Metabolic Response To Injury

Question 1

Definition of metabolic response to injury

Answer 1

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

Question 2

What causes the initiation of metabolic response to injury

PVU STI

Answer 2

Pain
Volume loss
Under perfusion
Starvation
Tissue damage
Invasive infection

Question 3

How many phase we have in metabolic response ?

Answer 3

Ebb phase
Flow phase

Question 4

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

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

Answer 4

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

Question 5

In flow phase , what happen ?

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

Answer 5

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

Question 6

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

Answer 6

Catabolic and Anabolic

Question 7

In anabolic phase , what happen ?

Anabolic phase = building up the body

Answer 7

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

Question 8

If there is excessive response metabolic , what will happen ?

Answer 8

systemic Inflammatory response syndrome (SIRS)

Question 9

Criteria of SIRS

Answer 9

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

Question 10

4 systems control the metabolic response (SAVE)

Answer 10

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

Question 11

Sympathetic nervous system response

Answer 11

-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

Question 11

Acute phase response

Answer 11

-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

Question 12

What are positive acute phase proteins

Answer 12

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

Question 13

Endocrine response 1

Answer 13

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

Question 14

Endocrine response 2

Answer 14

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

Question 15

Vascular endothelium 1

Answer 15

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

Question 17

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

Answer 17

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

Question 18

What are the negative acute phase protein

Answer 18

ALbumin
Transferrin