Metabolic Response To Injury Flashcards

1
Q

Definition of metabolic response to injury

A

The body responds to trauma with local and systemic reactions that attempt to contain and heal the tissue damage ,and to prptect the body while it is injured

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2
Q

What causes the initiation of metabolic response to injury

PVU STI

A

Pain
Volume loss
Under perfusion
Starvation
Tissue damage
Invasive infection

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3
Q

How many phase we have in metabolic response ?

A

Ebb phase
Flow phase

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4
Q

In ebb phase (at the time of injury) , what happen ?

in term of metabolism , temperature ,stress hormone , blood glucose

A

-decrease metabolism
-decrease core temperature
-increase stress hormone
-decrease blood glucose

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5
Q

In flow phase , what happen ?

in term of metabolism , temperature , insulin ,catecholamine , glucose ,lactate

A

-increase metabolism
-increase core temperature
-increase insulin but decreased respone
-increase glucose
- increase lactate

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6
Q

In flow phase , it is further divided into 2 . What are they?

A

Catabolic and Anabolic

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7
Q

In anabolic phase , what happen ?

Anabolic phase = building up the body

A

-Normal metabolism
-Protein , Fat and Glycogen restored
-Body weight gain

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8
Q

If there is excessive response metabolic , what will happen ?

A

systemic Inflammatory response syndrome (SIRS)

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9
Q

Criteria of SIRS

A

-abnormal body temperature (high /low )
-Tachycardia
-Tachypnea
-abnormal WBC (high / low)

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10
Q

4 systems control the metabolic response (SAVE)

A

-Sympathetic nervous system
-acute phase response
-endocrine response
-vascular endothelium

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11
Q

Sympathetic nervous system response

A

-gastrointestinal motility reduced
-increased bladder sphincter tone
-mydriasis , increased visual field
-uterine contraction and relaxation
-insulin production reduced and increased glucagon
-increased glycogenolysis -> hyperglycemia
-increased lipolysis -> ketogenesis

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11
Q

Acute phase response

A

-inflammation -> vasodilation -> increased permeability -> migration of neutrophil and monocytes
-coagulation system activated
-complement system activated
-proliferation of endothelial cells and fibroblast

-outflow of cytokines into systemic circulation is important factor in SIRS
-cytokines stimulate the production of acute phase proteins

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12
Q

What are positive acute phase proteins

A

-CRP
-Fibrinogen
-complement C3
-haptoglobin
-alpha-antichymotripsin
-caeruloplasmin

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13
Q

Endocrine response 1

A

Hypothalamus ,pituitary ,adrenal axis
-ACTH ,cortisol increase
-catabolic actions increase protein breakdown
-insulin antagonism by cortisol -> reduced insulin -> hyperglycemia
-cortisol’s anti inflammatory action -> reduced vascular permeability

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14
Q

Endocrine response 2

A

-aldosterone increase Na+ reabsorption
-vasopressin increase water reabsorption
-total T4 ,total and free T3 levels are reduced
-histamine increase vascular permeability

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15
Q

Vascular endothelium 1

A

-nitric oxide -> vasodilation
-platelet activating factor augment the cytokine response
-prostaglandins produce vasodilation and induce platelet aggregation

16
Q
A
17
Q

How will you limit the over response or damaging effects of responses

A

Less trauma
-surgical handling
-minimal invasive surgery
Control of infection
-antibiotics
-enteral feeding to maintain the mucosal barrier from transmigration of bacteria
-wound care , debride wound and drain pus

18
Q

What are the negative acute phase protein

A

ALbumin
Transferrin