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Revision Cards > Week 111 - Obesity > Flashcards

Week 111 - Obesity Flashcards

1
Q

What is the normal value for HbA1c and what does it represent?

A

≤ 6%

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2
Q

What HbA1c value is the target for treatment?

A

≤ 7.5%

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3
Q

What is Metformin and how is it useful in treating obesity?

A

It is an antidiabetic drug but puts patients off their food.

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4
Q

What is Orlistat and how does it work?

A

It is a lipase inhibitor so helps to reduce the absorption of fats.

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5
Q

What are the side effects of orlistat?

A

Steatorrhea, fecal incontinence.

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6
Q

When a patient has obesity, Diabetes Mellitus type II, Hypertension and Microalbuminuria, what condition are they said to have?

A

Metabolic syndrome.

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7
Q

What four conditions are required for a diagnosis of metabolic syndrome?

A

Obesity, Diabetes Mellitus type II, Hypertension and Microalbuminuria.

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8
Q

In how many cases of obesity is there a family history?

A

90%

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9
Q

What are some of the very rare secondary causes of obesity?

A

Hypothyroidism, Glucocorticoid excess, Hypothalamic dysfunction, Growth hormone deficiency and Pader Willi syndrome.

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10
Q

What are some of the medical complications caused by Obesity?

A

Pulmonary disease, Idiopathic intracranial hypertension, Stroke, Cataracts, CHD, Nonalcoholic fatty liver disease, Gall bladder disease, Gynaecological abnormalities, Osteoarthritis, Skin, Gout, Phlebitis, Cancer, Severe pancreatitis.

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11
Q

Which two drugs used for treatment of obesity have now been removed?

A

Sibutramine and Rimonabant.

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12
Q

What is GLP-1? And how may it be used in future management of obesity?

A

GLP-1 is naturally secreted by the small intestine when food is ingested, it increases the activity of Beta-cells resulting in increased insulin. It also decreases the activity of Alpha-cells resulting in a decreased amount of glucagon. This creates a feeling of satiety.

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13
Q

What are the nice guidelines for bariatric surgery?

A
  • BMI >40 or >35 with comorbidities.
  • 18-55yrs.
  • Minimum 5 years of obesity.
  • Failure of conservative treatment.
  • No alcoholism / major psychiatric illness.
  • No pregnancy within 2 years
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14
Q

What are the additional requirements to the nice guidelines for bariatric surgery in wales?

A
  • BMI >50
  • Uncontrolled type II DM
  • Hypertension
  • Obstructive sleep apnoea.
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15
Q

What are the three broad types of bariatric surgery?

A

Restrictive, Malabsorptive and Combined.

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16
Q

Restictive is one of the three types of bariatric surgery (along with Malabsorptive and Combined) What are the two types of operation?

A
  • Laproscopic gastric banding.

* Laproscopic sleeve gastrectomy.

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17
Q

Malabsorptive is one of three types of bariatric surgery (along with restrictive and combined), What is the name of the surgery performed?

A

Laproscopic biliary-pancreatic diversion and duodenal switch.

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18
Q

Combined is one of three types of bariatric surgery (along with malabsorptive and restrictive), What is the name of the surgery performed?

A

Laproscopic Gastric Bypass

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19
Q

Which form of bariatric surgery is the gold standard and what type is it?

A

Laproscopic sleeve gastrectomy - Restrictive

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20
Q

How is Laproscopic Gastric Banding performed and what type of bariatric surgery is it?

A

A band is fitted around the upper part of the stomach to create a small pouch with a narrow stoma. The band is connected to a port through which fluid can be passed to increase or decrease the size of the band. This makes the patient feel full sooner.

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21
Q

What are the complications of Laproscopic Gastric Banding?

A

The band can slip out of place, reflux, erosion of the band, infection of the port, 10-15% will require further surgery. DOES NOT WORK FOR CHOCOLATE!

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22
Q

What is Laproscopic sleeve gastrectomy?

A

Restrictive bariatric surgery. The stomach is changed into a tube by stapling the stomach this reduces portion size and transit time, so is also malabsorptive.

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23
Q

What are the complications of Laproscopic sleeve gastrectomy?

A

Reflux, stenosis and dilation.

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24
Q

What is bilio-pancreatic diversion and duodenal switch?

A

Malabsorptive bariatric surgery. Stage one is the same as sleeve gastrectomy excess stomach is removed. The small intestine is then divided into two limbs; • The enteric limb for food only.
• The biliary limb which takes the digestive juices from the pancreas and bile duct.
The food therefore only meets the digestive juices just before the cecum.

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25
Q

What are the cons of bilio-pancreatic diversion and duodnal switch?

A

120g of protein is needed per day. Malnutrition is a large problem and is technically the most demanding.

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26
Q

What is Laparoscopic gastric bypass?

A

Combined bariatric surgery. The stomach is bypassed through the use of the ilium and a small stomach pouch.

27
Q

Which form of bariatric surgery causes ‘Dumping Syndrome’ and what is it?

A

Laprioscopic gastric bypass, sweating and nausea after high sugar intake.

28
Q

What are the 2 year excess weight loss figures for the four types of bariatric surgery?

A
  • Laproscopic Gastric Banding - 55-60%
  • Laproscopic Sleeve Gastrectomy - 60%
  • Laproscopic bilio-pancreatic with duodenal switch - 90%
  • Laproscopic gastric bypass - 75%
29
Q

What are the three important subregions of the hypothalamus?

A

Lateral, Ventromedial and Acruate nucleus.

30
Q

Which subregion of the hypothalamus generates satiety? And what stimulus does it respond to?

A

Ventromedial hypothalamus, Increase in blood glucose.

31
Q

Which subregion of the hypothalamus generates hunger and what stimulates it?

A

Lateral hypothalamus, Decrease in blood glucose.

32
Q

How does the hypothalamus know your weight?

A

Level of body fat is know as adiposity. Leptin is an adipostat which are produced by the adipose tissue. Circulating levels of adipostat are proportional to body fat.

33
Q

Which gene produces Leptin?

A

The Ob gene.

34
Q

What does the Ob gene produce and what occurs when there is no Ob gene?

A

Leptin, Eat voraciously and gain weight.

35
Q

Where does leptin primary act?

A

The arcuate nucleus of the hypothalamus.

36
Q

Leptin primarily acts on the arcuate nucleus of the hypothalamus, what occurs when the leptin level falls?

A

Food intake goes up, energy expenditure down, parasympathetic activity up.

37
Q

Leptin primarily acts on the arcuate nucleus of the hypothalamus, what occurs when the leptin level rises?

A

Food intake reduces, energy expenditure increases, sympathetic activity increases.

38
Q

What is the physiology when high levels of leptin are detected?

A

Causes the production of anorexigenic peptides by the arcuate nucleus these inhibit feeding behaviour. These are Alpha-melanocyte stimulating hormone (Alpha-MSH) and CART.

39
Q

What is the physiology that occurs when low levels of leptin are detected?

A

Causes the production of Orexigenic peptides by the arcuate nucleus. Neuropeptide Y and Agouti-related peptide. These activate feeding behaviour.

40
Q

What are the two anorexigenic peptides? Where are they produced and in response to what?

A

Alpha-MSH and CART, the arcuate nucleus of the hypothalamus in response to high levels of leptin.

41
Q

What are the two orexigenic peptides? Where are they produced and in response to what?

A

Neuropeptide Y and agouti-related peptide, the arcuate nucleus of the hypothalamus in response to low levels of leptin.

42
Q

Which receptor do aMSH and AgRP bind to?

A

Melanocortin receptor, aMSH activates it whilst AgRP blocks it.

43
Q

The Melanocortin receptor is activated by one peptide and blocked by another, what are they?

A

aMSH - Activates

AgRP - Blocks

44
Q

What role does insulin take in controlling apetite?

A

Insulin acts directly on the hypothalamus to cause the arcuate nucleus to produce anorectic pepties (aMSH) this inhibits feeding.

45
Q

What is Grehlin?

A

Grehlin is produced by the stomach, high levels increases hunger. The levels rise before meals and falls after meals.

46
Q

The stimulation of which nerve causes satiety?

A

The vagus nerve.

47
Q

The vagus nerve is activated in which two ways by the stomach to produce satiety?

A

Stomach distension and the hormone cholecystokinin (CCK).

48
Q

What is the hormone CCK?

A

Cholecystokinin, produced by gut epithelia in response to food.

49
Q

What is serotonin?

A

Neurotransmitter and a mood regulator.

50
Q

What is the role of serotonin in apetite control?

A

Dopamine is released by the brain in response to food and increases apetite. Serotonin activates receptors on dopamine producing cells resulting in a decreased apetite.

51
Q

Sibutramine has now been withdrawn but how did it help manage apetite?

A

Sibutramine is a serotonin and noradrenaline reuptake inhibitor. So it both increased feelings of satiety and reduced metabolic supression that occurs with weight loss.

52
Q

What is the ‘reward circuit’?

A

Rewards stimulate the release of dopamine, palatable foods are very rewarding, this causes us to be highly motivated to consume them.

53
Q

What is homeostasis?

A

The maintenance of a stable internal environment.

54
Q

What is metabolism and what are the two aspects of it?

A

Degredation and synthesis of molecules. Anabolism and Catabolism.

55
Q

What is anabolism?

A

Building up of complex molecules required for life.

56
Q

What is catabolism?

A

The breakdown of complex nutrients into simple molecules.

57
Q

What are the two main electron carriers?

A

NAD+ and NADP+

58
Q

NAD+ is an electron carrier, during which metabolic process is it utilised?

A

Catabolic.

59
Q

NADP+ is an electron carrier, during which metabolic process is it utilised?

A

Anabolic.

60
Q

Where is glycogen stored?

A

Liver (and muscles)

61
Q

What is the basal metabolic rate?

A

This is the energy required by an individual at physical, emotional and digestive rest.

62
Q

What factors increase basal metabolic rate?

A

Hyperthyroidism, exposure to cold, regular exercise, disease, fever.

63
Q

What factors decrease basal metabolic rate?

A

Hypothyroidism, dieting, starvation, sustained illness, hypothermia.

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