Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Junior Posting > Metabolic response to trauma > Flashcards

Metabolic response to trauma Flashcards

1
Q

In modern surgery, a major goal is to ________ the metabolic response to surgery in order to _______ recovery times.

A

minimize; shorten

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When a major metabolic response does occur, the emphasis is on managing the patient in a way that minimizes _____________ either at the original site of injury or in other organs

A

further tissue damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Systems involved in metabolic response to trauma

________
__________
_____________
________________

A

Local events
Neural
Endocrine
Neuro-endocrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

In ebb phase

Spectrum of inflammatory processes occur with local and distant effect on other body organs
In current medical practice these processes may attenuated but not abolished by ____________

A

intravenous fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The predominant hormones regulating the ebb phase are:

_________
_____________
__________

A

Catecholamines
Cortisol
Aldosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Flow phase= ______________________

A

Systemic Inflammatory Response Syndrome(SIRS).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The flow phase may be subdivided into catabolic phase(________) and anabolic phase( _______)

A

3-10days

weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

From injury to convalescence opposing effect of _________________ and ______________

A

inflammatory response syndrome(SIRS)

counter anti-inflammatory
response(CARS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Local/Systemic effects in metabolic response

Mainly that of acute inflammatory response and its sequelae

Neural
-____________ nervous system
-_____________________ axis

Cellular
-_________
-___________
-____________

Humoral mediated
_________(pro-inflammatory and anti-inflammatory)
Other chemical mediator(prostaglandins,eicosanoids,proteases)
-pituitary and adrenal hormones
-thyroid hormones

A

sympathetic; hypothalamus pituitary adrenal

neutrophils; macrophages; lymphocytes

Cytokines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Activation of sympathetic nervous system

Impulses generated in afferent pain nerve endings at the site of tissue injury have a role in mediating the metabolic responseto injury.

Pain fibres comprise both ________________ fibres and _____________ fibres.

Pain fibres are stimulated via direct trauma or the release of nerve stimulants such as _________.

Nerve impulses reach the _______ via the _________ of the spinal cord and the ________________ tract.

Afferent impulses reaching the thalamus mediate the metabolic response via several mechanisms

A

unmyelinated C fibres and myelinated A

prostaglandins; thalamus

dorsal horn; lateral spinothalamic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Summary of metabolic response to surgery and trauma

Thalamus:

Heart and CVS:

Pituitary:

A

Pyrexia

Increased sympathetic activation leading to tachycardia

Increased ACTH and ADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Summary of metabolic response to surgery and trauma

Superarenal gland

Pancreas

Bone marrow

Skeletal muscle

A

Increased aldosterone, adrenaline, and cortisol

Decreased insulin, increased glucagon

Impaired red cell production

Increased muscle breakdown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Important Cytokines in metabolic response to trauma

Pro-inflammatory:

Anti-inflammatory:

Chemokines :

A

TNF; IFN; IL-1

IL-10; IL-6; TGF-B

IL-8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Negative acute-phase proteins (decrease after injury)

• ● __________
• ●___________ and __________

A

Albumin

Transferrin

Transthyretin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Clinical use: _______ is a useful marker of systemic inflammation

A

CRP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Clinical spectrum of infection and SIRS

Sepsis:

A

Focused source of infection + SIRS

17
Q

Hypovolaemia

Trigger: blood loss, inflammatory interstitial edema

Natural counteracting mechanism: _____,____ ,______

Prevention: _______________

A

ACTH,ADH,RAS

volume(fluids,blood) replacement

18
Q

Hypothermia:
Trigger: cold ambient temperature,hypovolaemia
Untreated may lead to cardiac arrhythmias,coagulopathy acidosis

Prevention: ______________, upper body forced-air heating cover.avoid exposure of viscera and prolonged surgery

A

warm Intravenous fluids

19
Q

Hyperthermia:

Trigger: increased ______________,
resetting of ______________ by _____

Consequence: increased evaporatory water loss. Pyrexia may also complicate infection occurring after injury.
Metabolic rate increases by _____% for each 1°C change in body temperature

Counteracting effects: Drugs- _______,______ . liberal fluid intake,rehydration

A

resting energy metabolism

hypothalalamic thermostat by IL-1

6–10

NSAIDS,paracetamol

20
Q

Weight loss
May be up to _____kg per day in severe trauma. More so if complicated by _____

Mechanism: increased ______________, perioperative ————-

Weight gain in severe trauma and sepsis may suggest ____________

A

0.5; sepsis

protein and fat catabolism; starvation

over hydration

21
Q

Immunosupression
Due to secretion of stress hormones( _________,_________) and ____________

A

catecholamines

glucocorticoids

prostaglandins

22
Q

INTRODUCTION TO PRINCIPLES OF
ENHANCED RECOVERY AFTER
SURGERY(ERAS) PROGRAM

•Commence ________ of _________ or even _________ the _________ after surgery

•_________ and _________ patients by within _________ of surgery

•_________ from the hospital.

•Faster _________ recovery.

A

oral intake; fluid ; food ; same day

Sit out of bed ; ambulate patients ; 24 hours

Early discharge

home

23
Q

Some clinical Interventions to reduce
metabolic response to surgery and
trauma

__________ techniques
Blockade of __________ stimuli (e.g. __________ analgesia)
Minimal periods of __________
Correct __________
Correct __________
Correct __________
Early __________

A

Minimal access techniques

painful stimuli ; epidural analgesia

starvation ; hypovolaemia

hypoxia; acidosis

mobilization

24
Q

PRINCIPLES OF ERAS

Pre-operative

Preadmission __________
__________ and __________ loading
__________ fasting
__________ bowel preparation
__________ prophylaxis
__________ prophylaxis

A

counseling
Fluid and carbohydrate
No prolonged
No/selective
Antibiotic
Thrombo

25
Q

PRINCIPLES OF ERAS

Intra-operative

_______ acting anaesthetic agents
No ______
Goal-directed ______ therapy
Mainateance of _________

A

Short

drains

fluid

normothermia

26
Q

PRINCIPLES OF ERAS

Post -operative

______ anesthesia
No nasogastric tubes
Prevention of nausea and vomiting
Goal directed fluid therapy
Early removal/avoidance of catheter
Early oral nutrition
Non-opioid oral analgesia
Early mobilization
Stimulation of gut motility
Audit of complainer or outcomes

A
27
Q

Four systems control the metabolic response

A

SNs
Acute phase response
Vascular endothelium and blood response
Endocrine response

28
Q

Factors responsible fro systemic response

A

Fall in intravascular volume
Reduced cardiac output and peripheral perfusion
Pain
Stress
SIRs
Inflammation
Excess heat loss
Sec effects on blood
Starvation

29
Q

Mild tachycardia in post operative PT is due to

A

Increase BP and PR from falling intravascular volume

30
Q

Counteracting heat loss in Op thru

A

Raising ambient temp
Wrapping exposed parts of body with insulating material
Warm water under blankets
Warming fluids IV infection

31
Q

Indicators of starvation

A

1)lack of nutritional intake for more than 10daus
2)reduced grip length
3)weight loss of more than 10% of normal body weight
4)low serum albumin >26mg/do
5)low serum transferring
6)reduced lymphocyte count

32
Q

Surgical.catabolism.
Key factors in response to systemic insults

A

Increased sympathetic activity
Circulating catecholamines
Insulin

33
Q

Surgical.catabolism.
Hormones and function

A

Reduced insulin secretion-utilisation of glucose
Stimulation of glucagon secretion-enhances glycogenesis and glycogenesis
Catecholamines and glucagon-lipolysis stimulation(main source of energy for peripheral tissues)
Increased pit ACTH-Increasing circulating glucocorticoids
GLUCOCorticoids-enhnace gluconeogenesis and catabolism of protein
Increased secretion of growth hormone and thyroid hormone-inhibit insulin and promote catabolism
Raised cortisol -suppresses immunity

34
Q

SIRS occurs if:

A

Two or more are present:
1)Temp>38 or <36
2)HR >90BEATS/MINS
3(RR->20BREATHS/MIN for spontaneous ventilation or PCO2-<4.3kpa(33mmhg)
White cell count >12,000cells/mm3 or <4000cells/mm3 or more than 10%immature forms in peripheral blood smear

Junior Posting (35 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions