Metabolic response to surgery

The insult of trauma, including surgery, results in a number of metabolic changes directed at containing and repairing the damage. This response is complex and involves many metabolic processes and body systems. The effects are mediated by the sympathetic nervous system, endocrine, inflammatory and endothelial responses. Not only has the response been implicated in healing but, more recently, has been suggested to play an important pathophysiological role in the complications of trauma, such as systemic inflammatory response syndrome (SIRS) and multiorgan failure (MOF). A full description of the changes observed is excessive for the purpose of this chapter, but it is worth highlighting a number of points that have bearing on everyday clinical practice.

Sympathetic activity causes a rise in heart rate and blood pressure, increasing cardiac work. Mobilisation of energy stores occurs shortly after injury, causing relative hyperglycaemia and insulin resistance. ADH secretion is increased resulting in water retention and a fall in urine output. Vascular permeability is increased, predisposing to oedema formation. Inflammatory mediators (e.g. prostaglandins and leucotrienes) are produced, causing systemic effects such as pyrexia; they might also be implicated in trauma pathophysiology. The immune system is impaired, predisposing to infective complications. After the initial brief mobilisation of energy stores (catabolic state) the body enters a more prolonged reparative anabolic state with increased energy and nitrogen demands. Activation of platelets leads to a hypercoagulable state.

Boost Your Metabolism and Burn Fat

Boost Your Metabolism and Burn Fat

Metabolism. There isn’t perhaps a more frequently used word in the weight loss (and weight gain) vocabulary than this. Indeed, it’s not uncommon to overhear people talking about their struggles or triumphs over the holiday bulge or love handles in terms of whether their metabolism is working, or not.

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