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Obesity Boards > Obesity Algorithm > Flashcards

Obesity Algorithm Flashcards

1
Q

What satiety hormone is elevated in Roux en Y bypass is elevated and why?

A

GLP-1. Because surgery bypasses the proximal small intestine therefore you have rapid transit of food to the distal small intestine and thus, higher levels of GLP1 will increase.

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2
Q

Why does Roux en Y surgery help diabetes?

A

Because you have elevated GLP-1 so you have decrease in hepatic gluconeogenesis which is usually always turned on in diabetics.

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3
Q

What is the most common monogenic defect predisposing to obesity?

A

MC4R

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4
Q

What are features of MC4R deficiency?

A

Hyperphagia
Tall stature
Insulin resistance
Autosomal recessive or dominant
Higher leptin/LR

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5
Q

What are features of POMC deficiency?

A

Decreased ACTH which can lead to congenital adrenal insufficiency
Decreased alpha MSH as POMC makes this too.
Pale skin/red hair - hypopigmentation
Autosomal Recessive
Hyperphagia

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6
Q

What are features of Lepr deficiency and congenital leptin deficiency?

A

LepR - normal or elevated Leptin,
Congenital - undetectable leptin
Both have - hyperphagia, hypogonadism
Impaired T cell - frequent infections
Autosomal recessive
Can use Setmelanotide for LEPR deficiency.
Can use Metreleptin for Congenital lefptin deficiency with lipodystrophy

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7
Q

What are features of Bardet Biedl Syndrom?

A

Rare
Hyperphagia
Vison loss- retinitis pigmentosa which can lead to night blindness
Renal disease
Metabolic syndrome
Delayed puberty
Polydactyly
Can use Setmelanotide to help obesity

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8
Q

What conditions is Setmelanotide approved for?

A

POMC
LEPR deficiency
Bardet Biedl

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9
Q

What are features of Cohen Syndrome?

A

Chromosome 8p22 mutation
Central obesity - thin arms/legs
Thick hair, eyebrows and eyelashes
Small face
Developmental delay
Retinal dystrophy
Hypermobility
Overly friendly
Neutropenia
Some will have seizures and deafness
Autosomal recessive

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10
Q

What are some features of Prader Willi?

A

High Ghrelin and low leptin
Hypotonia and poor feeding at birth
Hyperphagia at age 2
Thin face with almond shaped eyes
Delayed development and intellectual impairment
Hypogonadism
Paternal chromosome 15 - partial loss of function, deletion of q11-13 region
Most common form of syndromic obesity

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11
Q

What are some features of Albright’s Hereditary Osteodystrophy?

A

Short Stature
Pseudohypoparathyroidism
Dental abnormalities
Round face
Shortened fingers/toes
Resistance to several hormones
Genetic imprinting in autosomal dominant manner

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12
Q

What are some features of PCKS1 deficiency?

A

Severe weight loss and diarrhea seen in infancy, increase in appetite and weight gain by 2yo
poor linear growth

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13
Q

Beckwith-Weidermann Syndrome

A

11p15.5 mutation
Macroglossia
Hepatosplenomegaly
hypoglycemia in 30-50% of babies
predisposition to tumor development

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14
Q

Alstrom Syndrome

A

Photophobia
Nystagmus
Deafness
Blindness
Diabetes

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15
Q

What does indirect calorimetry estimate?

A

REE

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16
Q

How does indirect calorimetry estimate REE?

A

Measure carbon dioxide production and oxygen consumption. It is reimbursible.

17
Q

What does direct calorimetry measure?

A

Total energy expenditure -measures heat generated by organism via enclosed chamber

18
Q

What makes up total energy expenditure?

A

REE(60-75%) + TEM(10%) + EEPA(15-30%)

19
Q

What does Mifflin St Jeor measure?

A

REE

20
Q

What equations can measure REE?

A

Mifflin St Jeor and Harris Benedict equations

21
Q

What are features of lipedema?

A

Lipodystrophy
Affects women ages 15-30
Feels like nuts/rice/peas
Cuff sign
Spares feet
Subcutaneous fat accumulation in lower body
Soft, minimal pitting

22
Q

What are the Orexigenic neurotransmitters?

A

NPY
AgRP
MCH
Orexin A and B

23
Q

What are the Anorexic neurotransmitters?

A

POMC
CART
Alpha melanin stimulating hormone
Serotonin

24
Q

What is NPY inhibited by?

A

Insulin
Leptin
PYY
Serotonin

25
Q

What is AgRP inhibited by?

A

Insulin
Leptin
PYY
Serotonin

26
Q

What is Orexin A/B stimulated and inhibited by?

A

Stimulated by NPY/AgRP
Inhibited by Leptin

27
Q

What is MCH stimulated and inhibited by?

A

Stimulated by NPY/AgRP
Inhibited by Leptin

28
Q

What is POMC/CART stimulated and inhibited by?

A

Stimulated by Serotonin, Insulin and Leptin
Inhibited by NPY and GABA

29
Q

If arrested height but accelerated weight, what would you worry about in child?

A

Hormonal issue and should check TSH/T4, Dexamethasone suppression test and 24 hour urinary cortisol

30
Q

What is REE?(Weir equation)

A

VO2 and VCO2.

31
Q

What is VO2?

A

Oxygen uptake and consumption

32
Q

What is VCO2?

A

Carbon dioxide production/elimination

33
Q

What increases VO2?

A

Exercise
Overfeeding - thermic effect of meals
Shivering
Hyperthermia

34
Q

What increases VCO2?

A

Metabolic acidosis
Hyperventilation
Excessive Carb intake
Hypermetabolism

35
Q

What decreases VO2?

A

Paralysis
Starvation/fasting
Hypothyroidism
Hypothermia

36
Q

What decreases VCO2?

A

Metabolic Alkalosis
Hypoventilation
Starvation/ketosis
Hypometabolism

37
Q
A

Obesity Boards (11 decks)

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