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Injury Coughlin 7 7 08

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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-8 ,[object Object],[object Object],[object Object],[object Object]
Interleukin-10 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Interleukin-12 ,[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]
Interleukin-18 ,[object Object],[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]
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],[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]

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Injury Coughlin 7 7 08

  • 1. Systemic Response to Injury & Metabolic Support a review of Schwartz’s Principles of Surgery- Chapter 1 L. Coughlin, M.D. July 7, 2008
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  • 19. 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)
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