Obesity Flashcards
What is the role of leptin in weight?
Made in the adipocyte/acts on hypothalamus
Suppresses appetite
Genetic deficiency causes extreme obesity
However, most obese people have high leptin levels, which suggests they are leptin resistant.
What is role of ghrelin in weight?
Hormone made in stomach, acts on hypothalamus
Stimulates hunger
What is criteria for bariatric surgery?
BMI >40
OR
BMI >35 with one weight related co-morbitity
What are the 3 broad categories of bariatric surgeries?
Restrictive
Malabsorptive
Combo of two
What is adjustable gastric banding surgery?
Lap Band
Inflatable band on stomach that is adjustable/removable
This has no dumping, no malabsorption, low complication rate. However, weight loss more limited.
What is gastric sleeve?
75% of stomach removed
Creates a smaller, sleeve of stomach
Nutrition problems common
Stomach leakage problems
Rapid weight loss
What is biliopancreatic diversion?
Most complicated of all bariatric surgeries
70% of stomach removed
Anastomosis between stomach and intestine
Decreases length of small intestine
Able to hold more food, greater long term success
Frequent loose stools
Dumping syndrome
Nutritional problems
What is Roux-en-Y gastric bypass?
Small gastric pouch left that connects to jejunum
Good long term results
Nutrition problems
Dumping syndrome
Leaks can occur
What is dumping syndrome?
Contents of stomach empty too quickly into small intestine
Overwhelms small intestine and results in sudden decrease in plasma volume.
Looks like:
N/V
Weakness
Sweating
Faintness
Diarrhea
–Avoid eating sugar to reduce this–
–Lie down after eating to help–
What are some considerations for treating obese patients?
Plan ahead:
Have appropriate size gowns, bed, commode, BP cuff, wheelchair
Think of how will weigh and transport patient
Post op considerations for obese patients.
Excess adipose tissue can hold onto and later release anesthesia after initial post op period. Monitor LOC frequently
Keep HOB elevated to reduce abdominal pressure and increase lung expansion
Assess skin often. Keep folds clean and dry
Watch for infection, dehiscence, delayed healing.
What is android fat distribution?
Apple shape
Fat in abdomen and upper body
Greater risk for insulin resistance, cancer, heart disease and HTN
What is gynoid fat distribution?
Pear shape
Fat in hips and upper legs
Increased risk of varicose veins, osteoporosis
