Obesity Flashcards

1
Q

What are the two gut homes that are involved in weight control?

A

Gherlin
Glucagon-like peptide (GLP-1)

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2
Q

Where is Gherlin found? What does it do?

A

Fundus of the stomach
ONLY KNOWN CIRCULATING OREXIGEN or APPETITE STIMULANT

Also increases secretion of growth hormone, cortisol and epinephrine

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3
Q

When do you see gherkin suppression with gastric bypass surgery?

A

because it involves removal of the funds of the stomach, where it is made

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4
Q

What does Glucagon-like Peptide 1 do?

A

Enhances insulin release
Improves beta cell function
Inhibits glucagon secretion
delays gastric emptying
Decreases food intake

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5
Q

Where is GLP 1 found?

A

distal ileum and colon

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6
Q

How does GLP1 improve DM?

A

through effects on Glucagon, insulin, food intake and weight loss from anorexic effects of bariatric surgery

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7
Q

What are some CV effects of obesity?

A

Increase in circulating blood volume, plasma volume and CO
Increase blood volume –> increased preload & after load
All can lead to BiVent failure
HTN

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8
Q

___ L/Min increase in CO for every ____ of body fat

A

0.1 ; 1kg

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9
Q

What are some respiratory effects of obesity?

A

Increased demand and decreased supplyH

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10
Q

How does Obesity increase O2 demand?

A

increased oxygen consumption and CO2 production
Leads to increased alveolar ventilation

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11
Q

How does obesity decrease supply?

A

Decreased Chest wall compliance –> decreasing lung volume
Decreased FRC and EVR
Premature airway closure due to an increase in closing volume and capacity

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12
Q

What is closing volume

A

volume of gas in the lungs in excess of the RV at a time when the small airways close during maximum exhalation

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13
Q

What odes increased closing volume lead to?

A

Atelectasis and shunting of blood

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14
Q

Why is WOB increased in obese pts?

A

elevation of the diaphragm from fat layers on chest wall and abdomen

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15
Q

What three factors predict a return to DM after bariatric surgery?

A

long duration of DM
poor blood sugar control preop
required insulin therapy

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16
Q

WHAT IS METABOLIC SYNROME?

A

Truncal obesity + at least two of the following;
Hypertriglyceridemia
HTN
Hyperglycemia (fasting BG> 100)
Low LDL

17
Q

What are the classifications for truncal obesity

A

Men >40 in and women >35 in

18
Q

What are some risk factors for metabolic syndrome?

A

Age
Race
BMI 25
Hx of DM 2 in th family or women with GD

19
Q

What is OHS?

A

Obesity hypoventilation syndrome
Also called pickwickian syndrome

Hypoventilation, leads to respiratory alkalosis, hypoxemia and polycythemia

20
Q

What can OHS lead to

A

pHTN
Right axis deviation
RV hypertension
PE
Cor pulmonae
PNA
Conversion to hypoxic drive, hypersomnolence or difficult airway

21
Q

What is malignant OHS?

A

Essentially OHS with multi system organ failure related to obesti

22
Q

What is the major criteria for Malignant OHS?

A

BMI >40
Awake hypercarbia
HCO2 > 28
Metabolic syndrome
Restrictive lung disease

23
Q

What is the minor criteria for OHS?

A

Multiple hospital admissions for respiratory failure
chronic renal insufficiency
Sleep apnea
NASH
Eccentric LVH
Vit D Deficiency
Diastolic LV dysfunction
Elevated CRP
PHTN
RV Volume overload
Systemic HTN