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obesity Flashcards

1
Q

how many calories are required to produce 1g of body fat

A

9 calories

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2
Q

1g of carbs provides how many calories

A

4 calories

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3
Q

1g of protein provides how many calories

A

4 calories

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4
Q

1st and second leading causes of preventable death

A

1st smoking
2nd obesity

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5
Q

android obesity overview

A

most common in men and metabolically active
characterized by central visceral or abdominal fat accumulation
waist size >40 inches for men and >35 inches for women
associated with increased risk of ischemic heart disease, HTN, dyslipidemia, insulin resistance, death

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6
Q

gynecoid obesity overview

A

more common in women, characterized by gluteal and femoral fat accumulation
metabolically inactive, primarily used for energy storage
more likely to develop joint disease and varicose veins
reduced incidence of non insulin dependent DM

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7
Q

metabolic syndrome has at least 3 of the following

A

fasting plasma glucose >110mg/dL
abdominal obesity (>40 inches in men and >35 in women)
serum triglycerides >150mg/dL
HDL <40mg/dL in men and <50mg/dL in women
BP >135/85mmHg

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8
Q

BMI=

A

weight (kg) / height (m^2)

weight conversion is 2.2
height conversion to cm first (2.54) then to meters (cm / 100)
BMI = kg/m^2

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9
Q

adult BMI classification

A
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10
Q

child body weight class (2-18y)

A
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11
Q

IBW calculation (men v women)

A

men: height (cm) - 100
women: height (cm) - 105

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12
Q

respiratory effects of obesity

A

produces a restrictive ventilatory effect
reduction in FRC (due to decrease in ERV)
decreased VC, TLC

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13
Q

lung inflation in an obese patient is inhibited because

A

chest fat compresses rib cage and hinders outward expansion
abdominal fat shifts diaphragm cephalic and compresses the lungs
kyphosis and lordosis develop over time, which alters geometry of ribcage

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14
Q

how does PaCO2 differ in obese patient

A

patient may have hypoxemia but PaCO2 is usually normal r/t high diffusing capacity of CO2

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15
Q

because fat is metabolically active, what increases

A

O2 consumption, CO2 production, MV

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16
Q

HELP position

A

head elevated laryngoscopy position
-idea is to elevate head, shoulders, and upper body above the chest
-horizontal line from sternal notch to external auditory meatus

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17
Q

how to pre oxygenate obese patient

A

100% FiO2 + CPAP 10cmH2O until end tidal is >90%. this prolongs time before desaturation occurs by 50%

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18
Q

when does postoperative hypoxemia happen in this population

A

immediately or 2-5d postop

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19
Q

strategies to maximize postop oxygenation include

A

CPAP or BiPAP after extubation (esp if patient uses it at home)
elevate HOB 30 degrees
early ambulation
control surgical pain (non opioid analgesics and regional)
incentive spirometry

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20
Q

BV and CO

A

HR is usually unchanged but SV increases. CO increases an extra 100mL/min for every extra kg of fat

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21
Q

common EKG changes and causes

A

low voltage EKG (increased distance between heart and leads)
left axis deviation (stomach pushes heart up and to left, LVH secondary to volume overload and HTN)
right axis deviation (RV hypertrophy from OSA and volume overload)
QT prolongation (increases the risk of sudden death
ischemia (O2 supply and demand mismatch)
dysrhythmias (caused by fatty infiltration of conduction system, myocardial hypertrophy, hypoxemia, hypercarbia, obesity hypoventilation syndrome, ischemic heart disease

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22
Q

most useful confirmation of pHTN

A

presence of tricuspid regurg on TEE

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23
Q

what happens to Vd of lipophilic drugs? hydrophilic?

A

lipophilic: increased d/t larger fat mass
hydrophilic: increased d/t larger muscle mass and BV

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24
Q

circulation time in obese population

A

shortened circulation time due too larger CO

25
Q

Vd of drugs in obese patient is altered by

A

increased BV
increased CO
altered plasma protein binding
lipid solubility of the drug

26
Q

does muscle mass increase?

A

fat mass AND muscle mass increases

27
Q

lean body weight (LBW) =

A

IBW x 1.3

28
Q

propofol
induction dose should be based on
maintenance dose should be based on

A

induction dose should be based on LBW (IBW x 1.3)
maintenance dose should be based on TBW

29
Q

succ intubation dose should be based on

A

TBW

30
Q

rocuronium intubation dose should be based n

A

LBW

31
Q

vec maintenance dose should be based on

A

LBW

32
Q

cis intubation dose should be based on

A

TBW

33
Q

fent loading dose should be based on

A

TBW

34
Q

sufent maintenance dose should be based on

A

LBW

35
Q

remifent loading nad maintenance dose should be based on

A

LBW

36
Q

midaz loading and maintenance dose should be based on

A

TBW (not preop anxiolysis though)
r/t increased central Vd

37
Q

how much of normal epidural dose to give

A

75%

38
Q

three sets of muscles that dilate upper aw

A

tensor palatine (opens nasopharynx)
geniglossus (opens oropharynx)
hyoid muscle (opens hypo pharynx)

39
Q

OSA

A

defined as cessation of air flow for at least 10 seconds
with 5 or more unsuccessful efforts to breathe and a >4% reduction in SaO2

40
Q

hypopnea

A

common phenomenon in OSA. 50% reduction in air flow for 15 seconds, 15 or more times per hour, and is linked to snoring and decreased O2 saturation

41
Q

things that increase the likelihood that a patient has OSA

A

BMI >30kg/m^2
abdominal fat distribution
large neck girth (>17inches for men and >16 inches for women)

42
Q

pathophysiology of OSA

A
43
Q

apnea/hypopnea index

A

categorizes severity of OSA
mild: 5-15 episodes/h
moderate: 15-30 episodes/h
severe: >30 episodes/h

44
Q

classic triad of dysfunctional sleep

A
  1. apnea or snoring with hypopnea during sleep
  2. arousal from sleep
  3. daytime somnolence
45
Q

definitive test for OSA and AHI (apnea hypopnea index) equation

A

polysonmography, AHI= number of episodes of apnea and hypopnea/hours of sleep

46
Q

STOPBANG and high risk v low risk for OSA

A

high risk >3 q answered yes
low risk < 3 q answered yes

47
Q

obesity hypoventilation syndrome

A

long term consequence of OSA. over time, resp center in medulla fails to adequately respond to hypercarbia
classic presentation: apnea during sleep WITHOUT resp effort
old school name is pickwickian syndrome

48
Q

dx criteria for obesity hypoventilation syndrome

A

BMI >30
awake PaCO2 >45mmHg
dysfunctional breathing during sleep

49
Q

signs of obesity hypoventilation syndrome

A

obesity
hyper somnolence during the day
hypoxemia
hypercarbia
resp acidosis
compensatory metabolic alkalosis
polycythemia
pHTN
right HF

50
Q

type of weight loss procedure: malapsorption
examples
key points

A
51
Q

type of weight loss procedure: restriction
examples
key points

A
52
Q

type of weight loss procedure: combination
examples
key points

A
53
Q

most common s/sx of anastomotic leak include

A
  1. tachycardia
  2. fever
  3. abdominal pain
54
Q

Ma Huang

A

appetite suppressant, natural source of ephedrine. complications of adrenergic overstimulation including HTN, CVA, sz, death

55
Q

phentermine

A

NE reuptake inhibitor that acts as appetite suppressant and increases BMR

56
Q

sibutramine

A

NE and serotonin reuptake inhibitor, suppresses appetite and increases BMR
risks include adrenergic overstimulation and serotonin syndrome

57
Q

orlistat

A

lipase inhibitor that reversibly binds to lipase and hinders absorption and digestion of consumed fats. have to supplement ADEK vitamins

58
Q

for a patient undergoing laparoscopic gastric bypass, fluids should be based on

A

lean body weight

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