Metabolic response to trauma Flashcards
In modern surgery, a major goal is to ________ the metabolic response to surgery in order to _______ recovery times.
minimize; shorten
When a major metabolic response does occur, the emphasis is on managing the patient in a way that minimizes _____________ either at the original site of injury or in other organs
further tissue damage
Systems involved in metabolic response to trauma
________
__________
_____________
________________
Local events
Neural
Endocrine
Neuro-endocrine
In ebb phase
Spectrum of inflammatory processes occur with local and distant effect on other body organs
In current medical practice these processes may attenuated but not abolished by ____________
intravenous fluids
The predominant hormones regulating the ebb phase are:
_________
_____________
__________
Catecholamines
Cortisol
Aldosterone
Flow phase= ______________________
Systemic Inflammatory Response Syndrome(SIRS).
The flow phase may be subdivided into catabolic phase(________) and anabolic phase( _______)
3-10days
weeks
From injury to convalescence opposing effect of _________________ and ______________
inflammatory response syndrome(SIRS)
counter anti-inflammatory
response(CARS)
Local/Systemic effects in metabolic response
Mainly that of acute inflammatory response and its sequelae
Neural
-____________ nervous system
-_____________________ axis
Cellular
-_________
-___________
-____________
Humoral mediated
_________(pro-inflammatory and anti-inflammatory)
Other chemical mediator(prostaglandins,eicosanoids,proteases)
-pituitary and adrenal hormones
-thyroid hormones
sympathetic; hypothalamus pituitary adrenal
neutrophils; macrophages; lymphocytes
Cytokines
Activation of sympathetic nervous system
Impulses generated in afferent pain nerve endings at the site of tissue injury have a role in mediating the metabolic responseto injury.
Pain fibres comprise both ________________ fibres and _____________ fibres.
Pain fibres are stimulated via direct trauma or the release of nerve stimulants such as _________.
Nerve impulses reach the _______ via the _________ of the spinal cord and the ________________ tract.
Afferent impulses reaching the thalamus mediate the metabolic response via several mechanisms
unmyelinated C fibres and myelinated A
prostaglandins; thalamus
dorsal horn; lateral spinothalamic
Summary of metabolic response to surgery and trauma
Thalamus:
Heart and CVS:
Pituitary:
Pyrexia
Increased sympathetic activation leading to tachycardia
Increased ACTH and ADH
Summary of metabolic response to surgery and trauma
Superarenal gland
Pancreas
Bone marrow
Skeletal muscle
Increased aldosterone, adrenaline, and cortisol
Decreased insulin, increased glucagon
Impaired red cell production
Increased muscle breakdown
Important Cytokines in metabolic response to trauma
Pro-inflammatory:
Anti-inflammatory:
Chemokines :
TNF; IFN; IL-1
IL-10; IL-6; TGF-B
IL-8
Negative acute-phase proteins (decrease after injury)
• ● __________
• ●___________ and __________
Albumin
Transferrin
Transthyretin
Clinical use: _______ is a useful marker of systemic inflammation
CRP