. shoulder Epigastric
35
PT Considerations ## Footnote **Post-Op Bariatric Sx** **ALL but REALLY KNOW \*'d ONES!!!!**
* \***Tachycardia** * **HR\>110bpm** * **\*Fever** * sweating * **\*Drainage** * color (green, red) * smell * **\*Persistent pain** * L. shoulder, Epigastric * Wound dehiscence (opening) * Internal bleeding * DVT/PE\*\*\* * **\*DECd Urine output** * NPO day 1 * Incentive spirometer * Lifting restrictions \>10-15lbs for 2-3wks
36
Post-Op Bariatric Sx: ## Footnote **Follow-up medical care (6mo/1yr)**
* \*\***Nutritional Supplementation** * Vitamins for _LIFE_, esp **B12, calcium** * Monitor “liquid calories" * Dumping Syndrome * Ex. program for strength, endurance * Counseling & support groups, wound check, ulcers, reflux
37
Dumping Syndrome ## Footnote **\*esp important during Follow-up medical care (6mo/1yr)**
* **Sugary** food leaves stomach QUICKLY! * **Intestine swells up→ cramping and pain** * **Sx's:** * fast HR, sweating, nausea, vom/diarrhea
38
PT Exam ## Footnote **Hx**
Gen health status (health perception, phys function, psychological function, role function, social function) Social and health habits, lvl of phys fitness
39
PT Exam: **Systems Review** ## Footnote **Cardiovascular Pulmonary**
* RHR, BP, RR * \***Vital signs _should be monitored_ due to INCd risk!!!**
40
PT Exam: **Systems Review** ## Footnote **Integumentary**
* LE venostasis * **Friction of tissues in adjacent body segments\*\*\*\*\*\*\* BIG ONE!!!!**
41
PT EXAM: **Systems Review** ## Footnote **MSK**
* Pain, Postural dysf.
42
PT Exam: Systems Review ## Footnote **Neuromuscular**
* Impaired peripheral nerve integrity **secondary to** impingement by excessive **adiposity** **\*NOTE: Other PT Exam components:** Communication, cognition, pt goals
43
PT Exam: **Tests and Measures** ## Footnote **Documentation of functional limitations**
Larsson and Mattsson, 2001 * Women who are obese **perceived disability** to much higher extent vs women of “normal wt” * Noted diffs bw **perceived functional limits** and those that can be observed and measured\*\*\*
44
Other PT Considerations in Obesity
* Wound care/skin checks esp areas w/ high friction or full contact * self-check, hygiene * assess during PT exam\*\*\* * Dec skin shear during transfers * Support groups and social support * **HEP and promotion of daily physical activity!!!**

Medcon Rehab IV (18 decks)

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