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CP > Trauma and Nutrition > Flashcards

Trauma and Nutrition Flashcards

1
Q

What is the definition of trauma?

A

an injury or wound to living tissue caused by an extrinsic agent

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2
Q

What are the immediate features of physical trauma?

A

intravascular fluid loss
extravascular volume
tissue destruction
obstructed/impaired breathing

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3
Q

What are the more delayed features of physical trauma?

A

Starvation
Infection
Inflammation

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4
Q

What are the 4 most common causes of mortality from major trauma?

A

Haematological shock
head injury
acute respiratory distress syndrome
multi organ failure

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5
Q

What is interrupted in shock?

A

supply of substrates into the cell e.g. oxygen, glucose, water etc.
removal of metabolites from the cell e.g. CO2, water, free radicals etc.

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6
Q

What are the 3 phases of mortality from trauma?

A

Phase 1: clinical shoke
Phase 2: Hypercatabolic state
Phase 3: recovery (anabolic state)

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7
Q

How do you get from phase 1 to phase 2 in mortality from trauma?

A

spontaneous recovery - physiological adaptation

resuscitation - intervention

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8
Q

What is the duration of phase 1 (shock)?

A

develops 2-6 hours after injury

lasts 24-48 hours

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9
Q

What is secreted in phase 1 (shock)?

A

cytokines
catecholamines
cortisol

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10
Q

What are body’s responses in phase 1 (shock)?

A 
tachycardia - increased heart rate
increased respiratory rate
peripheral 
vaso-constriction - shut down of vital organs to preserve them
hypovolaemia
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11
Q

What are the primary aims in phase 1 (shock)?

A

stop bleeding

prevent infection

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12
Q

What is the duration of phase 2 (catabolic state)?

A

2 days after injury

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13
Q

What is secreted in phase 2 (catabolic state)?

A

Catecholamines
Glucagon
ACTH → Cortisol

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14
Q

What are the primary aims in phase 2 (catabolic state)?

A

Avoid sepsis

Provide adequate nutrition

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15
Q

What are body’s responses in phase 2 (catabolic state)?

A 
↑ Oxygen consumption
↑ metabolic rate
↑ Negative nitrogen balance
↑ Glycolysis 
↑ Lipolysis
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16
Q

What causes negative nitrogen balance?

A

skeletal muscle breakdown to release amino acids

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17
Q

What is the duration of phase 3 (anabolic state)?

A

3-8 days after uncomplicated surgery

can be weeks after severe trauma/sepsis

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18
Q

What are body’s responses in phase 3 (anabolic state)?

A

Gradual restoration of:

body protein synthesis, Normal nitrogen balance, Fat stores, Muscle strength

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19
Q

What are the primary aims in phase 3 (anabolic state)?

A

Adequate nutrition supply is critical in this phase - beware of risk of Refeeding syndrome risk

20
Q

What is ‘obesity paradox’?

A

the fact that after trauma, obese people do better in recovery

21
Q

What are the 5 steps in the inflammatory response at a trauma site?

A
  1. Bacteria and pathogens enter wound
  2. Platelets release clotting factors
  3. Mast cells secrete factors that mediate vasodilation - ↑ blood delivery to the injured area
  4. Neutrophils + macrophages recruited to phagocytose pathogens
  5. Macrophages secrete cytokines - attract immune cells + proliferate the inflammatory response
22
Q

What effect does inflammatory mediator release have on the capillaries?

A

systemic capillary leak - leaks H20, NaCl, albumin and energy substrates

23
Q

What effect does cytokines IL-1, IL-6 and TNF have on the body?

A 
local effects e.g. vasodilatation
catabolic effects
B/T cell proliferation
anorexia
endocrine effects
fever
fibroblast proliferation repair
24
Q

What are the 5 cardinal signs of inflammation?

A 
heat
redness
swelling
pain
loss of function
25
Q

What are the endrocrine effects of cytokines? What catabolic hormones are secreted?

A 
↑ ACTH → Cortisol
↑ Glucagon
↑ Catecholamines
↓ growth hormone
↓ insulin
26
Q

what organ in the body requires a constant supply of glucose?

A

Brain - has no glycogen store

uses ketones as back up energy substate

27
Q

What is Glycogenolysis?

A

Glycogen → Glucose

28
Q

What is Gluconeogenesis?

A

amino-acids → Glucose + Lactate production

29
Q

What is Lipolysis + Ketogenesis?

A

Free Fatty Acid → acetyl CoA → acetoacetate & hydroxybutyrate

30
Q

What is the effect of loss of ATP in anaerobic metabolism?

A

loss of membrane Na/K pump → cellular swelling → Loss of membrane integrity → lysosomal enzyme release

31
Q

What metabolic processes occur to drive Skeletal muscle
Proteolysis as oppose to Synthesis of
new protein?

A

↑ Inflammatory modulators and scavengers e.g. CRP
↓ Albumin
↑ Free amino acids
↑ Ammonia
↑ N2 loss (via urinary excretion of urea)

32
Q

How can protein turnover in trauma cause a patient to develop pneumonia?

A

Respiratory muscle weakness results → poor cough, retention of secretions = pneumonia

33
Q

What does excess lactate cause in the body?

A

tissue hypoxia

34
Q

What is used as a prognostic marker in trauma?

A

Lactate

35
Q

How much nitrogen loss occurs in long bones?

A

60-70g muscle protein

36
Q

How much nitrogen loss occurs in Severe burns?

A

300 g muscle protein

37
Q

Immobilisation increases losses of which ions?

A

Calcium
Phosphate
Magnesium

38
Q

What criteria should nutrition after trauma include?

A

ambient temperature
Use the gut if possible (nasogastric tubes)
TPN (trace elements, fat soluble vitamins)

39
Q

What is Primary Malnutrition?

A

Protein-calorie undernutrition (starvation)

Dietary deficiency of specific nutrients

40
Q

What is Secondary Malnutrition?

A

Nutrients present in adequate amounts but:
appetite is suppressed
absorption and utilization are inadequate
Increased demand

41
Q

What is refeeding syndrome?

A

Occurs in people who have experienced prolonged malnutrition and then started to eat again
insulin secretion resumes in response to increased blood sugar; resulting in increased glycogen, fat and protein synthesis

42
Q

What protein is mutated in CF?

A

Cystic Fibrosis Transmembrane Regulator (CFTR) protein

43
Q

What is the function of the CFTR protein?

A

production of thin, watery, free-flowing mucus -
lubricates airways and secretory ducts
protecting the lining of the: airways, digestive system, reproductive system

44
Q

What does Digestive enzyme deficiencies cause?

A

Malnutrition
Infection
Persistent inflammatory state

45
Q

What GI diseases are associated with CF?

A

Meconium ileus at birth
Severe hepatobiliary disease
Pancreatic cysts, exocrine insufficiency
e.g. decreased insulin

46
Q

What are the treatment options for the Respiratory diseases in CF?

A 
Physiotherapy
Exercise
Bronchodilators
Antibiotics 
Steroids
Mucolytics
47
Q

What are the treatment options for the GI diseases in CF?

A 
Pancreatic enzyme replacement (Creon)
Nutritional supplements
Fat-soluble vitamins
High calorie diet
Ursodeoxycholic acid - for treatment of primary biliary cirrhosis

CP (50 decks)

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