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Nurs 216B > obesity > Flashcards

obesity Flashcards

1
Q

cause of obesity

A

disbalance between energy intake and expenditure

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2
Q

metabolic disorders that characterize obesity

A

insulin resistance, type 2 diabetes, fatty liver disease, atherosclerosis, hypertension, hypercholesterolemia

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3
Q

hunger

A

CNS/hypothalamus receives info when blood sugar is low from Ghrelin

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4
Q

hunger hormones/peptides

A

hypothalamic peptides (neuropeptide Y)
Ghrelin (from empty stomach; binds to G receptors)
Dopamine stimulates appetite

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5
Q

hunger stimulation

A

hypothalamic secretion of thyroid and adreno-corticoids cause metabolism and utilization of food stuffs

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6
Q

satiety

A

CNS receives inhibitory signals from leptin which antagonizes ghrelin

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7
Q

satiety hormones/peptides

A

CCK + PYY + GLP-1; from the GI
Insulin
Leptin (from adipose tissue)
Lipid metabolism byproducts such as ketones

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8
Q

CCK

A

secreted in duodenum when protein and fat are present to trigger feedback mechanism

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9
Q

lipid metabolism byproducts such as ketones

A

shut off mechanism for hunger
can cause metabolic acidosis

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10
Q

keto diet

A

high lipids and protein and little to no carbs
- less intake due to quicker satiety
- more energy stores broken down to satisfy requirements
- risk of ketoacidosis

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11
Q

how keto diet works

A

based on hunger inhibitory mechanisms; quick satiety due to CKK inhibitory action when released in response to protein/fat in duodenum
- puts person in state of ketosis
- high protein breakdown strains renals
- caloric intake low

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12
Q

ketosis

A

when there arent enough carbs to burn for energy so body burns fat

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13
Q

causes of decreased hunger

A

sympathetic stimulation (pain, stress, trauma)
GI pathologies
Low iron (=low ghrelin)

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14
Q

simple carbs

A

better for athletes because they provide fast energy

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15
Q

fiber

A

not digested but provides satiety and no glucose so its good for diabetic patients

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16
Q

calorie use in obese patients

A

excess nutrients stored as glycogen and triglycerides in adipose cells which leads to weight gain

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17
Q

BAT (brown adipose tissue)

A

exists to insulate and create energy; has lots of mitochondria; “thermogenic organ”
- born with it and then declines over time
- people living in cold climates may have more

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18
Q

BAT synthesis

A

myogenic origin and more similar to skeletal muscle than to WAT
- differentiated differently than WAT

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19
Q

WAT (white adipose tissue)

A

an endocrine organ
provides energy, insulation, and protection; can be subcutaneous and visceral
- highest in obese, female, and elderly

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20
Q

WAT synthesis and secretion

A

leptin, adiponectin, cytokines

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21
Q

adipose cell composition

A

triglycerides and organelles

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22
Q

adipose cell function

A

uptake of excess nutrients –> transformed into triglycerides –> release 3 fatty acids and glycerol (then to glucose) for energy use

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23
Q

fat location in males

A

controlled by testosterone
- usually goes to abdomen

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24
Q

fat location in females

A

controlled by oestrogen
- usually goes to hips

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25
leptin
satiety hormone - decreased distribution and receptor binding creating resistance when WAT is high and increases hunger signaling
26
if total numbers of leptin are elevated
will lead to alternate binding sites --> pro inflammatory mediation and degradative connective tissue enzymes created which creates risk for arthritis, osteoarthritis, joint deformity and back pain
27
adiponectin
hormone that suppresses fatty acid influx to liver, enhances insulin function, and acts as an anti inflammatory
28
relation between high WAT and adiponectin
decreased synthesis and secretion which leads to - increased fatty acid deposition - insulin resistance - inflammation indicated by C-reactive protein and all these put at risk for cardiac disease, cholecystitis, hyperglycemia, DM II
29
relation between high WAT and cytokines
increases levels of cytokines due to increased number of cytokine synthesizing adipose cells and puts at risk for inflammatory diseases, atherosclerosis, metabolic resistance= insulin resistance
30
body fat accumulation
high sugar increases dopamine which causes person to eat more low estrogen genetic predispositions
31
firmicutes (bacterial phylum)
f=fat cells and fat cells=firmicutes - high in obese patients=higher digestion= higher absorption of fats
32
bacteroidetes (bacterial phylum)
higher in lean patients=lower fat absorption
33
treatment of firmicutes and bacteroidetes
probiotics to balance host flora as well as dietary fiber
34
lean adipose tissue effects
increase in anti-inflammatories, antioxidants, insulin sensitivity, angiogenesis
35
obese adipose tissue effects
increase in inflammation, oxidative stress, insulin resistance, dysfunctional angiogenesis
36
men waist circumference for obesity
if greater than 102cm then they are greatly at risk/obese
37
women waist circumference for obesity
if greater than 88cm then they are greatly at risk/obese
38
drug interactions in obese patients
increased half life and elimination due to meds going to fats
39
cholecystitis
gallbladder inflammation high fat intake--> low fatty acid oxidation d/t low adiponectin--> pro inflammatory state--> high cholesterol in bile --> gallstone formation
40
cholecystectomy
surgical excision of gallbladder
41
obesity complications of cholecystectomy
impaired wound healing due to dysfunctional angiogenesis pro inflammatory state opioids are lipophilic so it can cause addiction or require higher doses due to increased half life and elimination
42
osteoarthritis
degenerative disorder of articular cartilage - 'wear and tear' affecting type II collagen fibril and proteoglycan
43
osteoarthritis pathology
decreased proteoglycans and collagen-->tissue destruction due to pro-inflammatory mediators --> tissue destruction causing bone-bone articulating surface
44
osteoarthritis treatment
NSAID's and glucocorticoids (cortisone)
45
DM type II
insulin deficiency or resistance due to inflammatory state - low adiponectin and high cytokines
46
sulfonylureas
antidiabetic for DM II - increase beta cell insulin release; can cause hypoglycemia - glyburide (Diabeta); used instead of metformin
47
Glyburide (Diabeta)
a sulfonylurea used for DM II
48
Biguanides
antidiabetic for DM II - decrease glucose release - Metformin (Glucophage)
49
Metformin (glucophage)
a biguanide used for DM II - number one drug of choice - monitor liver
50
thiazolidinediones
antidiabetic for DM II - increase cellular blood glucose uptake - Rosiglitazone
51
rosiglitazone
a thiazolidinedione used for DM II - monitor weight gain
52
SGLT2 inhibitors
antidiabetic for DM II -increase glucose excretion - sanagliflozin (invokana)
53
sanagliflozin (invokana)
a SGLT2 inhibitor
54
GL1 receptor agonists
antidiabetic for DM II - slow GI absorption and decrease appetite - Dulaglutide (trulicity), Ozempic
55
dulaglutide (trulicity)
a GL1 receptor agonist used for DM II - monitor N&V as well as anorexia
56
metabolic syndrome
group of reversible risk factors for CV disease and DM II - can be the silent killer for people with obesity because while test values may appear normal they are on the higher end
57
5 diagnostic components of metabolic syndrome
- large waist circumference - elevated BP - low plasma HDL - elevated triglycerides - elevated fasting plasma glucose
58
lipase inhibitors
decrease fat and triglyceride absorption in intestines through inhibition of lipase - Orlistat (xenical)
59
orlistat (xenical)
lipase inhibitor - watch for decrease in lipophilic medications, fecal fat and leakage, GI bloating
60
contrave (buproprion + naltrexone)
anorexiant (antidepressant with opiate antagonist) - can be addictive so only good short term
61
bariatric surgery
limits food intake/absorption by making stomach smaller cause less ghrelin production -BMI must be over 40 to qualify for surgery
62
post bariatric surgery
take vitamin and mineral supplements to ensure patient does not become malnourished due to bypass from duodenum where nutrients and vitamins are absorbed
63
dumping syndrome
food exits stomach too quickly before it can be digested; high insulin release and sudden hypoglycemia - watch for N&V, cramping, hypoglycemia - can occur post bariatric surgery or with bolus feeding
64
dumping syndrome treatment
smaller food amount and low simple suagr foods

Nurs 216B (19 decks)

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