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Surgery > Systemic And Metabolic Response To Injury > Flashcards

Systemic And Metabolic Response To Injury Flashcards

1
Q

Release is in proportional to the severity of injury?

A

Adrenocorticotrpic hormones

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2
Q

Adrenocorticotropic hormones stimulate the production of?

A

Glucocorticoids and mineralocorticoids

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3
Q

Cortisol

A 
Glucocorticoid hormone from adrenal gland
Stress
Potentiate glucagon and epi
Decrease glycogenesis
Increase gluconeogenesis
Breakdown of protein
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4
Q

Cortisol release of

A

Fatty acids
Triglyceride
Glycerol

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5
Q

Cortisol reduces

A

Transforming growth factor B

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6
Q

Cortisol and glucocorticoid immunosuppressive properties

A

Thymic involution
Decreased killer cells and function
Inhibit leukocyte migration
Inhibits monocytes

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7
Q

Mineralocorticoids from zona glomerulosa of the adrenal cortex

A

Aldosterone

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8
Q

Aldosterone released is by?

A

ACTH
Angiotensin 2
Decrease intravascular volume
Hyperkalemia

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9
Q

Aldosterone increase intravascular volume by

A

Retain Na

Eliminate K and H

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10
Q

Aldosterone deficiency

A

Hypotension

Hyperkalemia

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11
Q

Aldosterone excess

A

Edema
Hypertension
Hypokalemia
Metabolic alkalosis

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12
Q

Activation of protein to renin

A

Renin angiotensin - aldosterone

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13
Q

Converts angiotensinogen- angiotensin 1

A

Renin

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14
Q

Converted to angiotensin2 in the lungs by angiotensin - converting enzyme

A

Angiotensin 1

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15
Q

Angiotensin 2

A

Potent vasoconstrictor
Increased heart rate
Increased vascular permeability
Stimulates aldosterone secretion

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16
Q

Metabolic activity of angiotensin 2

A

Glycogenolysis

Gluconeogenesis

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17
Q

ADH

Resorption of solute free water in the distal tubule and collecting ducts

A

Osmoregulator

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18
Q

ADH

Vasoconstriction

A

Vasoactive

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19
Q

ADH

Glycogenolysis/gluconeogenesis

A

Metabolic

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20
Q

Peak level of cathecolamines

A

24-48 hours after the injury

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21
Q

Secreted by chromaffin cell of the adrenal medulla

A

Epinephrine

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22
Q

Hemodynamics actions of epinephrine

A

Alpha mediated vasoconstriction

Beta mediated vasodilatation and increased heart rate

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23
Q

Low dose epinephrine

High dose epinephrine

A

Beta mediated

Alpha mediated

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24
Q

Cathecolamines metabolic

A

Mababa ang insulin, kaya mababa ang glucose sa periphery pero mataas sa liver.

Lipolysis and proteolysis

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25
Q

Catecholamines impairs wound healing

A

Increase TGF b and INF 1

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26
Q

Catecholamines immunodepressant

A 
Inhibit cytokines (inflammatory)
Enhance interkulin (anti inflammatory)
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27
Q

Initial suppression after injury mediated by cathecolamines and symphatetic nervous system

A

Insulin

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28
Q

Insulin secretion is stimulated by?

A

Glucose
Fatty acids
Ketone bodies

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29
Q

Insulin stimulates

A 
Glycogenesis
Glycolysis
Lipogenesis
Protein synthesis
Peripheral glucose uptake
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30
Q

Kapag walng insulin secretion in relationship to immune system

A

Glycosylation of immunoglobulin

Decreased phagocytosis

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31
Q

Secreted by pituitary gland

A

Growth factors

Insulin like growth factors

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32
Q

Growth factors

Insulin like growth factors metabolic effects

A

Increase protein synthesis and lipogenesis
Increase glycogen ess
Increase glucose uptake and lipid utilization

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33
Q

Growth hormones and insulin like growth factors

Immunomodulatory function

A

Increase lysosomal superoxide production

Increase T cell production

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34
Q

Stored and secreted by the anterior pituitary and macrophages

A

Macrophage migration inhibiting factor

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35
Q

Macrophage migration inhibiting factor

Immune function

A

Counter the anti inflammatory effects of cortisol on immunocytes
Increase the activity of immunocytes on pathogen

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36
Q

Acute phase proteins

A

Ceruloplasmin
Haptoglobin
C reactive proteins

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37
Q

Acute phase proteins produced by the liver thru the initiation of

A

IL -6
TNF- a
IL-1

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38
Q

Anti oxidant

A

Ceruloplasmin

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39
Q

Serves as opsonins

A

C reactive proteins

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40
Q

Acute phase proteins

Immune response

A

Not reliable as an index of inflammation in the presence of hepatic insufficiency

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41
Q

Eradicate invading microorganism and promote wound healing

A

Cytokine

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42
Q

Cytokine exaggerated pro inflammatory response seen in

A

Septic shock

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43
Q

Cytokine chronic production results to

A

Muscle wasting

Cachexia

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44
Q

Cytokine lessen the pain perception by

A

Increasing B endomorphins

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45
Q

Type of cytokine that are produced from monocytes, macrophages, T cell, kuffler cells and endothelial cells.

A

Tumor Necrosis Factor Alpha (TNF a)

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46
Q

Type of cytokine

Earliest and most potent mediator of inflammatory response to injury pero short lived

A

TNF -a

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47
Q

Major cytokine related to muscle catabolism and cachexia during stress

A

TNF-a

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48
Q

TNF-a activates coagulation and promotes release of

A

Prostaglandin
PAF
Glucorticoids
Eicosanoids

49
Q

Type of cytokines that release triggered by antigen stimulation of lymphocytes

A

Interleukin 2

50
Q

Anti inflammatory cytokines

A

TGF B

IL 10

51
Q

Strongest anti inflammatory cytokines

A

Interleukin 10

52
Q

Interleukin 6

A

Stimulate prostaglandin febrile response
Regulates hepatic acute phase
Enhance immune function

53
Q

Pyrogenic interleukins

A

IL -1
IL -6
TNF

54
Q

A cytokine produced by leukocytes, T cells and fibroblast

A

Interferons

55
Q

Produce protein that inhibits cell replication

A

Interferons

56
Q

Enhances the cytotoxic activity of natural killer cells

Used as therapeutic agents in hepatitis B and relapsing sclerosis

A

Type 1 interferons

57
Q

Enhances the phgocytic activity of macrophages

Increased microbial killing capability by releasing oxygen radicals

A

Type 2 interferons

58
Q

Expressed excessively by peroxisomes

Similar in viral infection by type 1

A

Type 3 interferons

59
Q

Produced as by product of oxygen metabolism and by anerobic process

A

Reactive Oxygen Species

60
Q

Host cells are protected from ROS by antioxidants

A

Glutathione peroxidase
Catalase
Superoxide dismutase

61
Q

Main areas of ROS production

A

Fatty acid metabolism
Cytochrome P-450
Respiratory phagocytic cells
Mitochondria

62
Q

Derived from oxidation of membrane phospholipid arachidonic acid

A

Eicosanoids

63
Q

Eicosanoids production leads to formation of

A

Lipoxin inhibits chemotaxis

64
Q

Eicosanoids are not produced in the cells but are produced rapidly in response to

A 
Injury 
Epi 
Vasopressin
Bradykinin
Acethylcholine 
Angiotensin 2
65
Q

Eicosanoids generate mostly pro inflammatory reaction with deleterious effects on the host such as

A

Acute lung injury
Renal failure
Pancreatitis

66
Q

Eicosanoids metabolic effect

Inhibits insulin release by B cells

A

Cyclooxigenase pathway

67
Q

Eicosanoids metabolic effect

Increase B cell activity

A

Lipoxygenase pathway

68
Q

Eicosanoids metabolic effect

A

Inhibits gluconeogenesis (prostaglandin)

69
Q

Eicosanoids

A

Prostaglandin
Thromboxane
Leukotrines

70
Q

Eicosanoids

Promotes inflammation

A

Prostaglandin

71
Q

Eicosanoids

Vasoconstrictor and platelet aggregating factor

A

Thromboxane

72
Q

Eicosanoids

Capillary leakage, bronchospasm, vasoconstriction

A

Leukotrines

73
Q

The ff blocks the effect if eicosanoids

A

Glucorticoids
NSAID
Leukotrine inhibitor

74
Q

Kallikrein plays a role in coagulation cascade it is activated by

A 
Hageman factor
Trypsin
Plasmin
Factor XI
Glass surface
75
Q

Bradykinin produce in the liver

A

Inhibits gluconeogenesis
Vasodilatation
Tissue edema

76
Q

Bradykinin and Kallikrein are elevated in

A 
Gram negative bacteremia
Endotoxemia
Tissue injury
Hemorrhage
Hypotension
77
Q

Derived from tryptophan

Produced in the neurons in the CNS and enterochromaffin cells of the GI tract and platelets

A

Serotonin

78
Q

Serotonin functions

A

Vaso and bronchoconstrictor
Platelet aggregation
Inotropic and chronotropic effect on the heart

79
Q

Derived from decarboxylation of AA histidine

They are stored or rapidly released in neurons skin gastric mucosa, mast cells, basophils and platelets

A

Histamine

80
Q

Increased histamine release is seen in

A

Hemorrhagic shock
Sepsis
Thermal injury

81
Q

Histamine receptors

Mediates vasodilation, bronchoconstrictor, intestinal motility and myocardial contractility

A

H1

82
Q

Histamine receptors

Gastric parietal and acid secretion

A

H2

83
Q

Histamine receptors

Down regulates histamine release

A

H3

84
Q

Histamine receptors

In the bone marrow, associated with chemo taxis of eosinophils and mast cells

A

H4

85
Q

Responsible for protein folding and targeting

A

Heat shock proteins

86
Q

Adrenocorticotropic hormones released by the?

A

Anterior pituitary gland

87
Q

Fatty acid metabolites precursors of

A

Eicosanoids

88
Q

Fatty acid metabolites

Primary lipid source is enteral nutrition, decrease production of inflammatory mediators

A

Omega 6 fatty acid

89
Q

Fatty acid metabolites

Anti inflammatory effect by inhibits the release of TNF, inhibits leukocyte adhesion and agrregation

A

Omega 3

90
Q

Cell mediated inflammatory response

Migration of the inflammatory cells at the site of the injury

A

Margin action

91
Q

Cell mediated inflammatory response

Attachment to the endothelium mediated by

A

E selectin
P selectin
L selectin

92
Q

Cell mediated inflammatory response

Become bound to the endothelial cells by

A

Integrins

93
Q

Cell mediated inflammatory response

Migrate between endothelial cells

A

Diapedesis

94
Q

Cell mediated inflammatory response

Derived from bone marrow megakaryocytes
Important in hemostatic response

A

Platelets

95
Q

Cell mediated inflammatory response

Platelets release substances that attract

A

Neutrophils

Monocytes

96
Q

Platelet is important source of

A

Eicosanoids

97
Q

Primarily an antihelminthic

Found mostly in tissues such as lungs ang GI

A

Eosinophils

98
Q

Eosinophil activation lead to release of toxic mediators

A

ROS
Histamine
Peroxidase

99
Q

Cell mediated inflammatory response

Among the first responders to the site of infection

A

Neutrophils

100
Q

Neutrophils short half life

A

4-10hrs

101
Q

Cell mediated inflammatory response

They are located in the tissues
Source of TNF recruitment of neutrophils and clearance of pathogens

A

Mast cells

102
Q

Mast cells plays an important role in

A

Anaphylactic response to allergens

103
Q

Cell mediated inflammatory response

Phagocytes that can differentiate into macrophage, osteoclast and dendritic cells

A

Monocytes

104
Q

Main effector cells in response infection

A

Monocytes

105
Q

Endothelium mediated injury

Barrier that regulates the migration of cells

A

Vascular endothelium

106
Q

Vascular endothelium anti coagulant properties

A 
Heparin sulfate
Plasminogen
Tissue plasminogen
Activator
Dermatan sulfate
107
Q

Endothelium mediated injury

Most potent vasoconstrictor
Serum level is proportion to the severity of injury

A

Endothelins

108
Q

Endothelins Ea receptors

A

Inotropic

Chronotropic

109
Q

Endothelins Eb receptors stimulate

A

NO

Prostacyclin production

110
Q

Endothelium mediated injury

Released in response to cellular injury, hypoxia and acethylcholine

A

Nitric oxide

111
Q

Nitric oxide also known as

A

Endothelium derived relaxing factor

112
Q

Promotes vascular smooth muscle relaxation

A

Nitric oxide

113
Q

Nitric oxide reduces micro thrombosis by inhibiting

A

Platelet aggregation

114
Q

Endothelium mediated injury

Primarily from atrial tissue but also formed in the gut, kidney, brain and adrenals
Vasodilator
Potent inhibitor aldosterone

A

Atrial natiuretic peptide

115
Q

Endothelium mediated injury

Eicosanoids produced by endothelial cells
Decreased production during systemic inflammation

A

Prostacyclin

116
Q

Prostacyclin is

A

Vasodilator

Platelet deactivator

117
Q

Endothelium mediated injury

Activates platelets
Increase vascular permeability

A

Platelet activating factor

118
Q

Platelet activating factor released from

A

Mast cells
Neutrophils
Platelets
Monocytes

Surgery (7 decks)

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