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► Med Misc 44 > Obesity > Flashcards

Obesity Flashcards

1
Q

what is defined as an increase in body weight above a standard related to height?

A

Overweight

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2
Q

what is defined as being characterized by an abnormally high percentage of body weight as fat of sufficient magnitude to impair health

A

obesity

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3
Q

what is a concept defines by life insurance companies- is the weight associated with the lowest mortality rate for a given height and gender?

A

Ideal body weight (IBW)

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4
Q

IBW:

what is IBW for a female

A

height (cm) - 105

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5
Q

IBW:

what is IBW for Males

A

height (cm) - 100

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6
Q

is lean body weight (LBW) synonymous with IBW

A

no

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7
Q

LBW:

how is it calculated or what is it defined as

A

the TBW minus the adipose tissue weight

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8
Q

LBW:

formula

A

IBW + (20 to 40%)

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9
Q

what is the formula for BMI

A

BMI = kg / m^2

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10
Q

BMI:

Underweight

A
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11
Q

BMI:

normal

A

18.5-24.9

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12
Q

BMI:

Overweight

A

25-29.9

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13
Q

BMI:

Obese (I)

A

30-34.9

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14
Q

BMI:

Obese (II)

A

35-39.9

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15
Q

BMI:

Morbid obesity (III)

A

>/= 40

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16
Q

BMI:

Superobese

A

>/= 50

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17
Q

BMI:

Super-superobese

A

>/= 60

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18
Q

Distribution of Body fat:

what are the 2 types of body fat?

A

Android (apple)

Gynecoid (pear)

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19
Q

Distribution of Body fat:

Apple or Pear

A

Apple

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20
Q

Distribution of Body fat:

Apple or pear

A

pear

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21
Q

Distribution of Body fat: Android (apple)

fat is predominetly located where?

A

upper body

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22
Q

Distribution of Body fat:​ Android (apple)

associated with increased consumption of what?

A

O2

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23
Q

Distribution of Body fat:​ Android (apple)

have an increaced incidence of CV disease particulary what?

A

LV dysfunction

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24
Q

Distribution of Body fat:​ Gynecoid (pear)

fat is usually where

A

hips

butt

thighs

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25
Q

Distribution of Body fat:​ Gynecoid (pear)​

why is there a decreases risk of CV disease in these pt’s

A

less metabolically active fat

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26
Q

what is the newly est standard used as a marker for abdominal obesity?

A

waist circumference

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27
Q

A waist circunference greater than what in men denotes an increased risk for certain diseases and conditions including DM, Heart dz, HTN, dyslipidemia, and death?

A

102 cm (40.2 inches)

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28
Q

A waist circunference greater than what in women denotes an increased risk for certain diseases and conditions including DM, Heart dz, HTN, dyslipidemia, and death?

A

58cm (34.6 inches)

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29
Q

Respiratory:

what happens to lung voumes

A

decrease

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30
Q

Respiratory:

what happes to work of breathing

A

increases

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31
Q

Respiratory:

what are some of the airway changes

A

decreased pharyngeal area

excessive hypopharyngeal tissue

posterior displaced hyoid bone

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32
Q

Respiratory:

fat accumulation on the thorax and abdomen decress chest wall and lung compliance by about how much

A

35%

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33
Q

Respiratory:

what happens to TLC, ERV and FRC

A

decreased

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34
Q

Respiratory:

what happens to TV, residual voume, and closing capacity

A

nothing, usually no changes

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35
Q

Respiratory:

the reduction in FRC is explained primarily d/t what?

A

reduced ERV

FRC = RV + ERV

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36
Q

Respiratory:

when CC > FRC what occurs

A

V/Q mismatch

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37
Q

Respiratory:

Once CC > FRC and the V/Q mismatch arises what occurs?

A

CO2 retention (acidosis)

right to left shunting

arterial hypoxemia

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38
Q

Respiratory:

In response to the CO2 retention and arteial hypoxia what are their respiration usually like

A

rapid and shallow

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39
Q

Respiratory:

they develop what type of respiratory disease pattern

A

restrictive

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40
Q

Respiratory: anesthesia concerns

the obese pt has a decrease in FRC of how much compared to the 20% decrease if the non-obese

A

50%

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41
Q

Respiratory:

obesity increases ____ and _____ even at rest

A

oxygen consumption and CO2 production

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42
Q

Respiratory:

bc of the increased O2 consuption and CO2 production combined with the decreased FRC and V/Q mismatch the obese pt usually develops chronic what?

A

arterial hypoxia

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43
Q

Respiratory:

the chronic arterial hypoxia leads to what CV problems

A

Pulm HTN and Cor Pulmonale

Aka right heart failure

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44
Q

OSA:

what is a milder precuror to OSA and is defined as partial decreased airflow (>50% reduction), lasting 10 seconds, occuring >15/hr of sleep, and accompied by at least a 4% reduction in arterial oxygenation.

A

OSH

obstructie sleep hypopnea

45
Q

OSA:

risk factors obese

A

male

middle aged

BMI > 30

evening ETOH consumption

46
Q

OSA:

risk factor for non-obese

A

crainofacial dytoses

cartilaginous abnormalities

Chronic nasal obstruction

tonsilar hypertrophy

trisomy 21

47
Q

OSA:

what are the hallmark signs of OSA

A

Snoring

daytime sleepiness

impaired concentration

memory problems

morning headaches

48
Q

OSA:

apnea is defined as what?

A

cessation of airflow > 10 sec

=/> 5 times per hour of sleep

dispite continued ventilatory effort against clossed glottis

in combination with at least 4% decrease in arterial oxygenation

49
Q

OSA:

what follows period of apnea and why?

A

hyperventilation

to compensate for hypercarbia

50
Q

OSA: Physical Alteration

what happens to arterial O2

A

Arterial Hypoxemia

51
Q

OSA: Physical Alteration

what happens to CO2

A

Hypercarbia

52
Q

OSA: Physical Alteration

what happens to pulmonary and systemic vasculature

A

Vasoconstriction

53
Q

OSA: Physical Alteration

what happens to blood components

A

polycythemia

54
Q

OSA:

the definative diagnosis for of OSA is made how?

A

polysomnography in sleep lab

55
Q

OSA:

what is an assessment questionmaire you may use in the preop period

A

STOP BANG

56
Q

OSA:

explain the STOP BANG questionnaire

A
  • do you SNORE loudly
  • do you feel TIRED during the daytime most everyday
  • has anyone see you STOP breathing during sleep
  • so you have a high blood PRESSURE
  • is BMI > 35
  • is AGE greater then 50
  • is NECK circumference greater then 40cm
  • in GENDER male
57
Q

OSA:

with the STOP BANG your at high risk for OSA if you score what?

A

> 3 are yes

58
Q

OSA:

you are at low risk for OSA if your score is what on the STOP BANG?

A
59
Q

OSA:

definative treatment of OSA is what?

A

Positive airway pressure in the forms of IPAP. EPAP, and CPAP

60
Q

OSA: Anesthestic concerns

they are exquisitely sensitive to all CNS depressants, so what should we use sparingly in the preop phase

A

Benzo

Opioids

61
Q

what is a disorder like OSA but more severe?

A

Obesity Hypoventilation Syndrome (OHS)

62
Q

Obesity Hypoventilation Syndrome (OHS)

is also called what?

A

Pickwickian Syndrome

63
Q

Obesity Hypoventilation Syndrome (OHS)

is a complication of extreme obesity, characterized by what

A

OSA

Hypercapnia

Daytime Hypersolmnolence

arterial hypoxemia

Cyanosis-induced polycythemia

respiratory acidosis

Pulm HTN

right sided heart failure

64
Q

Obesity Hypoventilation Syndrome (OHS)

can lead to central apnea, what is that?

A

Apnea without resp effort

65
Q

what is the main difference b/t Obesity Hypoventilation Syndrome (OHS) and OSA?

A

Obesity Hypoventilation Syndrome (OHS)- can lead to central apnea which is apnea without respiratory effort

66
Q

Obesity Hypoventilation Syndrome (OHS)

what are the 3 main diagnostic critera to define it

A

BMI > 30

Awake PCO2 > 45mmHg

sleep disordered breathing

67
Q

the prevalence of Obesity Hypoventilation Syndrome (OHS) in pts with OSA is what?

A

small 4-20%

68
Q

the prevelance of OSA with Obesity Hypoventilation Syndrome (OHS) is what?

A

high- 90%

69
Q

basically pts with Obesity Hypoventilation Syndrome (OHS) almost always have OSA

A

but pt’s with OSA usually don’t have Obesity Hypoventilation Syndrome (OHS)

70
Q

CV and Hematologic:

CO increases how much for each kg of excess body fat?

A

20-30 mL/kg

(about 100mL/min per kg)

71
Q

CV and Hematologic:

total blood volume is increased in the obese BUT on a volume to weight basis it is ______ than in the non-obese

A

less

72
Q

CV and Hematologic:

EBV calculation for Obese

A

50mL/kg

(vs 60mL/kg female non-obese and 70mL/kg male)

73
Q

CV and Hematologic:

the expanded blood volume places a greater demand on what?

A

the myocardium

74
Q

CV and Hematologic:

the expanded blood volume places a greater demand on the myocardium, specifically increased what?

A

LV wall stress

75
Q

CV and Hematologic:

the expanded blood volume places a greater demand on the myocardium, specifically increased LV wall stress. According to the LAw of Laplace the LV will do what in attempt to reduce wall stress

A

Hypertrophy

76
Q

CV and Hematologic:

LV hyertrophy leads to what complications

A

Hypertrophy

reduced LV wall stress

impaired diastolic filling

elevated LV pressures

Pulmonary edema

Systolic dysfunction

Biventricular failure

77
Q

CV and Hematologic:

adipose tissues releases a number of bioactive mediators (cytokines, chemokines, hormones) that promote a chronic, sub-clinical inflammatory state. This can contribute to what complications?

A

CV disease

Insulin resistance

coagulopathies

78
Q

CV and Hematologic:

obese people have a 2xs higher risk of developing what coag disorder

A

DVT

79
Q

CV and Hematologic:

high Factor ____ levels are associated w/ increased CV mortality

A

VIII

80
Q

Gastrointestinal:

what happens to gastric volume and acidity

A

increased

81
Q

Gastrointestinal:

why do they develop delayed gastric emptying?

A

increased abd mas

82
Q

Gastrointestinal:

what liver abnormalities are associated with obesity

A

NAFLD

inflammation

focal necrosis

Cirrhosis (1.5-2.5 x greater)

83
Q

Gastrointestinal:

both males and females who are obese have an increased risk for what cancer

A

esophageal and colorectal

84
Q

Endocrine and Metabolic:

the risk of what is linear with BMI

A

DMII

85
Q

Endocrine and Metabolic:

obese people have a higher incidence of what metobolic d/o (not DM)

A

Metabolic syndome

86
Q

Endocrine and Metabolic:

what is metabolic syndrome

A

constellation of metabolic abnormalities including

Abdominal obesity

glucose intolerance

HTN

dyslipidemia

87
Q

Endocrine and Metabolic:

diagnosis of metabolic syndrome requires what?

A

Android obesity

with at least 2 of the following

  • high triglycerides
  • reduced HDL
  • HTN
  • elevated fasting serum glucose
88
Q

Genitourinary:

what happens to Renal blood flow and GFR

A

increased

89
Q

Genitourinary:​

why does GFR and Renal blood flow increase in the obese

A

d/t the increased CO and Increased MAP

90
Q

Bariatric Surgery:

what are the 2 categories of sx

A

gastric restrictive

combo gastric restrictive and malabsortion

91
Q

Bariatric Surgery: Restrictive

what is the goal of this category

A

reduce and limt the pts capacity for food intake

92
Q

Bariatric Surgery:​ Restrictive

what are 3 procedures

A

Vertical band Gastroplasty (VBG)

Laparoscopic gastric band (LGB)

laparoscopic sleeve gastrectomy (LSG)

93
Q

Bariatric Surgery:​ Combined Restrictive & Malabsorption:

what is an example

A

Roux-en-Y gastric bypass (RYGB)

94
Q

Bariatric Surgery:​ Combined Restrictive & Malabsorption:

what is the biggest risk with the surgery

A

Anastomosis leak and peritonitis

95
Q

Pharmacology:

2 pharmacokinetics principles should be kept in mind when determining drug doses for obese pt’s what are they?

A

volume of distribution

clearance

96
Q

Pharmacology:

what is general rule to give drugs

A

IBW (induction) then titrate to effect

97
Q

Pharmacology:

most drugs we give should be given based off what weight (except for NDMR)

A

TBW

98
Q

Pharmacology:

how should NDMR be dosed

A

LBW (IBW)

99
Q

Anesthestic Management: Preop

what should we look for to evaluate for LEft and right ventricular failure

A

Elevated Jugular venous pressures

added heart sounds

Pulmonary crackles

Hepatomegaly

peripheral edema

100
Q

Anesthestic Management: Preop

what on the echo will inticate to us the pt has pulm htn

A

tricuspid regurg

101
Q

Anesthestic Management: Preop

what should we ask about r/t respiratory

A

Smoke

Exercise tolerance

somnolence

OSA

102
Q

Anesthestic Management: Preop

what do we wanna look for during airway evaluation

A

limited movement of Alantoaxial joint (fat pads)

Limited movent of cervical (fat pads)

Short thick neck

excessive tissue (neck folds)

very thick submental fat

103
Q

Anesthestic Management: Preop

Airway- is difficult airway closely correlated with BMI?

A

No

104
Q

Anesthestic Management: Preop

since difficult airway is not corralated with BMI what is it correlated with

A

Increased age

Male

TMJ

MALAMPATTI II or IV

abnormal upper teeth

OSA

Neck circumference

105
Q

Anesthestic Management:

what position provides the longest safe apnea period during induction of general anesthesia

A

Head up

Reverse trend

fowlers

106
Q

what are the the 3 axis to line up prior to intibation

A

oral axis

Pharyngal axis

laryngeal axis

107
Q

what is the only ventilatory parameter to show improved respiratory fxn in the obese

A

PEEP

108
Q

what happens to LA needs in the obese

A

may decrease by 20%

109
Q

at the end of sx goin from supine to sitting increases FRC by how much in the obese

A

30%

► Med Misc 44 (72 decks)

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