Obesity Flashcards
BMI calculation
weight(kg) / height (m2)
———–or———-
[weight(lbs) / height (in2)] x 703
Ideal body weight formula
male = height(cm) - 100
female = height(cm) - 105
what’s the BMI for overweight
25-29.9
what is the BMI for obese class 1
30-34.9
what is the BMI for obese class 2
35-39.9
what is the BMI for obese class III/ extreme obese
40-44.9
what is the BMI for obese class IV/severe obesity?
> 45
which type of fat distribution is more deadly
android - apple
where is the fat located in android distribution
central or abdominal visceral
where is the fat located in gynecoid
gluteal femoral or peripheral
what disease processes does gynecoid fat lead to
vertices veins, joint disease
T/F Gynecoid fat leads to an increased incidence of DM?
FALSE. reduced incidence
what defines a pediatric patient as obese?
weight-height ratio >90%
BMI >95%
T/F Maternal complication risk is increased after bariatric surgery.
TRUE
what happens to total body water in the obese
DECREASES
what happens to blood volume and VOD in the obese
INCREASE
what happens to lean body weight in the obese
INCREASE
what happens to the VOD for lipid soluble drugs
INCREASES
if a drug has high lipophilicity, most of the time you should dose based off ___
TBW
if a drug has low lipophilicity, most of the time you should dose off
IBW
Cardiac output increases by ___ for each kg of fat
0.1L/min
For every 13.5kg of fat = _____ of neovascularization
25mi
increased volume, increased ____ activity —-> htn
RAAS
what happens to the structure of the heart in obese patients
cardiomegaly, atrial and biventricular dilatation, hypertrophy
T/F CAD is an independent factor with obesity?
TRUE - it appears with or without htn, DM, or sedentary lifestyle
Define HTN.
SPB >140, DBP > 90, or both
why do obese people have twice the normal risk of developing hypertension?
increased blood viscosity, hyperinsulinemia, increased mineralocorticoids, Na reabsorption, compression of kidneys, impaired NA excretion, RAA activation
Which spirometry values decrease in the obese
FRC ERV VC TLC
why does FRC decrease
because expiratory reserve volume is below closing capacity which creates a situation where distal airway collapse occurs during tidal breathing.
Which flow volume loop pattern is best representative of the obese?
restrictive.
looks like a small ice cream cone
what is the gold standard test for OSA
polysomnography
STOPBANG - BMI >?
35
STOPBANG - Age > ?
50
STOPBANG - neck circ >?
40cm
someone is high risk for stop bang if they score a
3 or greater
according to nagel
how is OSA defined in terms of apnea episodes
excessive episodes of apnea (10s) and hypopnea >5 episodes/hr or 30/night
how is hypopnea defined?
not in ppt - taken from nagelhout
a 50% reduction in airflow for 10s that occurs 15 or more times/hr of sleep and is associated with snoring and a 4% decrease in O2 sat.
Obese hypoventilation (pickwickian) syndrome - which lab values are suggestive?
PCO2 >45 during wakefulness with compensatory metabolic compensation and hypoxemia (PO2 <70)
what is the difference between simply obesity and OHS?
With simple obesity, the PCO2, pH and pulmonary compliance are within normal ranges. Hypoxia may be present but no evidence of cardiac failures or differences in aterioalbeolar O2 exists. In contrast, OHS is diagnosed when the morbidly obese patient exhibits inappropriate and sudden somnolence, sleep apnea, hypoxia, and hypercapnia.
Signs of OHS include cardiac ____, cyanosis, polycythemia, and twitching
enlargement
___% of NIDDM are also obese
80
metabolic syndrome - in order to be diagnosed, one must have at least 3:
name the #’s
waist m/f triglycerides HDL m/f BP fasting glucose
waist m>40in
waist f>35in
triglycerides >150
HDL <40men
HDL<50 women
BP 130/85
fasting glucose >100
what should your tidal volumes be for an obese patient
6-10ml/kg
what should you use for maint fluids multiplier?
45-55 ml/kg (prodigy)
the maximum decrease in PAO2 occurs ____ post-op
2-3days (prodigy)
what is the most common cause of post-op mortality after bariatric surgery?
thromboembolism (prodigy)
T/F Succs dose for intubation are given according to TBW to ensure excellent intubating conditions
TRUE
the combination of an increased blood volume(increased Vd) and increased pseudocholinesterase activity (increased clearance) necessitates a TBW dose be given to ensure adequate paralysis.
(prodigy)
T/F NDNMB used for induction/ maintenance are given according to TBW.
FALSE - IBW
hydrophilic drugs given according to IBW will ensure shorter duration and a more predictable recovery in the respiratory challenged population.
(prodigy)
what is the most confirmatory test of pulmonary htn
tricuspid regurg on TEE
(prodigy)
BP cuffs with bladders that encircle a minimum of ___% of the upper arm circle should be used.
75
(prodigy)
T/F Forearm measurements with a standard cuff underestimates both systolic and diastolic BP in obese.
FALSE - overestimates
(prodigy)
what are the risk factors for mendelsons syndrome
gastric pH <2.5, gastric volume >25mL
If the gastric volume is less than 1.5ml/kg, the risk of aspiration can be considered low. (prodigy q)
which 3 positions are least ideal for the obese
prone supine trend
(prodigy)
T/F A vertical abdominal incision, as opposed to a horizontal (transverse) incision, prolongs post-op hypoxia.
TRUE
(prodigy)
How should you do a recruitment maneuver?
sustained 8-10s pressure of 40cm H20 or greater
prodigy
Explain how PEEP can help or hurt the situation
PEEP 10-12cmH20 - recruiting collapsed alveoli BUT may cause hotn or decreasing arterial oxygenation d/t a PEEP induced increase in pulmonary shunt function
(prodigy)
what is the most senstive sign of leak in bariatric surgery
tachycardia.
most common - tachycardia, fever, and pain.
(prodigy)
T/F Both fat mass and muscle mass increase.
TRUE
So the Vd for water soluble drugs will increase some because the plasma volume is larger, but the Vd for fat soluble drugs will increase a whole lot more because of the large fat mass.
vd lipophilic drugs»_space;> vd hydrophilic drugs, but both increase!
(apex)
for propofol, give induction dose based on ___, and maintenance dose based on ___
LBW
TBW
(apex)
Sugammadex is dosed based on IBW LBW or TBW?
TBW
apex
