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Physiologic Response to Surgery Flashcards

(65 cards)

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1
Q

Define Stress Response

A

Hormonal & metabolic changes that are triggered by “stress”

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2
Q

Physiological Changes that Occur During the Stress Response

A

Hormonal
Metabolic
Immunological
Hematological

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3
Q

Psychological Changes that Occur During the Stress Response

A

Fatigue
Malaise
Depression

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4
Q

Behavioral Change that Occurs During the Stress Response

A

Reluctance to move

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5
Q

Hormonal Response to Stress

A

Activation of HPA axis & sympathetic nervous system
Receive input from area of trauma or injury
Normal feedback mechanism fails: system doesn’t get shut off

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6
Q

Sympathetic Nervous System Response to Stress

A

Adrenal medulla releases catecholamines
Increased norepinephrine from presynaptic nerve terminals
Leads to tachycardia & HTN

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7
Q

Renal Effects due to Activation of the Sympathetic Nervous System

A

Renin release causes conversion of angiotensin I to II

Aldosterone release leads to Na+ retention

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8
Q

Pancreatic Effects due to Activation of the Sympathetic Nervous System

A

Glucagon release
Decreased release of insulin
Some insulin resistance

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9
Q

Hepatic Effects due to Activation of the Sympathetic Nervous System

A

Glycogenolysis
Increased glucose & lactate concentration
Mobilization of FFA from lipid stores

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10
Q

Hormones Released by the Anterior Pituitary in a Stress Response

A

ACTH
GH
Prolactin

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11
Q

What releasing factors are released from the hypothalamus to trigger hormone release from the anterior pituitary?

A

CRH

GHRF

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12
Q

What is the posterior pituitary controlled by?

A

Hypothalamus: directly

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13
Q

Hormones Released from the Posterior Pituitary in a Stress Response

A

ADH

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14
Q

Changes in the Anterior Pituitary During a Stress Response

A

Increased ACTH
Increased GH
Increased prolactin

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15
Q

Increased ACTH Leads to

A

Increased release of cortisol & glucocorticoids from the adrenal medulla

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16
Q

Increased GH Leads to

A

Increased blood sugar
Antagonizes insulin
May have positive role in wound healing

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17
Q

Why is there increased prolactin in the stress response?

A

Decreased prolactin inhibiting factor

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18
Q

Increases in ADH Leads to

A

Further increase in ACTH

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19
Q

Function of Cortisol

A

Promotion of protein breakdown & gluconeogenesis
Inhibits glucose use & increases blood sugar
Promotes lipolysis further increasing blood glucose
Glucocorticoid anti-inflammatory effects
Mineralocorticoid effects causing fluid retention & potassium loss

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20
Q

Function of Insulin

A

Promotes uptake of glucose into muscle & adipose tissue
Coverts glucose into glycogen & triglycerides
Inhibits protein catabolism & lipolysis

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21
Q

Function of Increased Glucagon Release

A

Promotes hepatic glycogenolysis
Increases gluconeogenesis from amino acids in the liver
Has lypolytic activity

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22
Q

Effects of the Stress Response on Thyroid Hormones

A

Total & Free T3 decrease & return to normal after several days
TSH decrease for 2 hours & then return to normal

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23
Q

Carbohydrate Metabolism in a Stress Response

A

Glucose homeostasis mechanisms are ineffective

Lack of insulin to get sugar into the cells

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24
Q

Hyperglycemia Leads to

A

Wound infection

Impaired wound healing

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25
Protein Metabolism in a Stress Response
Increased cortisol & cytokine concentration Weight loss & muscle wasting Can measure protein loos indirectly by nitrogen excretion in the urine
26
Increased Cortisol & Cytokine Concentration Leads to
Catabolism primarily from skeletal muscle | Albumin production reduced & alters extracellular volume
27
Lipid Metabolism in a Stress Response
Lipolysis & ketone production
28
Hormones Involved in Water & Electrolyte Metabolism in a Stress Response
ADH | Renin
29
ADH in a Stress Response
Promotes water retention | Concentrates urine
30
Renin in a Stress Response
Stimulates angiotensin II which stimulates aldosterone production Na+ & water resorption K+ loss
31
How does IL-6 & other cytokines cause the acute phase response?
Production of acute phase proteins
32
Examples of Acute Phase Proteins
``` Fibrinogen CRP Complement Alpha-2-macroglobulin Amyloid A Ceruloplasmin ```
33
Effects of IL-6 & Cytokines
``` Fever Granulocytosis Hemostasis Tissue damage limitation Promotion of healing ```
34
What is cytokine production limited by?
Cortisol
35
How does anesthesia affect the stress response?
Opioids Anesthetic drugs Regional
36
Opioids & the Stress Response
Suppress hypothalamic & pituitary hormone secretion
37
Disadvantages of Opioids in the Stress Response
Prolong recovery | Increase need for post-op ventilatory support
38
Types of Anesthetic Drugs
Etomidate Benzodiazepines Clonidine
39
Effect of Etomidate as an Anesthetic Drug
Suppresses cortisol production
40
Effect of Benzodiazepines as an Anesthetic Drug
May inhibit steroid production at the level of the pituitary
41
Effect of Clonidine as an Anesthetic Drug
Inhibit stress responses mediated by the sympathetic nervous system
42
Regional Anesthesia can Reduce
Glucose, ACTH, cortisol, GH, & epinephrine changes
43
Regional Anesthesia can Provide
Excellent anesthesia Reduce thromboembolic complications Improved pulmonary function Reduced paralytic illeus
44
Other Techniques for Modification of the Stress Response
Surgical technique: open vs. laparoscopic Nutrition Hormone therapy: insulin infusions Maintenance of normothermia
45
Define Dehiscence
Wound rupture along the surgical suture
46
Risk Factors for Dehiscence
``` Age Obesity DM Smoking Steroids Poor knot tying or closure techniques Excessive tension Trauma or infection ```
47
Define Evisceration
Abdominal organ are protruding out of an dehiscence wound
48
Define Cellulitis
Infection of the tissue just below the skin surface
49
Define Gangrene
Necrosis of the tissue occurs due to lack of adequate vascular supply or infections
50
Forms of Gangrene
Wet Dry Gas Other
51
Describe Wet Gangrene
Tissue infected Swollen Fetid smell
52
Describe Dry Gangrene
Ischemia without infection
53
Describe Gas Gangrene
Bacterial infection that produces gas in the tissues
54
Other Types of Gangrene
Necrotizing fasciitis
55
Define Abscess
Collection of pus built up within the body tissue
56
Describe an Abscess
Painful Tender Fluctuant Erythematous nodule
57
Define Bacteremia
Presence of bacteria in the blood
58
How can blood enter the bloodstream?
Complications of infections During surgery Due to catheters & other foreign bodies entering the arteries or veins
59
Define Septicemia
Bacteremia that often occurs with severe infections | Systemic signs & symptoms with organ failure
60
Define Systemic Inflammatory Response Syndrome (SIRS)
Clinical syndrome identical to sepsis characterized by dysregulation of inflammation caused by an infection or non-infectious etiology
61
Examples of Non-Infectious Etiologies
``` Autoimmune disorder Pancreatitis Vasculitis Thromboembolism Burns Surgery ```
62
Diagnosis of Systemic Inflammatory Response Syndrome (SIRS)
2+ abnormalities in temperature, heart rate, respiration, or WBCs
63
Pathophysiology of Sepsis/SIRS
Release of pro-inflammatory mediators in response to an infection exceeds the boundaries of the local environment, leading to a more generalized response
64
Coagulation in SIRS
Cytokines IL-1 & TNF-alpha Results in expression of tissue factor Tissue factor initiates production of thrombin & promotes coagulation Microvascular thrombosis occurs
65
Organ Dysfunction Occurs as a Result of
Cellular injury Microvascular thrombosis Release of pro-inflammatory & anti-inflammatory mediators

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