Schwartz Surgery Chapter 1 Flash Cards

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Title: Schwartz Surgery Chapter 1
Description: Systemic Response to Injury and Metabolic Support
Number of Cards: 25
Save Count: 3
Author: Matthew J Swenson
Created: 2009-04-19
Tags: 1 chapter schwartz surgery
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    • Question
    • Answer
    • Side 3
    • Lower fluid volume, potassium, phosporus, and magnesium is typical of what type of enteral formula?
    • Renal-failure formulas (pg 33)
    • Fifty percent reduction of carbohydrates is typical of what type of enteral formula?
    • Pulmonary-failure formulas (pg 33)
    • Fifty percent of proteins in the form of branched-chain amino acids (leucine, isoleucine, and valine) is typical of what type of enteral formula?
    • Hepatic-failure formulas (pg 33)
    • Increased arginine, omega-3 fatty acids, and beta-carotene is typical of what type of enteral formula?
    • Immune-enhancing formulas (pg 33)
    • Which acute-phase protein is useful because it is not secreted in a circadian rhythm, does not increase after a large meal, and is more sensitive that ESR as a marker of inflammation?
    • C-reactive protein. Be aware that in patients with liver failure, this acute-phase protein will not increase in response to stress
    • Administration of which hormone will decrease circulating IL-1 and IL-6, decrease capacity for intracellular killing by monocytes, and decrease T-cell function?
    • Cortisol (pg 6)
    • How much elevation in catecholamine levels may be seen after injury?
    • Epi and Norepi are increased three- to fourfold in plasma immediately following injury (pg 7)
    • How long will catecholamine levels remain elevated immediately following injury?
    • Epi and Norepi will have elevations lasting 24 to 48 hours before returning to baseline levels. (pg 7)
    • Healthy patients undergoing uncomplicated surgery can remain NPO (with fluid support) for how many days before significant protein catabolism occurs?
    • 10 days (pg 32)
    • Leukotrienes, prostaglandins, thromboxanes,hydroxyeicosatetraenoic acids, and lipoxins are derivatives of which membrane phospholipid?
    • Arachidonic acid (pg 10)
    • What type of nutrition results in a reduction of infectious complications in critically ill patients?
    • Enteral nutrition (pg 31)
    • Which hormone, synthesized in the pituitary, is characteristically elevated in proportion to the severity of an injury?
    • ACTH
    • Pain, anxiety, vasopressin, angiotensin II, cholecystokinin, vasoactive intestinal polypeptide, catecholamines, and proinflammatory cytokines are all prominent mediator of release of what pituitary hormone in the injured patient?
    • ACTH
    • What are the primary sources of TNF-alpha synthesis?
    • Monocytes/macrophages and T cells (pg 12)
    • What is the half-life of TNF-alpha?
    • Less than 20 minutes (pg 12)
    • The functions of which cytokine include muscle catabolism and cachexia, coagulation activation, promotion of expression or release of adhesion molecules, prostaglandin E2, platelet-activating factors, glucocorticoids, and eicosanoids?
    • TNF-alpha (pg 12)
    • Which type of enteral formula may delay intestinal transit time, decrease diarrhea, and can be used in critically ill patients?
    • Isotonic enteral formulas with fiber (pg 33)
    • Which type of enteral formula provides 1.5 to 2 kcal/ml, and is thus suitable for patients requiring fluid restriction or those unable to tolerate large volume infusions?
    • Calorie-dense formulas
    • Nitric oxide is formed from the oxidation of which amino acid?
    • L-arginine (pg 21)
    • Where is nitric oxide primarily made?
    • The endothelium (pg 20)
    • What is the half-life of nitric oxide?
    • A few seconds (pg 21)
    • Which type of substances are the most potent mediators of inflammatory response?
    • Cytokines (pg 10)
    • What is the most frequent trace mineral deficiency developing in a patient receiving parenteral alimentation?
    • Zinc
    • Deficiency of what mineral is marked by an eczematoid rash either diffusely or in intertriginous areas?
    • Zinc
    • What deficiency is characterized by scaling acrodermatitis and alopecia in the context of total parenteral nutrition?
    • Linoleic acid (Essential fatty acid deficiency)