OF TISSUE TO INJURY
Homeostasis - Concept
Components of Responses
Mediators of Responses
Phases of Responses & Key elements
Factors – Exacerbate & Avoidable
Homeostasis
Immunological
Cellular
Hormonal
response
Response Components
Physiological Consequences
Metabolic Manifestations
Clinical Manifestations
Laboratory Changes
Response Components
PHYSIOLOGICAL METABOLIC
CLINICAL LABORATORY
Fever Leucocytosis/Leucop
Tachycardia enia
Hyperglycemia
Tachypnoea
Elevated
Presence of wound CRP/Altered acute
or Inflammation phase reactants
Anorexia Hepatic/Renal
dysfunction
Mediators of Injury Response
Biphasic :
Postpone anabolism
Injury
CATABO ANABO
SHOCK
LISM LISM
Flow
Catabolic 3 – 10 Mobilisation of ↑ BMR, ↑ Temp, ↑ O2 Cytokines + ↑
days energy stores – consump, ↑ CO Insulin,
Recovery & Repair Glucagon,
Cortisol, Catechol
but insulin
resistance
Anabolic 10 – 60 Replacement of lost +ve Nitrogen balance Growth hormone,
days tissue IGF
Key catabolic elements of flow
phase
Hypermetabolism
Alterations in skeletal muscle
protein
Alterations in Liver protein
Insulin resistance
1. Hypermetabolism
Not Compensated
4.Insulin resistance
Hypothermia
Pain
Starvation
Immobilisation
Sepsis
Hypotension
Avoidable factors that compound
the response to injury
Continuing haemorrhage
Hypothermia
Tissue oedema
Tissue underperfusion
Starvation
Immobility
Avoidable Factors
Epidural analgesia
Early mobilisation
1.In stress response which one of
the following statements is false?
A Glucagon
B Cortisol
C Aldosterone
D Catecholamines
3.Which one of the following will not
exacerbate the metabolic response to
surgical injury ?
A Hypothermia
B Hypertension
C Starvation
D Immobilisation
4.Which one of the following statements
are false regarding Optimal peri-operative
care ?
A Volume loss should be promptly treated
by large intravenous (IV) infusions of fluid.
D Avoid immobility.
5. Which one of the following interleukin
promotes the hepatic acute phase
response in injury ?
A IL - 4
B IL - 5
C IL - 6
D IL - 8