General Surgery Body response to injury

General Surgery Questions: Body Response to Injury

Q1. Counter regulatory hormones in response to metabolic response to injury are all except
A. Glucocorticoids
B. Catecholamines
C. Thyroid hormones
D. Glucagon

Ans 1.  C Thyroid hormones

Stress or Injury produces CRF, ACTH, cortisol which further produces adrenaline and glucagon. Thyroid hormones have no relation to stress

Ref BAiley page 3

Q2. Direct effects of GH in metabolic response to injury are all except:-
A. Lipolytic
B. Insulin agonist
C. Insulin antagonist
D. Proinflammatory

Ans 2. b Insulin agonist

GH has direct lipolytic, insulin-antagonising and proinflammatory properties.

Stress also causes the following ;

Alterations in insulin release and sensitivity (Hyperglycemic state)

Hypersecretion of prolactin and growth hormone (GH)

Q3. Not an effect of stress response on carbohydrate metabolism
A. Peripheral insulin resistance
B. Increased glycogenesis
C. Hyperlactemia
D. Enhanced peripheral glucose uptake

Ans 3 b Increased glycogenesis

The stress response is characterized by a rapid mobilization of fat stores through catecholamine activation of triglyceride lipase.
The acute stress response also is accompanied by insulin resistance, with peripheral glucose intolerance and hepatic gluconeogenesis.
Meanwhile, in contrast to starvation, inflammatory states appear to suppress ketogenesis

ref sabiston page 106

Q 4 Which is not a metabolic response to injury
A) Increased nitrogen requirements
B) Insulin resistance and glucose intolerance
C) Preferential oxidation of lipids
D) Decreased gluconeogenesis

Metabolic response to trauma and sepsis
● Increased counter-regulatory hormones: adrenaline, noradrenaline, cortisol, glucagon and growth hormone
● Increased energy requirements (up to 40 kcal/kg per day)
● Increased nitrogen requirements
● Insulin resistance and glucose intolerance
● Preferential oxidation of lipids
● Increased gluconeogenesis and protein catabolism
● Loss of adaptive ketogenesis

● Fluid retention with associated hypoalbuminaemia

REf Bailey 279, summary box 19.2