Trauma metabolic changes

CH 18 SURVIVAL AFTER TRAUMA METABOLIC CHANGES AND RESPONSE OF THE IMMUNE SYSTEM... 

In the ebb phase, there is increased activity of the sympathetic nervous system and increased plasma levels of adrenaline and glucocorticoids but a decreased level of insulin. This results in mobilisation of glycogen in the liver and triacylglycerol in adipose tissue, so that the levels of two major fuels in the blood, glucose and long-chain fatty acids, are increased. This is, effectively, the stress response to trauma. These changes continue and are extended into the flow phase as the immune cells are activated and secrete the proinflammatory cytokines that further stimulate the mobilisation of fuel stores (Table 18.2). Thus the sequence is trauma increased endocrine hormone levels increased immune response increased levels of cytokines metabolic responses. 

Table 18.2 Endocrine hormones and cytokines responsible for metabolic changes in trauma...

Cachexia accompanies many diseases, which include sepsis, diabetes and AIDS, as weU as cancer (Chapter 16). The metabolic changes in cachexia are an extension of those presented above, but are more severe. An overview of the metabolic changes in cancer is given in Figure 21.24. The metabolic changes that occur in patients, after trauma and during cancer can be compared by reference to Table 21.5. 

Table 21.5 Metabolic changes in trauma patients and in cancer patients...

Plank LD, Hill GL. Sequential metabolic changes following induction of systemic inflammatory response in patients with severe sepsis or major blunt trauma. World J Surg 2000 24 630-638. 

Table 18.7 Extent of metabolic starvation changes in trauma and...

Osteoarthritis proves to be a more complex disease than autoimmune disease, with multiple variable manifestations like knee, hip, hand, DIP, elbow, shoulder, and spinal joints OA, which have different risk factors. The etiology of OA is multifactorial with inflammatory, metabolic and mechanical causes. A number of personal and environmental risk factors, such as obesity, occupation, and trauma, may initiate various pathological pathways. OA comprises degeneration of articular cartilage together with changes in subchondral bone of the joint margins and mild intraarticular inflammation. 

For some vitamins or trace elements, serum measurement is limited in value, especially in seriously ill patients. This is partly a result of the lack of correlation between the amount of nutrient in the plasma compartment with the amount within the intracellular compartment in most body tissue. For example, there may be substantial stores of particular vitamins or trace elements in individual tissue (e.g., vitamin A in the liver), but mobilization into the plasma is affected by the availability of the appropriate binding proteins or by metabolism. Also, there are differences in the content of individual vitamins or trace elements between tissues, and the serum concentration will not reflect these differences. Fur-tliermore, and particularly important, is the fact that the concentration in plasma can alter rapidly when an acute phase response (APR) to trauma or infection leads to redistribution of metals between body compartments there is increased synthesis of metallothionein, leading to the uptake of zinc into the fiver, and increased synthesis of ferritin causing uptake of iron. The result is a fall in plasma concentration of both zmc and iron. These changes in plasma concentration clearly do not reflect changes in whole body status. 

There are many reasons for immuno-defidency states change of lifestyle alcohol abuse severe trauma, severe metabolic disease (e.g. diabetes), acute infections, among others. 

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