Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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***

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Obesity is a _________ Disease

A

Multifactorial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Obesity is Multifactorial

More facts:

A
  • Complex, multifactorial**
  • Affects multiple body systems**
  • Genetics + Environment
  • Factors:
    • Physical, social, cultural, genetic, behavioral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

BMI Lvls: all then broken down

A
  • UNDERweight→ <18.5
  • Normal wt→ 18.5-24.9
  • OVERweight→ 25-29.9
  • Obesity→ 30+
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

BMI Lvls:

UNDERwt.

A

<18.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

BMI Lvls:

Normal Weight

A

18.5-24.9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

BMI Lvls:

OVERwt.

A

25-29.9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

BMI Lvls:

Obese

A

30+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Independent predictor of MI

A

Waist to Hip ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Waist to Hip Ratio

Obese #s Men vs Women

A

Men: >0.9= obese

Women: >0.85= obese

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

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

A

Adipokines or adipocytokines

Energy balance, Angiogenesis

Inflammation, Vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
Q

Bariatric Sx:

3 mentioned in lecture to KNOW:

A
  • Adjustable gastric band OR Vertical banded gastroplasty
  • Pancreatobiliary bypass or Duodenal switch
  • Gastric Bypass
26
Q

Bariatric Sx:

Adjustable gastric band OR Vertical banded gastroplasty

What does it do?

A

Restricts stomach volume by creating a smaller stomach pouch.

*Stomach left INtact

27
Q

Bariatric Sx:

Pancreatobiliary bypass or Duodenal switch

What does it do?

A

Malabsorptive procedure

*Removes portion of stomach

28
Q

Bariatric Sx:

Gastric Bypass procedure

What does it do?

A

Restricts stomach volume by bypassing the stomach w/ a gastrojejunostomy

29
Q

Gastric Banding Procedures

2:

A
  1. Adjustable gastric banding procedure
  2. Vertical banding gastroplasty
30
Q

Bariatric Sx:

Malabsorptive Procedures

2:

A
  1. Biliopancreatic Diversion (BPD)
  2. BPD w/ Duodenal Switch
31
Q

Gastric Bypass Procedure aka Roux-en-Y stomach bypass

the “Y” Connection one

A

Gastric Bypass

32
Q

Gastric Bypass procedure aka

A

Roux-en-Y procedure

33
Q

PT Considerations:

Post-op Bariatric Sx

BIG ONES TO KNOW!!!! then all in another card

A
  • Tachycardia*
    • HR >110bpm
  • Fever*
  • Drainage*
    • Color (green, red)
    • Smell
  • Persistent Pain*
    • L shoulder
    • Epigastric
  • DECd Urine output*
34
Q

Post-op bariatric sx PT Considerations

Persistent Pain

Where?

A

L. shoulder

Epigastric

35
Q

PT Considerations

Post-Op Bariatric Sx

ALL but REALLY KNOW *‘d ONES!!!!

A
  • *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
Q

Post-Op Bariatric Sx:

Follow-up medical care (6mo/1yr)

A
  • **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
Q

Dumping Syndrome

*esp important during Follow-up medical care (6mo/1yr)

A
  • Sugary food leaves stomach QUICKLY!
  • Intestine swells up→ cramping and pain
  • Sx’s:
    • fast HR, sweating, nausea, vom/diarrhea
38
Q

PT Exam

Hx

A

Gen health status (health perception, phys function, psychological function, role function, social function)

Social and health habits, lvl of phys fitness

39
Q

PT Exam: Systems Review

Cardiovascular Pulmonary

A
  • RHR, BP, RR
  • *Vital signs should be monitored due to INCd risk!!!
40
Q

PT Exam: Systems Review

Integumentary

A
  • LE venostasis
  • Friction of tissues in adjacent body segments******* BIG ONE!!!!
41
Q

PT EXAM: Systems Review

MSK

A
  • Pain, Postural dysf.
42
Q

PT Exam: Systems Review

Neuromuscular

A
  • Impaired peripheral nerve integrity secondary to impingement by excessive adiposity

*NOTE: Other PT Exam components: Communication, cognition, pt goals

43
Q

PT Exam: Tests and Measures

Documentation of functional limitations

A

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
Q

Other PT Considerations in Obesity

A
  • 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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions