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Gastro 3 > Obesity > Flashcards

Obesity Flashcards

1
Q

Obesity Assc w

classified as

poorly defined correlation

better correlation uses ___ and comorbids

Men waist circum and waist to hip ratio

Women waist circum and waist to hip ratio

A

comorbidities, shortened life expectancy

inc BMI

to comorbidities

centripetal obesity

102 cm (40in) or .9

88cm (35 in) or .85

indicates high values

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2
Q

Obesity Linked to

Main cerebral center controlling food intake

Lateral hypothalamic area fxns as

Ventromedal hypothalamic area serves as

A

inc calorie intake beyond need for metabolism/
activity

arcuate nucleus in hypothalamus

feeding center- food intake

satiety center- inhibiting food intake

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3
Q

Stimuli for food intake

released to stimulate

Stimuli for satiety

stimulate satiety through

Insulin/Leptin trigger satiety via

Ghrelin stimulates food intake via

A

nueropeptide Y, AgRP

food intake or antagonise MC4R (satiety)

POMC and CART

MC4R

antagonizing NPY nad AgRP, stimulating POMC/CART

stimulating NPY/AgRP release

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4
Q

Genetic alterations

MC4R mutation

Agouti gene expression

AgRP overexpression

A

prevents bind of alpha MSH, a derivative of POMC

altered via epigenetic mechanisms- methylation dec gene expression, environmental factors lead to hypomethylation/inc gene expression

inhibits satiety signal from AMSH binding at MC4R

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5
Q

Fasting state, stomach releases

W consumption

With food in SI

GLP1 inhibits food intake via

consumption of fat leads to

A

Ghrelin- stimulates lateral hypothalamus

Ghrelin inhibited, digestive hormones released

GLP1 released from intestinal enteroenddocrine cells

inc insulin/glucagon sec, inibits gastric emptying

CCK, inhibits gastric emptying

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6
Q

Carb intake stimulates

Incompletely digested nutrients enter ileum and colon

Adipocytes release

Leptin binds to cells in

Excessive intake or insulin

A

panc release of insulin- inhibits food intake

EE cells release peptide YY, inhibiting food intake/gastric emptying/intestinal motility

leptin proportional to fat mass

Lateral/VM hypothalamus to inhibit food intake

inc release of leptin

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7
Q

Mutation in leptin inc propensity to

Usually results in dec

these individuals will

A

develop obesity

leptin protein/receptor

consume excess calories/have low BMR

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8
Q

Brown adipose tissue found

abundance of

After infancy, ___ dominates

White fat fxn

Beige fat fxn

A

during infancy

mito in cells responsible for thermogenesis

white/beige fat

energy storage, few mito

moderate amount of mito, undergo thermogenesis in response to stress

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9
Q

MC genetic cause for obesity

FTO gene produces

plays a key role in

inc activity results in

Risk alleles have been identified

A

inc white fat prodxn

enzyme removing methyl groups from DNA

direct fat cell differentiation

higher body weight

inc risk for obesity

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10
Q

Wl accompanied by

After months, a rebound in

Research indicates this doesnt happen as often, so there is a need to

NT and hormones in person w obesity

excessive cals stored as, wl less likely to be followed with

A

dec BMR- natural survival response to conserve energy

Met rate back to baseline

dec cal intake over time

differ

fat mass, dec met rate

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11
Q

Environmental influences are

play role in

Consumption of ____ inc development of obesity

most significant in

A

essential

epigenetic alterations, impact cal intake and expenditure

sugar sweetened bevs/sat fat

children, FTO gene

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12
Q

Sedentary lifestyle

another consideration

this leads to an inc

A

inc risk for obesity

sleep deprivation- dec serum leptin, inc ghrelin

consumption of high carb foods

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13
Q

Many drugs result in

most w

Atypical antipsy C/O/R

TCA A/C/I

antiepileptics V/C

DM I/S/T

Exogenous

A

weight gain

clozapine/olanzapine/risperadone

amitryptiline, clomipramine, imipramine

valproic acid/carbamezipine

insulin, sulfonylureas, thiazolidinediones

CS

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14
Q

Medical conditions

Childhood

Leads to central obesity in

CS induce

Hypothyroidism

Hypothalamic obesity assc w

result of

GH deficinecy

A

Cushing’s syndrome/inc CS

face, neck, trunk, ab

11BHydroxysteroid dehydrogenase, inc lipogenesis

slows metabolism- modest wg (wl w meds)

damage to VM hypothalamus (hyperphagia)

massive trauma or hypothalamic dz/surgery

inc central adipose

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15
Q

Childhood obesity common pops

In adulthood

obesity more prev in

A

American Indian, Black, Mexican

all ethnicities except Asian Americans

Low income pops

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16
Q

Physiologic effects mediated via

Ab adipose tissue has inc propensity to

FFA in liver leading

Inc VLDL inc circ

FFA stimulates pancreas to release

serum glucose in

A

central adipose tissue

release FFA- induce change in liver, muscle and panc

steatosis (NAFLD), inc gluose/TG/VLDL release

dec HDL and inc LDL

insulin, muscle becomes insulin resistant- fat in muscles

insulin resistance

17
Q

Obesity inc risk of

indiv w ____ obesity at greatest risk

inc body weight also effects

OSA/obesity hypoventilation result from

Adolescent obesity assc w

Adult obesity assc w

A

CV dz, hyperlipidemia, DM< HTN, biliary stones, Ca

ab (metabolic syndrome)

breathing/MS function

obstructed upper airway (adipose tissue)

SCFE- bc strain on physis

OA/gout

18
Q

Screening for, obtain

BMI >25 obtain

waist circumference important bc of

BMI can be, look for

A

all patients, accurate w/h

w/h circumference

metabolic syndromes

misleading (lots of muscle mass), waist or w-h ratio

19
Q

Central obesity pt, clinician looks for

such as

obesity in childhood/adolescne at risk for

Test for
DM, LD, hyperlipidemia

A

contributing factors/comorbids

sedentary, inc calorie intake, meds

DM/CV dz

Fasting glucose and HbA1c (DM), liver enzymes (NAFLD), lipid profiles (hyperlipid)

20
Q

Primary goal of mx

mainstay of mx

Meds/surgery debated in, limited to

A

prevent/reverse comps

lifestyle modification

children, obese and fully mature who have failed lifestyle modfication

21
Q

Complication and Recommended intervention

BMI 25-30

27-30

30-40

35-40

40+

A

None- diet, exercise

HTN, DM, HL, OSA- diet, ex, meds

None- diet/ex/meds

2+: HTN/OSA/NAFLD/OA/HD/GI/HL- add surgery

None/any- same

22
Q

Goal of treatment

wl of 3-5% assc w

dec in BP w

A

lower weight

reduced TG/blood glucose/DM

wl of 7-10%

23
Q

successful diet/exercise leads to

for children, focus on

red met rate, must

even if met resistant, cal intake less than 1000

A

5-7% wl

health diet/exercise

reevaluate cal goals

leads to wl

24
Q

Best diet

key is to

Exercise effect is _____ calorie burn

Goal for patients w exercise

A

balanced

modify/monitor cal intake

overestimated

mod exercise 150+ min wk, maintaining wl and cv benefit

25
Q

Pharm therapy used as

agents usually have, some

drugs are for used on a _____ basis

typically have _____ once stopped

A

adjunct, for those not responding to diet/exercise

3-5% wl, SE, major wl

short term (<1yr)

wg

26
Q

Safest med is O_______

prevents

complications

A

orlistat, lipase inhibitor

hydrolysis of fat, inc excretion

inc fecal fat, cramps, fecal urgency/incont, spotting, flatus, FSV deficiency

27
Q

Serotonin agonists include F_______

mech

reduces

assc with

Lorcaserin (newer)

Mech

Less risk of

Concern with

SE

A

fenfluramine

5HT2B and C agonist

carcinoid HD, tricuspid regurg

agonist of 5HT2C receptor

HD

valvulopathy

nausea, HA, nasopharyngitis

28
Q

Phentermine, diethylproprion, benzphetamine, phendimetrazine class

stimulate release/reuptake of

SE

contraindications

A

sympathomimetics

NE, inducing satiety

sympathetic stimulation- dry mouth, insom, cons, nervous, inc HR/BP, cv events

CAD, HTN, hyperthyroid

29
Q

Antidepressants B_______

Mech\

similar to

Contraindication

A

buproprion

NE metabolism

sympathomimetic (similar AE)

epilepsy- lowers seizure threshold

30
Q

Antiepileptic med T______

Adverse effects include

A

topiramate

met acid, paresthesias, somnolence, difficulty concentrating

31
Q

GLP 1 agonists E_____ and L______

stimulates

SE

A

exenatide, liraglutide

Glucose dep insulin sec, inhibiting glucose release and inhibits gastric emptying

N/V

32
Q

combination products B and N

SE

P and T

contraindicated w

A

buproprion and naltrexone

nausea, HA, constipation

phentermine and topiramate (greater effect)

pregnancy and CV dz

33
Q

Bariatric surgery options

Malabsorptive procedures

Currently available

A

restrictive (dec size of stomach), malabsorptive (nut mal), or combo

rarely used bc of AE

restrictive and combined restrictive/malabsorptive

34
Q

Laparoscopic adjustable gastric banding

induces

process

wl is long term and

complications

can develop ___ years later

vitamin defic

A

restrics stomach size

sense of fullness/limits intake

ring encircles upper stomach, connected to SW resevoir w injection of saline for restriction

variable

band slippage, port malfxn, inc pressure of stomach/distal esoph (GERD, esophagitis)

cholelithiasis

Fe, B12

35
Q

Vertical sleeve gastrectomy is

process

results in

complications

develop

Def

A

permanent

remove greater curvature to produce a sleeve of stomach

dec GA release, altered hormone levels (dec Ghrelin inc GLP1 and PYY)

bleeding, stomach stenosis and GOO, gastric leak/peritonitis

cholelithiasis

Fe, B12, Ca

36
Q

Roux en Y bypass (combo)

process

results in

Hormones altered

induces _____ wl

SE, based on

Comps

Vit def in

highest risk

A

divide stomach, creating a proximal pouch, and anastamose to a limb of small bowel

dec quantity of food, malabsorption (food/enzymes dont mix until after anastamoses)

dec Ghrelin, inc GLP 1 and CCK

greatest

indiv, size of bypass/roux limb

stomal stenosis, marginal/internal ulcers, NV

Fe, B12, B1, D, folate, Ca

cholelithiasis

37
Q

Roux en y bypass

w consuming carbs, induces a

inc emptying of stomach bc of

results in vigorous hormonal response inc

30 min after meal

1-3 hrs later

Strict diet is necessary

A

dumping syndrome

lack of mixing and pylorus, inc delivery of hyperosmolar load to SB

CCK, PYY, VIP, RAAS

CV (flushing/diaphoresis, tachycard) and GI sx (N/cramps/belching/diarrhea)

hypoglycemic response, inc insulin

limit osmolar food to jejunum- low carb (esp simple sugar) w inc fat/prot

Gastro 3 (25 decks)

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