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MEDIATORS OF THE METABOLIC RESPONSE TO INJURY Tissue damage and inflammation Tissue injury is sensed in several ways. Tissue damage causes the release of cellular and other molecular fragments known as damage-associated molecular patterns (DAMPs) or alarmins. ...

MEDIATORS OF THE METABOLIC RESPONSE TO INJURY Tissue damage and inflammation Tissue injury is sensed in several ways. Tissue damage causes the release of cellular and other molecular fragments known as damage-associated molecular patterns (DAMPs) or alarmins. ...

METABOLIC CHANGES AFTER SURGERY AND TRAUMA The catabolic phase begins at the time of injury and lasts for approximately 24–48 hours. It may be attenuated by proper resuscitation and is characterised by hypovolaemia, decreased basal metabolic rate, reduced car...

Modern surgical care The role of surgical critical care, including resuscitation and/ or organ support, must be to work alongside the metabolic e ff ects of injury while the patient is restored to a situation from which homeostatic mechanisms can achieve a re...

Neuroendocrine response to injury Patients also respond rapidly to injury by the classical neuroen docrine pathways of the stress response, consisting of a ff erent nociceptive neurones, the spinal cord, thalamus, hypothalamus and pituitary ( Figure 1.2 ). No...

RESPONSE It is important to recognise that, in general or population terms, the metabolic response to injury is graded: the more severe - the injury , the greater the response ( Figure 1.1 ). This concept applies not only to physiological and metabolic changes...

Starvation Figure 1.7 Factors that exacerbate the metabolic response to surgical injury include hypothermia, uncontrolled pain, starvation, immobilisation, sepsis and medical complications. Starvation During starvation, the body is faced with an obligate need ...

Systemic inflammation and tissue Systemic inflammation and tissue Systemic inflammation and tissue

Tissue oedema During systemic inflammation, fluid, plasma proteins, leukocytes, macrophages and electrolytes leave the vascular space and accumulate in the tissues as oedema. The oedema - can diminish the alveolar di ff usion of oxygen and may also impair renal ...

Volume loss During simple haemorrhage, baroreceptors in the carotid artery and aortic arch and volume receptors in the wall of the left atrium initiate a ff erent nerve input to the central nervous system, resulting in the release of both aldosterone and anti...

b b o o l Insulin resistance Futile substrate cycling b b o o l Insulin resistance Futile substrate cycling b b o o l Insulin resistance Futile substrate cycling

l i i Muscle protein degradation l i i Muscle protein degradation l i i Muscle protein degradation

s s m m /H11001 /H11002 s s m m /H11001 /H11002 s s m m /H11001 /H11002

t a a Acute phase response t a a Acute phase response t a a Acute phase response

underperfusion xac - The vascular endothelium controls vasomotor tone and ter microvascular flow and regulates tra ffi cking of nutrients and biologically active molecules. When endothelial activation is excessive, compromised microcirculation and subsequent cel...

Analgesia The type and extent of analgesic requirement will depend on both the patient and procedural factors. Prior experience of opiate analgesia may increase patient tolerance to similar agents, necessitating larger doses. There is also evidence to sugges...

DEFINITION Minimal access surgery is a product of modern technology and surgical innovation that aims to accomplish surgical ther apeutic goals with minimal somatic and psychological trauma. This type of surgery has reduced wound access trauma and is less di...

DISCHARGE FROM HOSPITAL The discharge of patients is based on clinical indicators and the patient’s fitness for recuperating in a non-hospital environ - ment. One of the core drivers for the application of minimally invasive surgery is an earlier recovery and...