Obesity (Exam III) Flashcards
What is the #1 cause of medically-related preventable deaths?
- # 1 Smoking
- Obesity is #2.
What is the formula to calculate BMI?
Kg/m²
100 kg patient that is 6 foot
6’ = 72”
1” = 2.54 cm
72” = 182.88 cm = 1.8288 m
100 kg / (1.8288²) ≈ 29.9 BMI
What are the classifications for BMI? (4)
≻30 = Obese
25-30 = Overweight
18.5-25 = Normal
≺18.5 = Underweight
What is an android body fat distribution associated with? (3)
- Truncal/central obesity
- ↑O₂ consumption
- CV disease
Gynoid body fat distributions are _____ metabolically active and not as associated with ______ disease. How is gynoid obesity described?
less ; cardiovascular
Gynoid is more peripheral, including hips, buttocks, and thighs.
Total blood volume is ______ in obesity.
increased
Obesity blood volume to weight ratio is typically lower than _____ mL/kg.
50 mL/kg
What occurs with cardiac output in obese patients?
CO will ↑ by 20-30 mL per kg of excess body fat.
CO increases due to LV dilation and ↑ stroke volume.
What causes cardiac dysrhythmias in the obese patient? (2)
- Fatty infiltrates in the conduction system
- CAD
What EKG changes are typical of the obese patient? (3)
- ↓ QRS voltage
- LV hypertrophy
- Left axis deviation
Increased levels of what coagulative factors are noted in obesity? (4) What does this lead to?
- Fibrinogen
- Factor VII
- Factor VIII
- Von Willebrand
Increased levels => hypercoagulability.
Why does endothelial dysfunction occur in the obese patient?
Due to ↑ factor VIII and von Willebrand.
Gastric ______ and _____ are increased in the obese patient.
Gastric volume and acidity are increased.
What aspiration risk factors are present in an Obese patient due to changes in the GI system? (3)
- Delayed gastric emptying
- ↑ chance of gastric volume > 25mL
- ↑ chance of pH < 2.5
What are the results of increased intragastric pressure secondary to obesity? (2)
- LES relaxation
- Hiatal hernia formation
Glomerular _______ occurs with obesity due to increased ____________.
Glomerular hyperfiltration occurs with obesity due to increased renal blood flow.
What are the consequences of increased renal tubular absorption secondary to obesity? (2)
- Impaired natriuresis
- RAAS activation
What are the endocrine effects of obesity? (5)
- ↑ SNS activity
- Insulin resistance
- Enhanced NE and ANG II activity
- Na⁺ retention
- Thyroid hormone resistance
Metabolic syndrome diagnosis requires 3 of the following: (8)
- Abdominal obesity
- ↓ HDLs
- ↑ Triglycerides
- Hyperinsulinemia
- Glucose intolerance
- Hypertension
- proinflammatory state
- prothrombotic state
What ethnicities are at higher risk for metabolic syndrome? Men or women?
Hispanics and South Asians
Men > women
What drugs may cause metabolic syndrome? (4)
- Chronic corticosteroids
- Antidepressants
- Antipsychotics
- Protease inhibitors
Differentiate OSA and hypopnea.
- OSA: Complete cessation of breathing (5 times or more an hour)
- Hypopnea: Airflow reduction by ≥ 50% (15 times or more an hour)
What is another name for a sleep study for OSAHS? How is it reported?
Polysomnography
- Reported as total # of events/total sleep time
What would a mild apnea/hypopnea index be?
5 - 15 events/hour
What would a moderate apnea/hypopnea index be?
15 - 30 events/hour
What would a severe apnea/hypopnea index be?
> 30 events/hour
CPAP and weightloss are necessary for treatment of OSAHS (Obstructive sleep apnea and hypopnea syndrome) due to risk of what complications? (4)
- Systemic/Pulmonary HTN
- LVH
- Dysrhythmias
- Cognitive impairment
What’s another name for Obesity Hypoventilation Syndrome (OHS)?
Pickwickian Syndrome
What causes Pickwickian syndrome?
Long-term OSA
What does Pickwickian syndrome cause? (2)
Pulm HTN and Cor Pulmonale
How is Pickwickian syndrome diagnosed? (2)
- > 30 BMI
- Awake hypercapnia
What mentioned drug(s) classes are commonly used to treat obesity? (4)
- Phentermine
- Orlistat
- OTC Herbals
- GLP-1 Agonists
How does Phentermine work?
What are it’s side effects? (4)
- Sympathomimetic that decreases appetite
- ↑HR, palpitations, HTN, dependence
How does Orlistat work?
What are the adverse effects associated with it?
- Orlistat blocks absorption of dietary fat
- Liquid, fatty stools, urgency, flatulence and abd cramping.
- Fat soluble vitamin deficiencies
How can Orlistat precipitate coagulopathy?
Possible Vit K deficiency → prolonged PT
