Complications of Obesity
OVERVIEW
Obesity has multiple pathophysiological effects and leads to numerous multi-system complications
PATHOPHYSIOLOGY
GI
- ↑Intra-abdominal pressure: abdominal compartment syndrome can cause renal, hepatic failure and visceral necrosis
- ↓pH and increase gastric volume: GORD and aspiration risk
Neuro
- ↑Intracranial pressure: associated with raised intra-abdominal and pleural pressures
CVS
- ↑Central venous pressure: increased by high intra-abdominal and pleural pressures
- ↑blood volume and polcythaemia
- ↑cardiac output and ventricular work
Respiratory
- ↑upper airway soft tissues: difficult intubation and airway maintenance
- ↑Pulmonary artery occlusion pressure: increased by high intra-abdominal and pleural pressures
- ↑Pulmonary artery pressure: mild to moderate elevations may result from OSA alone
- ↓Total lung capacity
- ↓Vital capacity
- ↓Functional residual capacity: atelectasis and reduced oxygen stores increase propensity for desaturation
- ↑Pleural pressure: reflects chest wall compression
- ↓Respiratory system compliance: stiffer respiratory system likely from lung and chest wall contribution
- ↑Airway resistance: risk of asthma and airway closure
- ↓Hypercapnic ventilatory response: contributes to obesity hypoventilation syndrome
- ↑Upper airway resistance: contributes to difficult airway and sleep apnoea
Haematology/ Immunology
- hypercoagulable, platelet hyperactivity: increased risk of VTE
- obesity is a pro-inflammatory state
Pharmacology
- altered pharmacokinetics
COMPLICATIONS AND ASSOCIATED CONDITIONS
Cardiovascular
- Congestive heart failure
- hypertension
- myocardial infarction
- dyslipidemia
Respiratory
- Difficult airway
- Hypoventilation (Pickwickian) syndrome
- obstructive sleep apnea
- asthma
- respiratory failure
Gastrointestinal
- aspiration
- gastroesophageal reflux (GERD)
- nonalcoholic fatty liver disease (NAFLD) and steatohepatosis (NASH)
- gastroparesis
- gallstones and biliary tract disease
- pancreatitis
- hernias
Endocrine
- Diabetes mellitus (type II)
- metabolic syndrome / syndrome X
- polycystic ovarian syndrome
- hypothyroid
- infertility
Neurologic/Psychologic
- Stroke
- depression
- idiopathic intracranial hypertension
- disordered eating
Hematologic
- Deep vein thrombosis and pulmonary embolus (VTE)
- hypercoagulable state
- chronic venous stasis
Musculoskeletal
- Degenerative joint disease
- chronic back pain
Immune system/infection
- Pressure ulcers
- skin-fold infections
- poor wound healing
- pro-inflammatory state
Increased cancer risk
- Kidney
- esophagus
- pancreas
- colon
- breast
- ovary
- endometrial
- prostate
Logistics
- difficult IV access
- requires special monitoring
- pressure area cares
- more staff and equipment required to move
- imaging difficulties (difficult to ultrasound, may not fit in CT or MRI scanners)
References and Links
Introduction to ICU Series
Introduction to ICU Series Landing Page
DAY TO DAY ICU: FASTHUG, ICU Ward Round, Clinical Examination, Communication in a Crisis, Documenting the ward round in ICU, Human Factors
AIRWAY: Bag Valve Mask Ventilation, Oropharyngeal Airway, Nasopharyngeal Airway, Endotracheal Tube (ETT), Tracheostomy Tubes
BREATHING: Positive End Expiratory Pressure (PEEP), High Flow Nasal Prongs (HFNP), Intubation and Mechanical Ventilation, Mechanical Ventilation Overview, Non-invasive Ventilation (NIV)
CIRCULATION: Arrhythmias, Atrial Fibrillation, ICU after Cardiac Surgery, Pacing Modes, ECMO, Shock
CNS: Brain Death, Delirium in the ICU, Examination of the Unconscious Patient, External-ventricular Drain (EVD), Sedation in the ICU
GASTROINTESTINAL: Enteral Nutrition vs Parenteral Nutrition, Intolerance to EN, Prokinetics, Stress Ulcer Prophylaxis (SUP), Ileus
GENITOURINARY: Acute Kidney Injury (AKI), CRRT Indications
HAEMATOLOGICAL: Anaemia, Blood Products, Massive Transfusion Protocol (MTP)
INFECTIOUS DISEASE: Antimicrobial Stewardship, Antimicrobial Quick Reference, Central Line Associated Bacterial Infection (CLABSI), Handwashing in ICU, Neutropenic Sepsis, Nosocomial Infections, Sepsis Overview
SPECIAL GROUPS IN ICU: Early Management of the Critically Ill Child, Paediatric Formulas, Paediatric Vital Signs, Pregnancy and ICU, Obesity, Elderly
FLUIDS AND ELECTROLYTES: Albumin vs 0.9% Saline, Assessing Fluid Status, Electrolyte Abnormalities, Hypertonic Saline
PHARMACOLOGY: Drug Infusion Doses, Summary of Vasopressors, Prokinetics, Steroid Conversion, GI Drug Absorption in Critical Illness
PROCEDURES: Arterial line, CVC, Intercostal Catheter (ICC), Intraosseous Needle, Underwater seal drain, Naso- and Orogastric Tubes (NGT/OGT), Rapid Infusion Catheter (RIC)
INVESTIGATIONS: ABG Interpretation, Echo in ICU, CXR in ICU, Routine daily CXR, FBC, TEG/ROTEM, US in Critical Care
ICU MONITORING: NIBP vs Arterial line, Arterial Line Pressure Transduction, Cardiac Output, Central Venous Pressure (CVP), CO2 / Capnography, Pulmonary Artery Catheter (PAC / Swan-Ganz), Pulse Oximeter
LITFL
- CCC – Obesity and trauma
- CCC – Obesity and Critical Illness
- CCC – Complications of Obesity
- CCC – Obesity and Pharmacokinetics
- CCC – Nutrition of the Critically Ill Obese Patient
- CCC – Bariatric patient hot case
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
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