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Block 3; Week 4 Michelle > Surgical Interventions > Flashcards

Surgical Interventions Flashcards

1
Q

What is the twin epidemic to obesity?

A

Type II DIabetes

Diabesity Epidemic

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2
Q

What must solutions to obesity do?

A

Change the physiological set point

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3
Q

Does Obesity directly cause Type II Diabetes?

A

YES. not just linked, causative.

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4
Q

What percentage of Diabetes is Type II Diabetes in U.S.?

A

over 95% Whoa!

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5
Q

Does telling your patients to cut calories & exercise work?

A

usu not…so it is an ineffective treatment

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6
Q

How old is this obesity epidemic?

A

only about 40 years

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7
Q

What have been the changes to the food supply in recent years?

A

it is sweeter, white, less green, less purple, less bitter

*wheat has a higher glycemic index than table sugar

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8
Q

Is the obesity more about physical activity or food supply?

A

More about the food supply

**the change in physical activity isn’t significant enough to account for the current epidemic

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9
Q

What types of cancer are attributable to obesity?

A

breast & colon cancer

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10
Q

If you get the obesity to go away does the Type II Diabetes go away?

A

yes

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11
Q

What does a spike in blood sugar do?

A

It causes a hormone cascade that is partially responsible for obesity

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12
Q

What are 4 environmental drivers of obesity?

A

Altered Food Supply
Decreased Physical Activity
Stress & Distress
Drugs

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13
Q

In order to treat Type I Diabetes…what do you take & what does this dO?

A

insulin & that causes weight gain

there are similar side effects with other common drugs

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14
Q

Diabetes is the #1 cause of what 3 things?

A

blindness
kidney failure
amputations

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15
Q

What’s the deal with Pre-Diabetes?

A

there are 79 million people in US who are just below diabetes & 1/3 of them will become diabetic in 3 years.
HgbA1c over 5.7%; Diabetic: over 6.5%

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16
Q

What’s the Hgb A1c?

A

indication b/c of the glycation of molecules of long term blood sugar levels…indicative of like a month’s worth data or something…

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17
Q

Obesity causes CO2 retention. How?

A

inadequate ventilation
obesity hypoventilation syndrome
don’t breathe hard enough b/c of weight?

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18
Q

What is the hunger hormone?

A

ghrelin

19
Q

What can cause ghrelin to increase?

A

diet

20
Q

What is the nickname of CCK? What happens to it when you go on a diet?

A

hormone of satiety

it goes down on a diet!

21
Q

When you go on a diet & decrease your set point…what happens to your absorption & metabolic burn rate?

A

Your absorption increases

Your metabolic burn rate decreases…

22
Q

Where is the glimmer of hope @ the end of your diet w/ hormonal changes & angry body defense of your set point?

A

after about a year…these effects will decrease…your body will not push you as hard to your set point

23
Q

How do we get a higher set point?

A

we just continuously get a higher point…b/c it is an evolutionary advantage. Live 3 months 5 pounds heavier–>that’s your new set point

24
Q

Who created the BMI standards?

A

insurance industry!!

as a predictor for longevity

25
Q

At what BMI does a surgical intervention improve mortality risk, health, quality of life?

A

27

**not that you should do it, but this recognizes the lethality of a higher BMI

26
Q

What’s the deal w/ fenfluramine?

A

5-HT 2b receptor valvulopathy

resulted in cardiac valvular abnormalities, people had to have cardiac valve replacements

27
Q

What’s the deal w/ sibutramine (Meridia)?

A

acts on 5-HT

cardiovascular disease issues

28
Q

What’s the deal w/ Xenical/Alli?

A

it blocks the pancreatic lipase enzyme
you can’t break down fat & is excreted out.
doesn’t help obesity, but it does help w/ constipation

29
Q

What’s the deal w/ phentermine?

A

mild stimulant, like caffeine
somewhat effective
people lose 2-3% of body weight
it is half the drug of fen fen, but safer.

30
Q

What are the 2 new weapons/drugs we have?

A

Qsymia

Belviq

31
Q

What’s the deal w/ Qsymia?

A

phentermine & topiramate (these aren’t new)

works a little bit

32
Q

What’s the deal w/ belviq?

A

acts on 5-HT but doesn’t seem to be dangerous yet

some people lose significant weight on it

33
Q

What is the spectrum of surgical interventions…from mild to extreme?

A 
diet & exercise
some other stuff
Lap Band
gastric sleeve
gastric bypass
34
Q

Who qualifies for weight loss surgery?

A

BMI 30 & above w/ comorbidities (diabetes, HTN, sleep apnea)

35
Q

The risk of the gastric sleeve on par w/ what?

A

a C-section

about 20% of the people regain their weight.

36
Q

What’s the hormonal aspect of the gastric sleeve procedure?

A

the body of the stomach w/ the greater curvature…the mucosa there releases hormones thought to be responsible for absorption & fat deposition.

37
Q

What does the sleeve do to the set point?

A

it changes the sleeve set point
they are less hungry
their metabolic rate goes up

38
Q

Why is the sleeve better than gastric bypass?

A

less invasive
safer
simpler

39
Q

What percentage of the stomach is removed during the sleeve?

A

75-80%

40
Q

What are the things that can change the physiologic set point?

A

surgery–assuredly
weight loss maintenance for one year–maybe
walking 60-90minutes per day, probably.

41
Q

What is the #1 reason for liver transplants?

A

obesity–Non fatty liver disease

then cirrhosis from alcohol & hepatitis

42
Q

What 3 things determine whether you will get Diabetes?

A

age
weight
genetic predisposition
**we will all probably get diabetes if we live long enough

43
Q

What are the big 3 vitamin deficiencies w/ gastric bypass surgery?

A

Vitamin D, B12, & iron

Block 3; Week 4 Michelle (9 decks)

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