الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Obesity is considered a major health and socio-economic problem. Overweight, obesity and morbid obesity are terms often used to describe individuals with an increased body fat. The most common definition of morbid obesity is a body mass index (BMI) of 40 Kg /m2 or more. The etiology of this condition is multifactorial including; familial and genetic predisposition, drug induced obesity, endocrinal causes, childhood overnutrition, intake of food in large quantities and many times in the day, psychological factors, environmental factors, special habits like alcohol consumption and smoking and personal factors like; age, gender, ethinity and parity.
Clear understanding of the pathophysiology of morbid obesity is essential for management and prevention of this disaster. There are several factors concerning the occurrence of obesity, the first one is the genetic control also central nervous system control afferent signals pattern of feeding socio-economic factors, exercise and pattern of distribution of excess adipose tissue.
There are many disastrous diseases associated with morbid obesity including; cardiovascular diseases, diabetes mellitus respiratory problems, digestive diseases arthritis chronic abdominal compartmental syndrome, hernia infectious problems endocrinal abnormalities psychological problems, complications associated with pregnancy, cancer, neurological complications and other medical problems compounded by obesity.
Approximately 5% of morbidly obese patients may have obstructive sleep apnea syndrome. Recurrent attacks of apnea during sleep leading to hypoxemia, hypercapnia and pulmonary and systemic vasoconstriction. Recurrent hypoxemia leads to secondary polycyathemia and is associated with an increased risk of ischemic heart disease, while hypoxic pulmonary vasoconstriction leads to right ventricular failure.
Morbid obesity is associated with reductions in functional residual capacity, expiratory reserve volume and total lung capacity. These changes have been attributed to mass loading and splitting of the diaphragm.
Cardiovascular system dominates morbidity and mortality in obesity and manifests itself in the form of ischemic heart disease, hypertension and cardiac failure. Hypoxia, hypercapnia,electrolyte disturbance caused by diuretic therapy and coronary heart disease may precipitate arrhythmias in obese patients.
Diagnosis of morbid obesity can be done by several ways including clinical examination, calculation of body mass index (BMI>40 Kg/m2), measuring skin folds also imaging techniques can be applied to measure the distribution of body fat as magnetic resonance techniques and dual energy X-ray absorptiometry.
Treatment of morbid obesity may be conservative as medical treatment (behavior modification, diet regimen, exercise and drugs) and active physical interventions ( gastric balloon, acupuncture and waist cord) or it may be surgical as which may be open as gastric bypass , intestinal bypass and gastroplasty which divided in to vertical banded gastroplasty, horizontal gasroplasty gastric banding and gastric wrap or laparoscopic surgery as laparoscopic vertical banded gastroplasty laparoscopic adjustable gastric banding laparoscopic gastric bypass laparoscopic malabsorpative procedure and laparoscopic bariatric pacing.
Surgical treatment seems to be more effective in the management of morbid obesity with acceptable rate of complications. The surgical modalities used in the bariatric surgery initially used in treating other conditions and these modalities were found to cause weight loss postoperatively as a side effect.
Complications of bariatric surgery include; abdominal catastrophe, wound infections anastmotic leakage and stenosis splenic capsule tear gastric stasis, bleeding pulmonary complications cholelithiasis and neuropathy.
Morbid obesity changes the management of anesthesia at every possible step and in all possible ways starting from getting a venous access to maintaining adequacy of post-extubation ventilation.