Obesity 3 Flashcards
Obesity hypoventilation syndrome is a long-term consequence of
untreated OSA
The classic presentation of obesity hypoventilation syndrome includes
episodes of apnea during sleep WITHOUT any respiratory effort
Diagnostic criteria for obesity hypoventilation syndrome is
BMI >30 kg/m2
awake PaCO2 >45 mmHg
dysfunctional breathing during sleep
Signs of obesity hypoventilation syndrome include
obesity, hypersomnolence during the day, respiratory acidosis, compensatory metabolic alkalosis, polycythemia, pHTN, and right heart failure, hypoxemia, and hypercarbia
_________________ puts patients with obesity hypoventilation syndrome at high risk of airway obstruction and respiratory arrest.
The administration of any respiratory depressant drug
_________ is the old school name for obesity hypoventilation syndrome
Pickwickian syndrome
With obesity hypoventilation syndrome, over time, the respiratory center in the medulla
fails to respond to hypercarbia appropriately
Medications that could be considered for patients with obesity hypoventilation syndrome include
regional anesthesia, NSAIDs, acetaminophen, ketamine, dexmedetomidine
What is the MOST sensitive sign of an anastomotic leak following gastric bypass?
a. shoulder pain
b. unexplained tachycardia
c. abdominal pain
d. fever
b. unexplained tachycardia
_________ is the most effective treatment for reversing obesity.
Bariatric surgery
Bariatric surgery usually leads to the resolution of
comorbidities such as hypertension and type 2 diabetes
The three approaches to surgical weight loss include:
malabsorption
restriction
combination
Examples of malabsorption surgeries include
jejunoileal bypass
bileopancreatic diversion
duodenal switch
Examples of restrictive surgeries include
gastric band
sleeve gastrectomy
Examples of combination surgeries include
Roux-en-Y gastric bypass
What type of surgical approach for bariatric procedures yields the best weight loss and improvement of comorbidities?
Roux-en-Y gastric bypass
__________ is the most sensitive sign of an anastomotic leak
Unexplained tachycardia
Other common s/sx of anastomotic leak include
fever & abdominal pain
The risk associated with combination surgery include
risk of nutritional deficiency
The risk of malabsorption surgery includes
risk of Vit K, Vit B12, iron, and folate depletion
What type of procedure results in reduced gastric hormone secretion?
restriction
Additional signs and symptoms of an anastomotic leak include
shoulder pain (usually left)
pelvic pain
substernal pressure
dyspnea
hypotension
oliguria
increased thirst
restlessness
hiccups
There is no data that illustrate _________ on the basis of BMI alone
an increased risk of pulmonary aspiration
Obese patients with other risk factors such as GERD or diabetes should be considered
candidates for aspiration prophylaxis and RSI
Non-prescription appetite suppressants that may be a source of drug interactions in the perioperative period include
Ma Huan, phentermine, sibutramine, and orlistat
Obesity is the most significant risk factor for the development of
nonalcoholic fatty liver disease and nonalcoholic steatohepatitis
Ma Huang is a
natural source of ephedrine, an indirect-acting adrenergic agonist and thermogenic agent
Complications of taking Ma Huang include
hypertension
adrenergic overstimulation
CVAs
seizures and death
A norepinephrine reuptake inhibitor that acts as an appetite suppressant and increases BMR is
phentermine
Complications of taking phentermine include
adrenergic overstimulation
A norepinephrine and serotonin reuptake inhibitor that acts as an appetite suppressant and increases BMR is
sibutramine
Complications of taking sibutramine are
adrenergic overstimulation
serotonin syndrome
A lipase inhibitor that reversible binds to lipase and hinders the absorption and digestion of consumed fats is
orlistat
Complications of taking orlistat include
impaired vitamins (D, A, K, E)
vitamin K impairs synthesis of clotting factors and can cause coagulopathy
What clotting factors are impaired with vitamin K impairment?
2, 7, 9, and 10
