Endocrine and Metabolic Response to Surgery

Question 1

name given to the hormonal and metabolic changes which follow injury or trauma

Answer 1

stress response

Question 2

The overall metabolic effect of the hormonal changes due to surgery, trauma, ect

Answer 2

increased catabolism to provide energy sources and retain salt and water to maintain fluid volume and CV homeostasis

Question 3

Hypothalamic activation of the sympathetic ANS results in secretion of what to cause tachycardia and hypertension

Answer 3

catecholamines and norepi

Question 4

Surgery is one of the most potent activators of ACTH and cortisol. How soon can increased plasma concentrations of both hormones be measured during surgery?

Answer 4

within minutes of the first incision

Question 5

inhibits glucose uptake and use by cells, which spares glucose for use by neurons in situations of glucose scarcity. stimulates protein synthesis and inhibits protein breakdown

Answer 5

growth hormone

Question 6

increased as part of the stress reponse to surgery and also during exercise. It has little metabolic activity

Answer 6

prolactin

Question 7

can be modified by anesthetic intervention

Answer 7

cortisol response

Question 8

Effect of cortisol on carbs, fats, proteins

Answer 8

promotes protein breakdown, gluconeogenesis in liver, and lipolysis increases gluconeogenic precursors

Question 9

Anti-inflammatory activity of cortisol

Answer 9

inhibit accumulation of macrophages and neutrophils interfering w/prostaglandins

Question 10

Anabolic hormone. Promotes uptake of glucose into muscle/adipose tissue and stimulates formation of glycogen in liver. Inhibits protein catabolism and lipolysis

Answer 10

insulin

Question 11

decrease after the induction of anaesthesia, and during surgery there is a failure of this hormone to match catabolic response

Answer 11

insulin

Question 12

what causes of insulin inhibition during surgery

Answer 12

alpha adrenergic inhibition of β cell secretion

Question 13

failure of the usual cellular response to insulin which occurs during perioperative period

Answer 13

insulin resistance

Question 14

This hormone promotes hepatic glycogenolysis, increases gluconeogenesis from amino acids in the liver and has lipolytic activity. However, it’s not a major contributor to hyperglycemic response

Answer 14

glucagon

Question 15

stimulate the oxygen consumption of most of the metabolically active tissues of the body. increase metabolic rate and heat production

Answer 15

thyroid hormones

Question 16

What happens to thyroid hormones after surgery?

Answer 16

decrease

Question 17

Responsible for the hyperglycemia associated with surgery

Answer 17

Cortisol and catecholamines facilitate glucose production, while peripheral use of glucose is decreased

Question 18

related to the intensity of the surgical injury; the changes follow closely the increases in catecholamines. changes are less marked with minor surgery

Answer 18

blood glucose concentrations

Question 19

risks of prolonged perioperative hyperglycaemia

Answer 19

wound infection and impaired wound healing

Question 20

stimulated by increased cortisol concentrations. results in marked weight loss and muscle wasting in patients after major surgical and traumatic injury

Answer 20

protein catabolism

Question 21

Associated with a faster recovery of immunological parameters, fewer infectious complications and a shorter hospital stay

Answer 21

enteral nutrition

Question 22

promotes water retention and the production of concentrated urine by direct action on the kidney. may continue for 3-5 days post-op

Answer 22

ADH

Question 23

secreted from the juxtaglomerular cells of the kidney, partly as a result of increased sympathetic efferent activation

Answer 23

renin

Question 24

stimulates the release of aldosterone from the adrenal cortex, which in turn leads to Na+ and water reabsorption from the DCT

Answer 24

angiotensin II

Question 25

activated by afferent neuronal impulses from the site of injury

Answer 25

endocrine response to surgery

Question 26

Produced from activated leukocytes, fibroblasts, and endothelial cells as an early response to tissue injury and have a major role in mediating immunity and inflammation

Answer 26

cytokines

Question 27

main cytokine responsible for inducing the systemic changes known as the acute phase response

Answer 27

IL-6

Question 28

How soon after the start of surgery does the concentration of IL-6 increase?

Answer 28

30-60 minutes

Question 29

acute phase proteins that act as inflammatory mediators, anti‐proteinases and scavengers and in tissue repair

Answer 29

CRP and fibrinogen

Question 30

proteins that decrease during the acute phase response

Answer 30

albumin and transferrin

Question 31

Concentrations of what cations decrease partly as a consequence of the changes in the production of the transport proteins

Answer 31

zinc and iron

Question 32

inhibit cytokine production

Answer 32

glucocorticoids

Question 33

inhibits the stress response to surgery, but has no significant effect on cytokine production

Answer 33

regional anesthesia

Question 34

suppress hypothalamic and pituitary hormone secretion, but want to avoid high doses which require prolonged ventilatory support due to respiratory depression

Answer 34

opioids

Question 35

will prevent the endocrine and metabolic responses to surgery, reduce incidence of thromboemoblic complications, and decrease paralytic ileus following abdominal procedures

Answer 35

regional/epidural analgesia

Question 36

associated with rapid recovery and early discharge from hospital due to reduced tissue injury

Answer 36

laparoscopic surgery

Question 37

patient has edema-indicating that there’s enough fluid in his body-but his vital signs and urine output suggest that he’s hypovolemic. what’s going on?

Answer 37

third spacing, trapping of fluid in interstitial spaces due to decreased oncotic pressure or damage to the capillary membranes