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Surgery > Physiologic Response to Surgery > Flashcards

Physiologic Response to Surgery Flashcards

1
Q

Define Stress Response

A

Hormonal & metabolic changes that are triggered by “stress”

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2
Q

Physiological Changes that Occur During the Stress Response

A

Hormonal
Metabolic
Immunological
Hematological

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3
Q

Psychological Changes that Occur During the Stress Response

A

Fatigue
Malaise
Depression

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4
Q

Behavioral Change that Occurs During the Stress Response

A

Reluctance to move

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5
Q

Hormonal Response to Stress

A

Activation of HPA axis & sympathetic nervous system
Receive input from area of trauma or injury
Normal feedback mechanism fails: system doesn’t get shut off

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6
Q

Sympathetic Nervous System Response to Stress

A

Adrenal medulla releases catecholamines
Increased norepinephrine from presynaptic nerve terminals
Leads to tachycardia & HTN

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7
Q

Renal Effects due to Activation of the Sympathetic Nervous System

A

Renin release causes conversion of angiotensin I to II

Aldosterone release leads to Na+ retention

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8
Q

Pancreatic Effects due to Activation of the Sympathetic Nervous System

A

Glucagon release
Decreased release of insulin
Some insulin resistance

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9
Q

Hepatic Effects due to Activation of the Sympathetic Nervous System

A

Glycogenolysis
Increased glucose & lactate concentration
Mobilization of FFA from lipid stores

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10
Q

Hormones Released by the Anterior Pituitary in a Stress Response

A

ACTH
GH
Prolactin

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11
Q

What releasing factors are released from the hypothalamus to trigger hormone release from the anterior pituitary?

A

CRH

GHRF

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12
Q

What is the posterior pituitary controlled by?

A

Hypothalamus: directly

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13
Q

Hormones Released from the Posterior Pituitary in a Stress Response

A

ADH

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14
Q

Changes in the Anterior Pituitary During a Stress Response

A

Increased ACTH
Increased GH
Increased prolactin

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15
Q

Increased ACTH Leads to

A

Increased release of cortisol & glucocorticoids from the adrenal medulla

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16
Q

Increased GH Leads to

A

Increased blood sugar
Antagonizes insulin
May have positive role in wound healing

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17
Q

Why is there increased prolactin in the stress response?

A

Decreased prolactin inhibiting factor

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18
Q

Increases in ADH Leads to

A

Further increase in ACTH

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19
Q

Function of Cortisol

A

Promotion of protein breakdown & gluconeogenesis
Inhibits glucose use & increases blood sugar
Promotes lipolysis further increasing blood glucose
Glucocorticoid anti-inflammatory effects
Mineralocorticoid effects causing fluid retention & potassium loss

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20
Q

Function of Insulin

A

Promotes uptake of glucose into muscle & adipose tissue
Coverts glucose into glycogen & triglycerides
Inhibits protein catabolism & lipolysis

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21
Q

Function of Increased Glucagon Release

A

Promotes hepatic glycogenolysis
Increases gluconeogenesis from amino acids in the liver
Has lypolytic activity

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22
Q

Effects of the Stress Response on Thyroid Hormones

A

Total & Free T3 decrease & return to normal after several days
TSH decrease for 2 hours & then return to normal

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23
Q

Carbohydrate Metabolism in a Stress Response

A

Glucose homeostasis mechanisms are ineffective

Lack of insulin to get sugar into the cells

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24
Q

Hyperglycemia Leads to

A

Wound infection

Impaired wound healing

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25
Q

Protein Metabolism in a Stress Response

A

Increased cortisol & cytokine concentration
Weight loss & muscle wasting
Can measure protein loos indirectly by nitrogen excretion in the urine

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26
Q

Increased Cortisol & Cytokine Concentration Leads to

A

Catabolism primarily from skeletal muscle

Albumin production reduced & alters extracellular volume

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27
Q

Lipid Metabolism in a Stress Response

A

Lipolysis & ketone production

28
Q

Hormones Involved in Water & Electrolyte Metabolism in a Stress Response

29
Q

ADH in a Stress Response

A

Promotes water retention

Concentrates urine

30
Q

Renin in a Stress Response

A

Stimulates angiotensin II which stimulates aldosterone production
Na+ & water resorption
K+ loss

31
Q

How does IL-6 & other cytokines cause the acute phase response?

A

Production of acute phase proteins

32
Q

Examples of Acute Phase Proteins

A 
Fibrinogen
CRP
Complement
Alpha-2-macroglobulin
Amyloid A
Ceruloplasmin
33
Q

Effects of IL-6 & Cytokines

A 
Fever
Granulocytosis
Hemostasis
Tissue damage limitation
Promotion of healing
34
Q

What is cytokine production limited by?

35
Q

How does anesthesia affect the stress response?

A

Opioids
Anesthetic drugs
Regional

36
Q

Opioids & the Stress Response

A

Suppress hypothalamic & pituitary hormone secretion

37
Q

Disadvantages of Opioids in the Stress Response

A

Prolong recovery

Increase need for post-op ventilatory support

38
Q

Types of Anesthetic Drugs

A

Etomidate
Benzodiazepines
Clonidine

39
Q

Effect of Etomidate as an Anesthetic Drug

A

Suppresses cortisol production

40
Q

Effect of Benzodiazepines as an Anesthetic Drug

A

May inhibit steroid production at the level of the pituitary

41
Q

Effect of Clonidine as an Anesthetic Drug

A

Inhibit stress responses mediated by the sympathetic nervous system

42
Q

Regional Anesthesia can Reduce

A

Glucose, ACTH, cortisol, GH, & epinephrine changes

43
Q

Regional Anesthesia can Provide

A

Excellent anesthesia
Reduce thromboembolic complications
Improved pulmonary function
Reduced paralytic illeus

44
Q

Other Techniques for Modification of the Stress Response

A

Surgical technique: open vs. laparoscopic
Nutrition
Hormone therapy: insulin infusions
Maintenance of normothermia

45
Q

Define Dehiscence

A

Wound rupture along the surgical suture

46
Q

Risk Factors for Dehiscence

A 
Age
Obesity
DM
Smoking
Steroids
Poor knot tying or closure techniques
Excessive tension
Trauma or infection
47
Q

Define Evisceration

A

Abdominal organ are protruding out of an dehiscence wound

48
Q

Define Cellulitis

A

Infection of the tissue just below the skin surface

49
Q

Define Gangrene

A

Necrosis of the tissue occurs due to lack of adequate vascular supply or infections

50
Q

Forms of Gangrene

A

Wet
Dry
Gas
Other

51
Q

Describe Wet Gangrene

A

Tissue infected
Swollen
Fetid smell

52
Q

Describe Dry Gangrene

A

Ischemia without infection

53
Q

Describe Gas Gangrene

A

Bacterial infection that produces gas in the tissues

54
Q

Other Types of Gangrene

A

Necrotizing fasciitis

55
Q

Define Abscess

A

Collection of pus built up within the body tissue

56
Q

Describe an Abscess

A

Painful
Tender
Fluctuant
Erythematous nodule

57
Q

Define Bacteremia

A

Presence of bacteria in the blood

58
Q

How can blood enter the bloodstream?

A

Complications of infections
During surgery
Due to catheters & other foreign bodies entering the arteries or veins

59
Q

Define Septicemia

A

Bacteremia that often occurs with severe infections

Systemic signs & symptoms with organ failure

60
Q

Define Systemic Inflammatory Response Syndrome (SIRS)

A

Clinical syndrome identical to sepsis characterized by dysregulation of inflammation caused by an infection or non-infectious etiology

61
Q

Examples of Non-Infectious Etiologies

A 
Autoimmune disorder
Pancreatitis
Vasculitis
Thromboembolism
Burns
Surgery
62
Q

Diagnosis of Systemic Inflammatory Response Syndrome (SIRS)

A

2+ abnormalities in temperature, heart rate, respiration, or WBCs

63
Q

Pathophysiology of Sepsis/SIRS

A

Release of pro-inflammatory mediators in response to an infection exceeds the boundaries of the local environment, leading to a more generalized response

64
Q

Coagulation in SIRS

A

Cytokines IL-1 & TNF-alpha
Results in expression of tissue factor
Tissue factor initiates production of thrombin & promotes coagulation
Microvascular thrombosis occurs

65
Q

Organ Dysfunction Occurs as a Result of

A

Cellular injury
Microvascular thrombosis
Release of pro-inflammatory & anti-inflammatory mediators

Surgery (20 decks)

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