Obesity Flashcards
Adipose tissue is considered an organ–T/F?
True!
What are (2) formulas that can be used to calculate BMI?
BMI = weight (kg) / height (m^2)
BMI = [weight (lbs) / height (in^2)] x 703
BMI class (ASA)–overweight = ___-___
25-29.9
BMI class (ASA)–obese class I = ___-___
30-34.9
BMI class (ASA)–obese class II = ___-___
35-39.9
BMI class (ASA)–obese class III/extreme obese = ___-___
40-44.9
BMI class (ASA)–obese class IV/severe obesity = > ___
> 45
How to calculate ideal body weight (IBW) for males and females using Broca’s index?
Male = height (cm) - 100
Female = height (cm) - 105
How to calculate lean body weight (LBW)?
IBW x 1.3
What type of fat distribution is central or abdominal visceral; patients are apple shaped?
Android
What type of fat distribution is gluteal, femoral, or peripheral; patients are pear shaped?
Gynecoid
Which type of obesity (android or gynecoid) is associated with more comorbidities?
Android
What (5) things is android obesity associated with?
- Heart disease
- Diabetes mellitus
- Hypertension
- Dyslipidemia
- Death
What (2) things is gynecoid obesity associated with?
- Varicose veins
- Joint disease
There is a/an ___ (increased/decreased) metabolic demand from fat organs
There is an INCREASED metabolic demand from fat organs
Increased cardiac output of ___ L/min for each kg of fat
Increased CO of 0.1 L/min for each kg of fat
HTN in obesity is defined as SBP > ___, DBP > ___, or both
HTN in obesity is defined as SBP > 140, DBP > 90, or both
Respiratory–obese patients have ___ (increased/decreased) lung compliance; why?
Obese patients have DECREASED lung compliance; d/t pressure from abdominal, diaphragmatic, and thoracic fat
Obese patients have a ___ F/V loop pattern
Obese patients have a RESTRICTIVE F/V loop pattern
Obese patients have ___ (increased/decreased) FRC, ERV, VC, TLC; ___ (increased/decreased) dead space; ___ (increased/decreased/no change) in RV, CC, FVC, and FEV1
Obese patients have DECREASED FRC, ERV, VC, TLC; increased dead space; no change in RV, CC, FVC, and FEV1
Obese patients ___ventilate, which leads to ___carbia and ___osis
Obese patients HYPOventilate, which leads to HYPERcarbia and acidosis
What volumes/capacities are decreased in obese patients?
Decreased
- FRC
- VC
- TLC
- ERV
What volumes/capacities show no change in obese patients?
No change
- RV
- CC
- FVC
- FEV1
OSA rates are directly proportional to ___
OSA rates are directly proportional to BMI
Risk factors for OSA–BMI > ___, ___ fat distribution, large ___ girth
Risk factors for OSA–BMI > 35, abdominal fat distribution, large neck girth
For BMI > 35, OSA occurs in 71-77% of patients–T/F?
True
What is OSA defined as?
Excessive episodes of apnea (10 seconds) and hypopnea
What exactly occurs during episodes of apnea?–obstruction leads to ___ia and ___carbia, surge of muscles to open airway, period of ___ventilation reverses ___carbia, ___ breathing, repeat
obstruction leads to hypoxia and hypercarbia, surge of muscles to open airway, period of hyperventilation reverses hypercarbia, normal breathing, repeat
OSA includes > ___ episodes of apnea per hour or ___ per night
OSA includes > 5 episodes of apnea per hour or 30 per night
OSA leads to ___ia, ___carbia, ___ and ___ hypertension, and cardiac ___
OSA leads to hypoxia, hypercarbia, systemic and pulmonary hypertension, and cardiac arrhythmias
80-95% of patients who have OSA are undiagnosed–T/F?
True
What is the gold standard test for OSA?
Polysomnography (PSG)
What questionnaire can we use to evaluate patients for OSA and has up to 93% sensitivity?
STOP-BANG
What does STOP-BANG stand for?
S-Snoring (Do you snore loudly?)
T-Tiredness (Do you often feel tired, fatigued, or sleepy during the daytime?)
O-Observed apnea (Has anyone observed that you stop breathing, or choke or gasp during your sleep?)
P-high blood Pressure (Do you have or are you being treated for high blood pressure?)
B-BMI (Is your body mass index more than 35 kg per m^2?)
A-Age (Are you older than 50 years?)
N-Neck circumference (Is your neck circumference greater than 40 cm [15.75 inches]?)
G-Gender (Are you male?)
What syndrome does this describe?–inappropriate and sudden somnolence, OSA, hypoxia, hypercapnia, arterial hypoxemia, cyanosis-induced polycythemia, respiratory acidosis, pulmonary hypertension, right sided heart failure
Obese hypoventilation (Pickwickian) syndrome
Obese hypoventilation (Pickwickian) syndrome can lead to what? How?
Right heart failure d/t hypoxic pulmonary vasoconstriction (AKA cor pulmonate)
Pediatric obesity classifications–weight for height ratio > ___%, BMI > ___%
weight for height ratio > 90%, BMI > 95%
Pharmacology in obese patients–___ (increased/decreased) volume of distribution; ___ (increased/decreased) blood volume; ___ (increased/decreased) total body water
increased volume of distribution; increased blood volume; decreased total body water
IBW vs. TBW–for drugs with LOW lipophilicity, use ___
for drugs with LOW lipophilicity, use IBW
IBW vs. TBW–for drugs with HIGH lipophilicity, use ___
for drugs with HIGH lipophilicity, use TBW (most of the time)
i.e.: digoxin, remifentanil, procainamide
You want to use their TBW because they have increased volume of distribution for lipid-soluble drugs (there’s more area for the drug to be distributed to)
Pharmacokinetic changes associated with obesity–___ (increased/decreased) fat mass; ___ (increased/decreased) cardiac output; ___ (increased/decreased) blood volume; ___ (increased/decreased) lean body weight; ___ (increased/decreased) total body water; ___ (increased/decreased) renal clearance; ___ (increased/decreased) volume of distribution of lipid-soluble drugs
increased fat mass; increased cardiac output; increased blood volume; increased lean body weight; decreased total body water; increased renal clearance; increased volume of distribution of lipid-soluble drugs
Effects of general anesthesia–obese patients have __% reduction in FRC compared to ___% in non-obese patients
Obese patients have 50% reduction in FRC compared to 20% in non-obese patients
Tidal volumes in obese patients–___-___ ml/kg of ___ (IBW or TBW) for volumes
6-10 ml/kg of IBW for volumes
Volume replacement for obese patients–increased ___ volume, but proportionately decreased ___ volume
increased total body volume, but proportionately decreased estimated blood volume
EBV in obese patients–use ___-___ ml/kg
use 45-55 ml/kg
