extra (after exam 3) and specifically what he wants us to know for the final Flashcards
BMI, what is considered under weight, normal weight, obese I and morbid obesity III?
Underweight: < 18.5 Normal weight: 18.5 - 24.9 Overweight: 25 - 29.9 Obese I: 30 – 34.9 Obesity II: 35 – 39.9 Morbid Obesity III: > or equal to 40
What BMI does morbid obesity start at?
40 (equal to or greater)
What are the three types of body fat distributions (body types and how you gain fat)
Android (central obesity)
Visceral fat
gynecoid
Android, visceral fat, and gynecoid… how do these body types differ in how they gain fat?
ANDROID: CENTRAL OBESITY: ADIPOSE TISSUE IS LOCATED PREDOMINANTLY IN THE UPPER BODY (TRUNCAL DISTRIBUTION) AND IS ASSOCIATED WITH INCREASE OXYGEN CONSUMPTION AND INCREASE INCIDENCE OF CARDIOVASCULAR DISEASE
VISCERAL FAT: PARTICULAR ASSOCIATED WITH CARDIOVASCULAR DISEASE AND LVD (LEFT VENTRICLE DYSFUNCTION)
GYNECOID: PERIPHERAL OBESITY: ADIPOSE TISSUE IS LOCATED PREDOMINANTLY IN THE HIPS, BUTTOCKS, AND THIGHS. THIS FAT IS LESS METABOLICALLY ACTIVE SO IT IS LESS CLOSELY ASSOCIATED WITH CVD.
What kind of issues will you likely have (in relation to your heart) if you have sleep apnea that is not treated?
Right ventricular issues
what does waist circumference correlate with?
abdominal fat and is an independent risk predictor of dz
what drug is phentermine similar to in that it can have the same effects?
amphetamine (think of adipex (phentermine) as legal meth lol)
Most effective treatment for morbid obesity class III?
Bariatric surgery
Should surgery be the first thing morbidly obese people try in order to lose weight?
No!
There are multiple less invasive techniques
If someone is obese will this result in increased or decreased lung compliance?
DECREASED LUNG COMPLIANCE: FAT ACCUMULATION ON THORAX AND ABDOMEN RESULTS IN DECREASE CHEST WALL AND LUNG COMPLIANCE
What position results in even further reduction in chest wall compliance and increased elastic resistance for obese patients, and what results?
Supine, thus resulting in rapid breathing and limited maximum ventilatory capacity.
What is the most commonly reported abnormalities of pulmonary function in obese patients?
Decreased FRC and ERV
Anesthesia and supine position in an obese patient can decrease FRC up to how much? how does that compare to a non obese patient?
decreases FRC up to 50% in obese, compared to 20% in non obese patient.
What condition increases O2 consumption and CO2 production even at rest?
obesity
Gold standard diagnostic test for OSA is?
polysomnography (OPS)
CO increases with increasing weight by as much as how much ml/kg? Why?
20-30ml/kg increase in CO.
Due to ventricular dilation and increased SVR
Obese individuals have an increased blood volume, what is obese blood volume per kg compared to non obese blood volume per kg?
non obese 50ml/kg
obese 70ml/kg
systolic and diastolic changes in BP due to being obese?
3-4 mm/Hg INCREASE IN SYSTOLIC AND 2mm/Hg INCREASE IN DIASTOLIC ARTERIAL PRESSURE FOR EVERY 10 Kg OF WEIGHT GAIN
Obese individuals are more likely to have OSA due to excess soft tissue, tell me some physiological abnormalities R/T OSA?
HYPOXEMIA, HYPERCAPNEA
PULMONARY HPTN, SYSTEMIC VASOCONSTRICTION
SECONDARY POLYCYTHEMIA FROM RECURRENT HYPOXEMIA
INCREASED RISK OF ISCHEMIC HEART DISEASE
CEREBROVASCULAR DISEASE
RV FAILURE D/T HYPOXIC PULMONARY VASOCONSTRICTION
If someone has sever OSA what can you consider for them before surgery?
pre-op CPAP
What is pickwickian syndrome?
OBESITY HYPOVENTILATION SYNDROME (OHS) OR PICKWICKIAN SYNDROME RESULT FROM LONG TERM OSA. SEEN IN 5-10% OF MORBID OBESE
If you are obese, what does that do to your gastric volume and acidity?
increase acidity and gastric volumes.
obese individuals have up to 75% larger stomach volumes, this increases risk for what? (a lot of risks, just name some- general idea) ULTIMATELY increasing risk for?
INCREASED RISK OF HIATAL HERNIA, GERD, DELAYED GASTRIC EMPTYING, HIGHER ACIDITY, INCREASED ABD PRESSURE….
ALL of the above results in INCREASED RISK for aspiration and pneumontis!
what % of obese patients potentially have subclinical hypothyroidism?
25%