Metabolic response to trauma

General Surgery

Mosul university- College of dentistry-oral & maxillofacial surgery department
Dr. Ziad H. Delemi B.D.S, F.I.B.M.S. (M.F.)
Metabolic response to trauma .Post-Operative Complications

METABOLIC RESPONSE TO TRAUMA

It is a natural response to any kind of injury, mediated by various neural & hormonal reflexes ( the center is in the hypothalamus & mediated by the sympathetic nervous system). It is divided in to:- 1-Early or immediate phase. 2-Catabolic phase. 3-Turning phase. 4-Anabolic phase.
Mosul university- College of dentistry-oral & maxillofacial surgery department

Early phase (low flow phase)

It is a fight, flight, fright reaction, causes: pain, fear, blood loss. The cause is adrenaline, nor-adrenaline secretion from the sympathetic nerve ending or adrenal medulla lead to vasoconstriction and increased in blood pressure and heart rate.
Mosul university- College of dentistry-oral & maxillofacial surgery department


Increased out put of catecolamines from adrenal medulla lead to glycogenolysis in the liver, increased lipolysis , increased lactic acid released from the muscle and converted in to glucose in the liver lead to hyperglycemia, glucose urea. Decreased insulin secretion which promote gluconeogenesis in the liver result in hyperglycemia.
Mosul university- College of dentistry-oral & maxillofacial surgery department
Early phase

Catabolic phase

It is due to excessive release of cortisol and aldosterone ( from adrenal cortex) and ADH from posterior pituitary. Metabolic changes reflected by: decreased in body weight , increased in energy expenditure and increased in basal metabolic rate 2- Lipolysis due to increased secretion of cortisol, catecholamines and glucagon and decreased in insulin secretion. 3- Hyperglycemia which proportional to the severity of the injury due to decreased insulin secretion and impaired peripheral uptake of glucose.

Mosul university- College of dentistry-oral & maxillofacial surgery department

Importance of hyperglycemia glucose is the main source of energy to the brain. Osmotic transfer of fluid from the intracellular to extra cellular space which aid in the resuscitation of blood volume.
Catabolic phase
Mosul university- College of dentistry-oral & maxillofacial surgery department


Fluid and electrolytes metabolism (Na +) retention is the hall mark of these changes and caused by:- Increased cortisol & aldosterone secretion which cause reabsorption of sodium at the distal convoluted tubules in the kidney. Increased peritubular oncotic pressure which increase sodium and water reabsorption.
Catabolic phase
Mosul university- College of dentistry-oral & maxillofacial surgery department


2- K + metabolism: potassium mobilize from the cells to the blood which result in increase serum potassium and at the same time there is increase urinary excretion of potassium by the action of aldosteron. 3. Water metabolism: increased anti diuretic hormone & aldosteron secretion result in water retention and oligurea state.

Catabolic phase

Mosul university- College of dentistry-oral & maxillofacial surgery department

Turning phase

It is corticosteroid withdrawal phase. It is characterized by:- K+ balance return to normal, potassium return inside the cells (intracellular). Na + excreted with water. Diuresis with increase in urinary out put. +ve nitrogen balance, nitrogen loss stops and protein synthesis starts.
Mosul university- College of dentistry-oral & maxillofacial surgery department

Anabolic phase

No more cortisol secretion. Growth hormone and insulin secretion which allow +ve nitrogen balance, protein synthesis and prevent further Lipolysis. Anabolic steroid secretion e.g. Androgen and Estrogen secretion which result in:- +ve nitrogen balance, no more nitrogen loss. Re-synthesis of muscle protein which result in increase in body weight. Reverse all metabolic changes in the catabolic phase.

Mosul university- College of dentistry-oral & maxillofacial surgery department

post-operative complications
1- Major complications. 2- Minor complications. 3- Other complications.

Mosul university- College of dentistry-oral & maxillofacial surgery department

Major complications
1- Pulmonary Complications: -inadequate respiration -atelectasis -pneumonia -pneuomothorax

Mosul university- College of dentistry-oral & maxillofacial surgery department

Major complications
2- Cardiovascular complications: -hypotension (ht) -dysarrythmia -myocardial infarction (MI) -deep venous thrombosis (DVT) & pulmonary embolism.

Mosul university- College of dentistry-oral & maxillofacial surgery department

Major complications
3- Central nervous system complications: -CNS -PNS -psychological

Mosul university- College of dentistry-oral & maxillofacial surgery department

Major complications
4- Abdominal complications: - hepatic (liver failure or hepatitis) - renal ( acute tubular necrosis acute renal failure )

Mosul university- College of dentistry-oral & maxillofacial surgery department

Major complications
5- Local complications: -hematoma (dt. poor hemostasis ) -thrombophlebitis ( from cannula )

Mosul university- College of dentistry-oral & maxillofacial surgery department

Minor complications
1- Nausea & vomiting. 2- Sore throat (intubation trauma, dryness of laryngeal mucosa). 3- Hoarseness of voice (prolonged pressure on vocal cords). 4- Laryngeal granuloma (pressure, irritation, ulceration)

Mosul university- College of dentistry-oral & maxillofacial surgery department

Minor complications
5- Head ache. 6- Trauma to teeth. 7- Ocular complications (corneal ulcer, blindness). 8- post-operative parotitis


Mosul university- College of dentistry-oral & maxillofacial surgery department
Other post-op. complications:
1- Wound dehiscence. 2- Wound infection. 3- Wound hemorrhage , hematoma, seroma.