lecture 12 stress and surgical nourishment. action of the inside of the body organ system on cause...
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Lecture 12Stress and surgical nourishment
Action of the inside of the body organ system on cause of causing stress ,that is, to stressor
物理的:外傷、火傷、手術
化学的:感染、中毒、無酸素
心理的:不安、緊張、怒り
Adrenal cortex
Hypothalamus
Pituitary
Cerebral limbic system
Adrenal medulla
Stressor
ACTH Secretion Noradrenalinesecretion
CRH secretion
Adrenaline and noradrenalinesecretion
Glucidic cortisol secretion
Automatic nervours systemImmunity
system
Discharge neurotransmitter and neuromodulator
A surgical operation is a typical stress. The correspondence method becomes the example of all stresses
Nitrogen receipts and disbursements after it operates
The tenth of the adrenocortical hormone decrease of → period the ninth of adrenal skin quality period the fourth → assimilation period > 10 days
Dissimilation protein
Removing the stitches
Absorption protein
Pro
tein
day
day
Yasuo KAGAWA. “Nourishment biochemistry” KAGAWA Nutrition publishing, 1970, p.263
gluconeogenesis
Anabolism
negative
positive
equilibrium Primary healing of operation wound
Fever after operation (up to 38c)
Relieving pain
Intestine activity
Op
era
tio
n
Surgical operation
It operates safely by using the operation monitor for the animal that can measure the density of oxygen and the temperature the ventricular rate, the electrocardiogram, the blood pressure, the number of breaths, the breath gas carbon dioxide concentration, the pulse, and in blood at the same time. The artificial respirator is attached to the anesthesia apparatus
It is possible to swim for as much as three days by giving the adrenocortical hormone though it will die in three hours when the rat is put in cold water.
As for the adrenocortical hormone, the serious case was called the new medicine of the miracle whose it was able to be vigor. The inflammation is suppressed.
However, it weakens, the diabetic and osteoporosis are caused easily, and it is harmful in infection when using it at a long term
Kidney
Hypothalami
Adrenalgland
Adrenal cortex Adrenocortical hormone Aldosterone Glucidic cortisol Androgen (male hormone)
Adrenal medullaAdrenal medullary hormoneAdrenaline (epinephrine)Noradrenaline (norepinephrine)
Fluid infusion and transfusiontreatment in intraoperative period
Abdomen general surgeryIntraoperative period
management
Coexisting illness and density of serum albumin
Serum albumin
Freq
uen
cy of C
oexistin
g illn
ess
Gullet
Pancreas
Figure 2
Contrast (Stomach, Colon)
Role of liver
Review of alimentary system
Protein Glucose
Am
ino
acid
Am
mo
nia
Oxy
gen
Uri
ne
Liver
Organization
Digestive tube
To
xic
sub
sta
nce
Lipid
Cholesterol
Fatty acidF
atty
ac
id
Blo
od
of s
ug
ar
Ala
nin
e
La
ctic
ac
id
he
pa
tic a
rtery
mo
no
sa
cc
ha
ride
gly
ce
rol
Glycogenic substance
Keto protist substance
bile
Ke
ton
e b
od
yPla
sm
a p
rote
in, lip
id
He
pa
tic v
ein
biliru
bin
kidney
ProcessingStoringTransportationBile secretion
Energy product
Detoxication
Portal vein
Yasuo KAGAWA. “Nourishment biochemistry” KAGAWA Nutrition publishing, 1970, p.286
Administering necessity amount according to stress
energy protein
kcal/kg/hr kcal/kg/d g/kg/d
Fundamen
tal
Rest
Light
Middle
Heavy
1 1.10
1.25
1.50
1.75
24
26
30
36
42
0.8
0.6-1.0
1.0
1.2
1.4If the amount of the basal metabolic rate of one hour per weight kg is seen,
one‘s twenties becomes the man and woman and 1kcal/kg/the hour Rest : Hospitalization, Light infectious disease Light : Damage, Middle level infectious disease Middle : Fractures, heavy infectious disease Heave : Burn, various stresses
Percutaneous endoscopic gastrostomy PEG
Source) PEG Doctor’s network
Stomach
Outer of the body
Walls of the abdomen
X rays X rays
Explanation
Explanation
MealFast Fast Fast
Blood test Blood test
Test
Test
DripDrip for 24 hoursDrip for 24 hours Drip for 24 hours
Day before operation
PEG (Hospitalization plan)
Electrocardiogram
Day of operationDay after operation
2 days afteroperation
Explanation when hospitalization
Start drip for 24Hours
Intradermal testing of antibiotic
Gauze exchangeOf PEG
Gauze exchangeOf PEG
Please askUncertin point
Explanation when hospitalization
From doctor
AgreementPlease take a stamp
We explain the methodOf PEG administration
begins the moisture injection on two days
after it operates
The keeping biliary damage is in the passing tube nourishment the digestive tube immunity function compared with the center vein nourishment and th
ere is not infection few either. PEG is widely done now
Cause of burn of serious illness(in-patient)
High temperatureliquid
Fire
High temperature solid
BombElectricity Chemical
(Data: Tokyo burn emergency liaison council assembly)
Structure of skin and level of burn
hair
Epidermal
Corium
Depth of burn
Hypodermis-subcutaneous
tissue
Sweatgland
Hair pus
Treatment of burn (by Doctor)
Prevention of cicatrice (pressure, internal medicine)
Covering with ointment and dressing (prevent of infection)
Body fluid replenishment in 10% or more of area of body surface with drip
Excising the pollution organization (Debridman)
After an enough washing, the wound of the burn is disinfected
It is an inhalation of oxygen, and an airway management in the burn of the respiratory tract and CO intoxication
Drug therapy : Antibiotic and tetanus inoculation to analgesic and polluted wound
It excises and three degrees are grafted to the burn at the early stage
Emergency measure of burn
The fire of clothes is put out (Burn due to a fire)
cooling by water at once. (Ice is unnecessary)
Hand, leg Head, face, whole body Eye, ear
It encompasses it with a clean towel etc. without treating anything.
And go to the hospital
Symptom that appears from the first stage of stress(order of frequency)
The head is not refreshing (The head is heavy)
not possible to get up pleasantly in the morning
Dreaming very often
Feel cold hands and legs often
Pain in the back and waist
Easy stiff shoulders
Easy tiring eyes
Orthostatic dizziness
Food often weighs heavy on the stomach
Investigation : psychosomatic medicine (Nihon University)
Symptom that appears in state of chronic stress(order of frequency)
The tongue becomes white
The favorite one doesn't think that it eats too much either
The working nature doesn't happen
It catches a cold well and it doesn't recover easily
Recently, weight has decreased
Tiredness cannot be taken easily
Meeting person became troublesome
When something is done, it becomes tired at once
It is not possible to go to sleep easily after it awakes at midnight
The belly puts, it hurts, and there are often diarrhea and constipation
It is angry with a few and seems to get irritated
It is sore and often gets rough in the mouth
Investigation : psychosomatic medicine (Nihon University)
Reaction by stress
Hypothalamus
Immune system
Sympathetic nervous system
An adrenaline secretion increase
Living body cell
Adrenalcortex
AutomaticNervous system
Internal secretion
system
Adrenalcortex
Stressor
Immunocompetent cell
anterior
pituitary gland
Vario
us sym
pto
ms o
f the w
ho
le bo
dy
(Stress d
isease)
Cortisol(corticosteroid )
secretion increase
Sympathetic nervous system
TensionFacilitation
Sickness that is often psychosomatic disease
Alimentary system
Respiratory system
Nervous system
Dermal system
Ophthalmologic field
Otorhinolaryngology area
Bone muscle system
Obstetrics and gynecology area
Internal secretionsystem
Urinary systerm
Circulatory organssystem
Asthenopia, Ptosis, blepharospasm
Bed-wetting, Impotence,Nervous pollakisuria
Dysmenorrhea syndrome, Perimenopausal symptom, Frigidity
Obesity, Diabetics, hyperthyroidism
bronchial asthma, hyperventilation syndrome
Meniere's disease, allergic rhinitis , tinnitus
Headache, Dizziness, Cold character, Chronic fatigue
essential hypertension, Low blood pressure, Angina, Arrhythmia
chronic rheumatism , writer's cramp
gastric ulcer , irritable bowel syndrome, ulcerative colitis
Neurodermatitis, Atopic dermatitis, Round alopecia, Essential hyperhidrosis
Appearance of disease of depression
Depression
StressCause of body, medicine
Inherited constitution
Weakness to stress
Upbringing
Multipronged understanding is necessary
Bereavement with parents of early days.
Cruelty. Disregard
Gene related to character such as serotonin dopamine
Potential cerebral infarction,
Medicine, Disease
Lose job, Overwork, Promotion, Death of
a familiar person, Moving, Divorce
Gene-environmental interaction
Number of events in full stress life
The appearance of disease rate of depression by the stress is different because of the individual variation of the serotonin transporter gene (character and relation)
Pro
ba
bil
ity
of
de
pre
ss
ion
a
pp
ea
ran
ce
of
dis
ea
se
Non crueltyPossibility
+ Heavy cruelty or more
Treatment method of stress symptom
Antianxiety medicine
Antidepressant medicine
Sleeping medicine
Autonomic adjustment medicine
Treatment medicine of physical illness etc.
Drug therapy Mental therapy
Counseling
Autonomous training therapy
Behavior therapy
etc
Invitation to self-destroyed lifeThe nutrition education of S/S type man thrown easily by the
waywardness is a large problem
1. Immoderate eating and drinking is borne in mind. (overweight is good thing)
2. It doesn't move so much. (Sitting is great position)3. It eats a lot of sweet one and the cakes. (Communicatio
n is also important)4. It eats a lot of animal fats. (epicure's honor)5. A lot of hoochs are drunk. (cannot defeat by alchol)6. I like cigarette smoke. (This dose is a salt of life)7. It eats a lot of salty foods. (It is good for the switch of al
cohol)8. I like staying up late. (It's my free time)9. I stick to small thing (I always complains and bully some
one)10. Attention "Quiet murderer" etc. of the checkup are disr
egarded. (I will know myself)「 Maihichi life 」 : 8, 1994 p.24