Metabolic response to trauma Flashcards
Mediators of injury response
- Neuro endocrine ( Hormonal )
* Metabolic and Cytokine axes
The Neuro-endocrine response to severe injury/critical illness is biphasic
Acute phase
Chronic phase
Characterized by an actively secreting pituitary & elevated counter regulatory hormones (cortisol, glucagon, adrenaline).
Acute phase
Associated with hypothalamic
suppression & low serum levels of the respective target organ hormones.
Chronic phase
Proinflammatory cytokines
Il 1, Il 6, TNF alfa
NO
Endothelin 1 Cytokine antagonist
Interleukin receptor antagonist, TNF soluble receptors are released within hours of injury
Endothelin 1 Cytokine antagonist
The natural response to injury includes
- Immobility
- Anorexia
- Catabolism
Main hormones in ebb phase are
catecholamines, cortisol, and aldosterone
This phase involves mobilization of body
energy stores for repair and recovery
flow
Key catabolic elements of flow phase
- Hypermetabolism
- Alterations in skeletal muscle protein
- Alterations in Liver protein
- Insulin resistance
The Hepatic acute phase response represents a reprioritization of body protein metabolism towards the liver & is characterized by:
Positive reactants
Negative reactants
A normal human ingests _____ of protein per day, which is metabolized and excreted in urine as ammonia and urea
70-100 g
Careful limitation of intra operative administration of colloids and crystalloids so that there is no net weight gain
volume loss
Trauma death triad:
Hypothermia, acidosis, coagulopahty
During systemic inflammation, fluid, plasma proteins, leucocytes, macrophages and electrolytes leave the vascular space and accumulate in the tissues.
tissue edema
The vascular endothelium controls vasomotor tone and micro vascular flow and regulates trafficking of nutrients and biologically active molecules.
Systemic inflammation and tissue under perfusion
Has been recognized as a potent stimulus for inducing muscle wasting. Early mobilization is an essential measure to avoid muscle wasting
inmobility
A prospective approach to prevent unnecessary aspects of the surgical stress response
- Minimal access techniques
- Blockade of afferent painful stimuli (epidural anesthesia)
- Minimal periods of starvation
- Early mobilization
