Obesity, Bariatric Surgery Flashcards
What are some issues that obese parturients experience?
high birth wt (macrosomic infant), higher rates of C section and also M&M with procedure, increased abortion/miscarriages, gestation DM, preeclampsia, PIH, possibly postpart hemm. Harder to dx fetal issues, RA hard.
What is adipose?
endocrine gland – liver fat metabolism goes into overdrive
Do obese have slower or faster onset for inhaled agents?
SLOWER d/t increased CO
What are some features of OHS?
central apnea (doesn’t matter if awake or asleep). CO2 > 45. Not position dependent
What kind of lung dz pattern do obese people exhibit?
restrictive – DECREASED FVC, FEV1. INCREASED ratio.
What happens to resp vol in extreme obesity?
FRC = RV so that’s why they desat so quickly
What happens to resp vol in morbid obesity?
DECREASED RV, TLC
How is apnea for OSA defined?
lasts > 10 seconds, have > 30 episodes/night
What happens to fat cells in adult obesity?
fat cell hypertrophy
What happens to fat cells in pediatric obesity?
increase in the number of cells
What percentage of the world is obese?
10%
How many times more likely are obese to have gallbladder/biliary issues?
3x
What percentage are obese at increased risk of death?
10-15%
What is the highest increased risk obese face?
cardiac disease – 50-100%
List BMI and accompanying obese name
> 30 = obese. > 40 = morbid. > 50 = super. > 60 = super super/malignant
How is central obesity defined?
waist to hip ratio. men > 0.85, women > 0.92
What are the waist numbers for obesity?
men 40” 102 cm. women 35” 88 cm
What is peripherla gynecoid/gluteal femoral obesity?
waist hip ration < 0.76. + varicose veins, joint disease. NIDDM less?? all these d/t metabolic attributes of adipose
Obesity = increased BV…what are the estimates to determine this?
for every 13.5 kg fat, you need 25 miles of neurovasculature extra
How much does CO increase with obesity?
0.1 LPM per kg fat
What CN are involved in swallowing?
V, IX, X, XII
What are the features of metabolic syndrome?
low HDL, high fasting BG, high waist number, high triglycerides, HTN
Do obese have increased or decreased total body water?
Decreased
What are some features that must be met to have bariatric surgery?
BMI > 40 or > 35 with comorbidites worsened/due to obesity, diet failed, psychologically stable, motivated, medically stable
What are some issues pregnancy brings to someone who had bypass?
IUGR, dumping syndrome
Roux En Y – what are some considerations?
extensive. aspiration risk, ICU, keep intubated?? don’t want to perf/leak
What happens with bypass surgery?
decreased FRC, decreased CO2, DVT, PE
