Harman hints test #1 fat asses Flashcards
per Harmans help
BMI formula
weight (in kg) / height (in meters)^2
or
weight (lbs) / Height (inches^2) x 703
side note how many inches in 1 meter (for BMI conversion)
0.0254
Calculate BMI using either or both formulas for 6’9” man who weight 300lbs (round it off JAKE)
300lbs=136kg 6'9"= 81 inches (6,561 inches^2) 81 inches= 2.0574 meters (4.2 meters ^2) ok so.... 136kg/4.2m^2=32.3 kg/m^2 or 300lbs / 6,562 inches^2 x 703 = 32.1
BMI ranges under weight Normal overweight obese I obese II extremly obese III superobese super-super obese
under weight- < 18.5 Normal- 18.5-24.9 overweight- 25-29.9 obese I- 30-34.9 obese II- 35-39.9 extremly obese III- > 40 superobese- >50 super-super obese- > 60
IBW formulas
MEN:
height (cm) - 100
WOMEN:
Height (cm) - 105
side note how many cm in an inch
- 54cm
* **(so for IBW use 2.54 conversion for inches to cm and for BMI use 0.0254 for inches to meters)
calculate IBW
MAN- 18’9”
WOMAN- 5’8”
man 18'9"= 225inches=571.5 cm so 571.5-100= 471 kg woman 5'8"=68 inches=172.72cm so 172.72cm-105=67.72kg
how is IBW recorded
Kg
what % of U.S. adults are overweight or obese
65%
what % of U.S. adults are obese
30%
re-read N&P pg 1036 aspiration prophylaxis and consider inLMA is ALWAYS contraindicatedbin obese pt?
-it is known GERD and hiatal hernia are more prevalent in the obese, and this may predispose them to esophagitis and pulmonaryaspiration
- More recent data, howver, have demonstrated that obese pts (BMI > 30) may have lower incidence of “at rrisk” stomach contents compared to lean pts
-in one study researchers evaluated gastric contents of 232 surgical pts. only 20 of 75 (27%) had high, volume, low PH stomach contnets, compared to 66 of 157 (42%) of lean pts
-more recent studies have also demonstrated that obese pt’s who are fasting may not have gastric PH and volumes that would put them at risk for Pulmonary aspiration.
-there is no concensus on wheter obese pts have delayed, normal, or accelerated gastric emptying
-obesity is significantly r/t GERD
-More recent and favorable data, some advocate the ovoidance of RSI on obese pt’s as standard of care
SO I WOULD SAY NO
indications for bariatric sx
u have dieted and failed
- BMI > 40
- BMI >35 and have serious health conditions associated with your obesity (DM, HTN, Depression, heart disease, OSA)
- more than 100lbs over IBW
3 types of bariatric sx’s
restricive
combined restrictive and malabsorptive
malabsorptive
3 types of restrictive procedures
LAP band
Sleeve gastrectomy
Verticle banded gastroplasty
1 ex of combined restrictive and malabsorptive procedures
Roux-en-Y gastric bypass
1 ex of malabsorptive procedure
biliopancreatic Diverson with duodenal switch
Long term risk of gastric bypass
weight regain
anemia
vit/min deficiency
ETOH use d/o
short term risk of gastric bypass
Hair loss Kidney stones N/V Gallstones hernia/ SBO/LBO periphreal neuropathy
Complications with bariatric sx
dumping syndrome cholelithiasis PE/DVT anastomotic leak GJ stricture
Complications unique to AGB procedure
port disconnection/rupture port displacement with stomach slippage band rupture/erosion port blockage/infection tube related malfunction
Benefits of gastric sx
reversing metabolic syndrome
decreased bp
decreased trig;ycerides
improves OSA/OHS
improves
-Nonalcoholic liver disease
-GERD
-Incontinence
-polycystic ovarian syndrome
-venous stasis
-DJD
cure DM
Improves endocrine systemUnique thing about gastric sx and DM
it can actually improve or cure DM even B4 weight loss
expected weight loss of sx (of excess body weight only)
AGB-25-80%
Sleeve- 65-75%
Rouex-en-Y 50-70%
