Metabolic response to trauma

Question 1

Mediators of injury response

Answer 1

• Neuro endocrine ( Hormonal )

* Metabolic and Cytokine axes

Question 2

The Neuro-endocrine response to severe injury/critical illness is biphasic

Answer 2

Acute phase

Chronic phase

Question 3

Characterized by an actively secreting pituitary & elevated counter regulatory hormones (cortisol, glucagon, adrenaline).

Answer 3

Acute phase

Question 4

Associated with hypothalamic

suppression & low serum levels of the respective target organ hormones.

Answer 4

Chronic phase

Question 5

Proinflammatory cytokines

Answer 5

Il 1, Il 6, TNF alfa
NO
Endothelin 1 Cytokine antagonist

Question 6

Interleukin receptor antagonist, TNF soluble receptors are released within hours of injury

Answer 6

Endothelin 1 Cytokine antagonist

Question 7

The natural response to injury includes

Answer 7

1. Immobility
2. Anorexia
3. Catabolism

Question 8

Main hormones in ebb phase are

Answer 8

catecholamines, cortisol, and aldosterone

Question 9

This phase involves mobilization of body

energy stores for repair and recovery

Answer 9

flow

Question 10

Key catabolic elements of flow phase

Answer 10

• Hypermetabolism
• Alterations in skeletal muscle protein
• Alterations in Liver protein
• Insulin resistance

Question 11

The Hepatic acute phase response represents a reprioritization of body protein metabolism towards the liver & is characterized by:

Answer 11

Positive reactants

Negative reactants

Question 12

A normal human ingests _____ of protein per day, which is metabolized and excreted in urine as ammonia and urea

Answer 12

70-100 g

Question 13

Careful limitation of intra operative administration of colloids and crystalloids so that there is no net weight gain

Answer 13

volume loss

Question 14

Trauma death triad:

Answer 14

Hypothermia, acidosis, coagulopahty

Question 15

During systemic inflammation, fluid, plasma proteins, leucocytes, macrophages and electrolytes leave the vascular space and accumulate in the tissues.

Answer 15

tissue edema

Question 16

The vascular endothelium controls vasomotor tone and micro vascular flow and regulates trafficking of nutrients and biologically active molecules.

Answer 16

Systemic inflammation and tissue under perfusion

Question 17

Has been recognized as a potent stimulus for inducing muscle wasting. Early mobilization is an essential measure to avoid muscle wasting

Answer 17

inmobility

Question 18

A prospective approach to prevent unnecessary aspects of the surgical stress response

Answer 18

1. Minimal access techniques
2. Blockade of afferent painful stimuli (epidural anesthesia)
3. Minimal periods of starvation
4. Early mobilization