Obesity & Undernutrition Flashcards
What is primary obesity ?
most prevalent
- excess calorie intake over expenditure for the body’s metabolic demand
What is secondary obesity ?
due to a medical problem
- Ex.) endocrine disorders, CNS lesions/disorders/meds, chromosomal/congenital anomalies
What is Leptin ?
our appetite suppressant
- increases fat metabolism
- a deficiency or resistance to this can cause obesity
What is the Hypothalamus linked to obesity ?
our appetite stimulant
- if there is an imbalance (Neuropeptide Y) then it can cause overeating
What is Ghrelin ?
inhibits leptin
- found in the gut
- gastric bypass surgery decreases ghrelin
What can obesity cause ?
- increases fat mass (adipocytes) which increases adipokines
- increases adipokines contribute to insulin resistance and atherosclerosis, disrupts immune factors and predispose to certain cancers
What are the values for BMI ?
- > 25: overweight
- > 30: obese
- > 40: extreme obesity
What are the values for waist circumference for obesity ?
> 35 inches in women and >40 in men
- bigger adverse outcomes for heart attacks and other cardiac events
What is the waist-to-hip ratio for determining obesity ?
waist measurement/hip measurement
- < 0.8 is optimal and >0.8 indicates truncal fat
What types of diseases can an apple body shape cause ?
carries fat more above waist
- heart disease
- DM
- breast cancer
- endometrial cancer
- HTN
- hyperlipidemia
What types of conditions can a pear body shape cause ?
carries fat more below waist
- osteoporosis
- varicose veins
- cellulitis
What are some health risks associated with obesity ?
- sleep deprivation from obstructive sleep apnea can lead to overeating (cause of decrease in leptin)
- reduced chest wall compliance
- increase work of breathing
- cancers due to increase estrogen
- colorectal cancer due to hyperinsulin
- insulin and adipolines can stimulate cancer call proliferation
What conditions must be met to have medication intervention for weight loss ?
- adults with a BMI 27 or greater with at least 1 weight-related condition
- BMI of 30 of greater
What are some considerations for a nutrient absorption-blocking med ?
Orlistat: Xenical: Alli
- blocks fat breakdown and absorption in the GI tract
- can cause: diarrhea, bloating, flatulence, liver damage, and fatty stools
What are some consideration for use of Bupropion/Naltrexone (Contrave) ?
an antidepressant/opioid antagonist
- works on the brain to decrease cravings
- can cause: dry mouth, HA, and constipation
How does Plenity aid in weight loss ?
increases volume of stomach and small intestine contents
- gel pieces taken with meals
What are some consideration for use of Qysmia ?
Phenermine (sympathomimetic) & Topiramate (anti-seizure/migraine med)
- (phenermine) increases metabolism and (topiramate) decreases appetite
- addictive
- can cause: restlessness, tachycardia, palpations and insomnia
What is Semaglutide used for in weight loss ?
Wegovy
- induces satiety by slowing gastric motility
- same as Ozempic but a higher dose
- weekly injection
- can cause: hypoglycemia if used with other diabetic meds, gastroparesis and GI distress
- can slow food down so much it can cause paralytic ileus
What is the criteria for Bariatric surgery ?
- BMI 40 or greater
- BMI 35 with 1 or more severe obesity-related medical condition
- psychological screening to ensure patient can commit to lifelong behavior change and screen for depression and addiction and ability to cope with new body image
- no advanced cancers, liver and kidney disease and cardiopulmonary disease
What is the lap band technique ?
band goes around top part of stomach which causes food to go through the stomach but slower
- will feel full longer
- port is under skin
What is the gastric sleeve technique ?
- portion of stomach is cut out so causes decreased absorption of food
What is the gastric plication ?
similar to gastric sleeve
- but stomach is folded and not cut
- reversible
What is the intragastric ballon ?
ballon is inserted into the stomach that is filled with about 400-700 mL saline
- leads to feeling of fullness
What is the Gastric Bypass 1 (with duodenum) ?
majority of stomach is cut out and left with a tiny stomach
- food passes through duodenum as usually but smaller stomach leads to feeling full faster
What is a Gastric Bypass 2 (bypass duodenum) ?
smaller gastric pouch is where food goes and this pouch is surgically connected to the jejunum
- bypass portion of the stomach
- we bypass the duodenum and go straight into the jejunum which reduces absorption
- only the digestive juices go through the duodenum while food though the jejunum
What is dumping syndrome ?
gastric contents empty too rapidly into the small intestine which decreases absorption
- can cause pt’s to never eat normally again
- not every pt will experience this but some can
- pt’s will follow everything we tell them but they may still get this
- can cause: N/V, weakness, diarrhea
What can be done Post-Op to prevent Dumping Syndrome ?
- low sugar, and low carb
- small meals (6 per day)
- chew well
- rest after eating (moving causes foods to move along the GI tract faster and digest faster)
- drink beverages between meals, not with meals (drinks can cause the food to flush along the GI tract faster and not digest/absorb)
How long does a patient need to be NPO after a gastric bypass surgery ?
until bowel sounds return
How long will a pt remain on a liquid diet after a gastric bypass ?
7-10 days
When can a pt return to a regular diet after gastric bypass ?
4-6 weeks
What is Metabolic Syndrome ?
collection of risk factors that increase an individual’s chance of developing cardiovascular disease, stroke and diabetes
What medications are used to Tx Metabolic Syndrome ?
will focus on treating BP, cholesterol, and glucose
- “statin” to decrease cholesterol
- “Metoprolol, or Lisinopril” to decrease BP
- Metformin to increase sensitivity to insulin
What is primary/starvation related Protein-Calorie Malnutrition (PCM) ?
- chronic starvation
- no inflammation (anorexia nervosa)
What is secondary/chronic disease-related PCM ?
calorie intake should be enough but tissues aren’t met due to disease process
- cancers, RA
What is acute disease/injury-related malnutrition ?
- burns
- trauma
- major infections
What are clinical manifestations of malnutrition ?
- dry, scaly skin rashes
- crusting/ulceration around the mouth
- thin hair/loss
- brittle nails
- sunken eyes
- decreased body temp
- decreased muscle mass
- mental status changes (difficulty concentrating, irritable, confused)
- delayed wound healing
- susceptible to infection
What are some expected lab values in malnutrition ?
- low Iron, RBC, Albumin vitamins and WBC
- BUN will be high at 1st due to dehydration then both will go low
- in prolonged starvation the Na-K pump stop working so K will increase and Na is low
- short term malnutrition the K will be low
What is Nasogastric (NG) tube used for ?
- temporary
- good suction/decompress the abdomen
- good absorption of medications and tube feedings
What is a Naso-Jejunal/Duodenal tube used for ?
- temporary
- goes past the stomach
- less risk of aspiration
- cannot be used for suction
What is a gastrostomy tube used for ?
long term nutritional support
What is a Jejunostomy tube used for ?
long term nutritional support
