Little Piggies

Question 1

Bariatric and morbid definition

Answer 1

BMI >30, Morbid >40

Question 2

Bariatrics often present with

Answer 2

resp failure
sepsis
chf
acs
DM
medication
post op complications
pe/dvt
stroke

Question 3

Surgical approach

Answer 3

restrictive, malabsorption, dual

Question 4

obesity in children CVS

Answer 4

HTN, dislipidemia, structural abnormalities, premature atherosclerotic lesions, adult CVD

Question 5

obesity in children ENDOcrine

Answer 5

non-alcoholic fatty liver

cholelithiasis

Question 6

obesity in children Neuro

Answer 6

idiopathic intracranial hypertension

Question 7

obesity in children RESP

Answer 7

asthma, OSA, obesity Hypoventilation syndrome

Question 8

Bariatric post op complications

Answer 8

pre-op: anesthesia, bleeding, positioning

early post op:

• bleeding, anastomosis leak, infection 2nd to leak,
• pulmonary: atelectasis, pNA, PE, Resp arrest, ARDS, OSA

Question 9

Cardiovascular changes in bariatrics

Answer 9

1. sleep apnea leads to hypoxemia/acidosis, leading to pulmonary HTN, RV enlargement and failure
2. increased total and central blood volume, increased LV stroke volume, increased cardiac output, increased LV dilation - HTN, increased wall stress = systolic/diastolic failure

Question 10

Respiratory changes in fat

Answer 10

• upper airway obstruction
• sleep apnea
• baseline hypoventilation (atelectasis)
• baseline hypercarbia
• decreased lung capacity
• increased O2 consumption
• high pressure (decreased compliance/increased resistance)
• aspiration risk

Question 11

Bariatric lung volumes

Answer 11

decreased FRC, Decreased VT, decreased ERV, decreased TLC

Question 12

bariatric lung compliance

Answer 12

decreased Chest wall, decreased lung compliance

Question 13

Factors affecting pharmacokinetics in obesity

Answer 13

1. Volume distribution
   -increase fat mass
   -increased LBW
   -increased TBW
   -increased blood volume
   -increased CO
   Organomegaly
2. protein binding
3. drug metabolism (increased activity of some CYP450 Enzymes)
4. Excretion
   - increased renal blood flow
   - increased GFR
   - increased renal tubular secretions and reabsorption

Question 14

Bariatric intubation position

Answer 14

ear to sternal, head elevation and ramping