THE EFFECTS OF SURGERY

METABOLISM AND NUTRITIONAL CONSIDERATIONS IN SURGICAL PATIENTS

1. METABOLISM

1.1 Surgical disorders, and surgical interventions, alter the
Internal environment of the patients, and the significant factors are :

* Nutritional deficiency due to the disorder, or the post-operative
starvation
* Metabolic effects of surgical intervention trauma, during, and after the procedure
* Metabolic effects, of physical trauma, in injuries and accidents
* Metabolic effects on cells, and tissues, due to bacterial
invasions in inflammatory disorders
* Tumour burden effects, of uncontroled cell multiplication, and spread
in cancer patients
The main stimulus, responsible for endocrine response, is pain, from the site of
Injury, or disease up along the spino-thalamic tract.
These messages are received in the brain stem, thalamus, and cortex.
The centers in the hypothalamus activate the sympathetic
nervous system and the pituitary. This results in raising serum
levels of :

* Cortisol
* Epinephrine
* Nor-epinephrine
* Aldersterone
* ADH
* Glucagons

1.2 A controlled injury received in surgical interventions is limited.
In cases of trauma, the factors of extent, and severity of injury are
Are variable, the injury occurs outside the hospital, and in many instances severity of injury can only be calculated, from the number of limbs, organs and
body cavities involved.
It has been noted that, the metabolic response, and endocrine response are related to the severity of the injury and in many instances these response may be many times more than the responce caused by a planned surgical interventions.
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