Obesity, Bariatric Surgery

Question 1

What are some issues that obese parturients experience?

Answer 1

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.

Question 2

What is adipose?

Answer 2

endocrine gland – liver fat metabolism goes into overdrive

Question 3

Do obese have slower or faster onset for inhaled agents?

Answer 3

SLOWER d/t increased CO

Question 4

What are some features of OHS?

Answer 4

central apnea (doesn’t matter if awake or asleep). CO2 > 45. Not position dependent

Question 5

What kind of lung dz pattern do obese people exhibit?

Answer 5

restrictive – DECREASED FVC, FEV1. INCREASED ratio.

Question 6

What happens to resp vol in extreme obesity?

Answer 6

FRC = RV so that’s why they desat so quickly

Question 7

What happens to resp vol in morbid obesity?

Answer 7

DECREASED RV, TLC

Question 8

How is apnea for OSA defined?

Answer 8

lasts > 10 seconds, have > 30 episodes/night

Question 9

What happens to fat cells in adult obesity?

Answer 9

fat cell hypertrophy

Question 10

What happens to fat cells in pediatric obesity?

Answer 10

increase in the number of cells

Question 11

What percentage of the world is obese?

Answer 11

10%

Question 12

How many times more likely are obese to have gallbladder/biliary issues?

Answer 12

3x

Question 13

What percentage are obese at increased risk of death?

Answer 13

10-15%

Question 14

What is the highest increased risk obese face?

Answer 14

cardiac disease – 50-100%

Question 15

List BMI and accompanying obese name

Answer 15

> 30 = obese. > 40 = morbid. > 50 = super. > 60 = super super/malignant

Question 16

How is central obesity defined?

Answer 16

waist to hip ratio. men > 0.85, women > 0.92

Question 17

What are the waist numbers for obesity?

Answer 17

men 40” 102 cm. women 35” 88 cm

Question 18

What is peripherla gynecoid/gluteal femoral obesity?

Answer 18

waist hip ration < 0.76. + varicose veins, joint disease. NIDDM less?? all these d/t metabolic attributes of adipose

Question 19

Obesity = increased BV…what are the estimates to determine this?

Answer 19

for every 13.5 kg fat, you need 25 miles of neurovasculature extra

Question 20

How much does CO increase with obesity?

Answer 20

0.1 LPM per kg fat

Question 21

What CN are involved in swallowing?

Answer 21

V, IX, X, XII

Question 22

What are the features of metabolic syndrome?

Answer 22

low HDL, high fasting BG, high waist number, high triglycerides, HTN

Question 23

Do obese have increased or decreased total body water?

Answer 23

Decreased

Question 24

What are some features that must be met to have bariatric surgery?

Answer 24

BMI > 40 or > 35 with comorbidites worsened/due to obesity, diet failed, psychologically stable, motivated, medically stable

Question 25

What are some issues pregnancy brings to someone who had bypass?

Answer 25

IUGR, dumping syndrome

Question 26

Roux En Y – what are some considerations?

Answer 26

extensive. aspiration risk, ICU, keep intubated?? don’t want to perf/leak

Question 27

What happens with bypass surgery?

Answer 27

decreased FRC, decreased CO2, DVT, PE