Injury Coughlin 7 7 08

Systemic Response to Injury & Metabolic Support a review of Schwartz’s Principles of Surgery- Chapter 1 L. Coughlin, M.D. July 7, 2008

Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Clinical Spectrum of SIRS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Signaling ,[object Object],[object Object],[object Object],[object Object],[object Object]

Hormone Signaling ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Adrenocorticotropic Hormone ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Glucocorticoids ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Exogenous administration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Macrophage Inhibitory Factor ,[object Object],[object Object],[object Object],[object Object],[object Object]

Growth Hormone ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Catecholamines ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Epinephrine – other effects ,[object Object],[object Object],[object Object]

Aldosterone ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Insulin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Acute Phase Proteins ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Inflammatory Mediators ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Heat Shock Proteins ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Reactive Oxygen Metabolites ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Eicosanoids Phospholipids Arachadonic Acid Cyclic endoperoxidases (PGG2, PGH2) Hydroperoxyeicosatetraenoic acid (HPETE) Prostaglandins PGD2, PGE2, PGF2 α , PGI2 Thromboxane TXA2 Hydroxyeicosatetraenoic Acid HETE Leukotrienes Cyclooxygenase 1 & 2 Lipoxygenase Phospholipase A2 Corticosteroids Glucocorticoids (Cortisol)

Eicosanoids ,[object Object],[object Object],[object Object],[object Object],[object Object]

Eicosanoid Effects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Fatty Acid Metabolites ,[object Object],[object Object],[object Object],[object Object],[object Object]

Kallikrein-Kinin System ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Serotonin ,[object Object],[object Object],[object Object],[object Object]

Histamine ,[object Object],[object Object],[object Object],[object Object]

Cytokines ,[object Object],[object Object],[object Object],[object Object],[object Object]

Tumor Necrosis Factor α ,[object Object],[object Object],[object Object],[object Object],[object Object]

Interleukin-1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Interleukin-2 ,[object Object],[object Object],[object Object],[object Object]

Interleukin-4 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Interleukin-5 ,[object Object],[object Object]

Interleukin-6 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Interleukin-10 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Interleukin-13 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Interleukin-15 ,[object Object],[object Object],[object Object]

Interferon- γ ,[object Object],[object Object],[object Object],[object Object],[object Object]

Granulocyte-Macrophage Colony-Stimulating Factor ,[object Object],[object Object],[object Object],[object Object]

High Mobility Group Box 1 ,[object Object],[object Object],[object Object],[object Object]

Cell Signaling Pathways ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cell Signaling Pathways ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cell Signaling Pathways ,[object Object],[object Object],[object Object],[object Object],[object Object]

Tumor Necrosis Factor ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cell Mediated Inflammation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cell Mediated Inflammation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cell Mediated Inflammation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Endothelium-Mediated Injury ,[object Object],[object Object],[object Object],[object Object],[object Object]

Nitric Oxide ,[object Object],[object Object],[object Object],[object Object]

Prostacyclin (PGI2) ,[object Object],[object Object],[object Object],[object Object]

Endothelins ,[object Object],[object Object]

Platelet Activating Factor ,[object Object],[object Object],[object Object],[object Object],[object Object]

Metabolism During Fasting ,[object Object],[object Object],[object Object],Mass (kg) Energy (Kcal) Days Available Water 49 0 0 Protein 6 24,000 13 Glycogen 0.2 800 0.4 Fat 15 140,000 78 Total 70.2 164,800 91.4

Metabolism During Fasting ,[object Object],[object Object],[object Object],[object Object]

Metabolism of Simple Starvation ,[object Object],[object Object],[object Object],[object Object]

Metabolism of Prolonged Starvation ,[object Object],[object Object],[object Object],[object Object],[object Object]

Metabolism Following Injury ,[object Object],[object Object],[object Object],[object Object],[object Object]

Lipid Absorption ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Fatty Acid Oxidation ,[object Object],[object Object],[object Object],[object Object]

Carbohydrate Metabolism ,[object Object],[object Object],[object Object],[object Object]

Protein and Amino Acid Metabolism ,[object Object],[object Object],[object Object],[object Object]

Nutrition in the Surgical Patient ,[object Object],[object Object],[object Object],[object Object]

Surgical Nutrition ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Enteral Feeding ,[object Object],[object Object],[object Object],[object Object]

Initiation of Enteral Feeding ,[object Object],[object Object],[object Object]

Enteral Formulas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Enteral Formulas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Enteral Formulas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Enteral Access ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Percutaneous Endoscopic Gastrostomy-Jejunostomy ,[object Object],[object Object],[object Object],[object Object]

Direct Percutaneous Endoscopic Jejunostomy ,[object Object],[object Object],[object Object]

Surgical Gastrostomy and Jejunostomy ,[object Object],[object Object],[object Object]

Parenteral Nutrition ,[object Object],[object Object],[object Object],[object Object]

Parenteral Nutrition Rationale ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Total Parenteral Nutrition ,[object Object],[object Object],[object Object]

Peripheral Parenteral Nutrition ,[object Object],[object Object],[object Object],[object Object],[object Object]

Parenteral Nutrition ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Parenteral Nutrition ,[object Object],[object Object],[object Object]

Complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Special Formulations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

References ,[object Object],[object Object]

Injury Coughlin 7 7 08

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Injury Coughlin 7 7 08