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Lecture 12 Stress and surgical nourishment

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Title: Lecture 12 Stress and surgical nourishment


1
Lecture 12 Stress and surgical nourishment
2
Action of the inside of the body organ system on
cause of causing stress ,that is, to stressor
??????????? ???????????? ???????????
Stressor
Cerebral limbic system
Discharge neurotransmitter and neuromodulator
Hypothalamus
CRH secretion
Pituitary
Automatic nervours system
Immunity system
ACTH Secretion
Noradrenaline secretion
Adrenal cortex
Adrenal medulla
Glucidic cortisol secretion
Adrenaline and noradrenaline secretion
3
A surgical operation is a typical stress. The
correspondence method becomes the example of all
stresses
4
Absorption protein
Fever after operation (up to 38c)
Nitrogen receipts and disbursements after it
operates
equilibrium
Primary healing of operation wound
Relieving pain
Operation
positive
Intestine activity
Removing the stitches
Protein
Anabolism
gluconeogenesis
day
negative
Dissimilation protein
day
The tenth of the adrenocortical hormone decrease
of ? period the ninth of adrenal skin quality
period the fourth ? assimilation period gt 10 days
Yasuo KAGAWA. Nourishment biochemistry KAGAWA
Nutrition publishing, 1970, p.263
5
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
6
Adrenal cortex Adrenocortical hormone
Aldosterone Glucidic cortisol Androgen
(male hormone)
Hypothalami
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
Adrenal medulla Adrenal medullary
hormone Adrenaline (epinephrine) Noradrenaline
(norepinephrine)
Adrenal gland
Kidney
7
Abdomen general surgery Intraoperative period
management
Fluid infusion and transfusion treatment in
intraoperative period
8
Coexisting illness and density of serum albumin
Figure 2
Frequency of Coexisting illness
Contrast (Stomach, Colon)
Gullet
Pancreas
Serum albumin
9
Organization
Blood of sugar
Ketone body
Processing Storing Transportation Bile secretion
Alanine
Lactic acid
Liver
Glycogenic substance
Role of liver Review of alimentary system
Plasma protein, lipid
Energy product
Oxygen
Hepatic vein
hepatic artery
Keto protist substance
Detoxi cation
Cholesterol
Ammonia
Urine
bilirubin
Toxic substance
Portal vein
bile
glycerol
monosaccharide
Fatty acid
Fatty acid
Amino acid
Protein
Glucose
Lipid
kidney
Digestive tube
Yasuo KAGAWA. Nourishment biochemistry KAGAWA
Nutrition publishing, 1970, p.286
10
Administering necessity amount according to stress
energy energy protein
kcal/kg/hr kcal/kg/d g/kg/d
Fundamental 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 1.4
If the amount of the basal metabolic rate of one
hour per weight kg is seen, ones 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
11
Percutaneous endoscopic gastrostomy PEG
Stomach
Outer of the body
Walls of the abdomen
Source)PEG Doctors network
12
The keeping biliary damage is in the passing tube
nourishment the digestive tube immunity function
compared with the center vein nourishment and
there is not infection few either. PEG is widely
done now
PEG (Hospitalization plan)
Day before operation
Day of operation
Day after operation
2 days after operation
Explanation
Agreement Please take a stamp
We explain the method Of PEG administration
Explanation when hospitalization From doctor
Explanation
Explanation when hospitalization
Please ask Uncertin point
Test
X rays
X rays
Electrocardiogram
Test
Blood test
Blood test
Drip
Drip for 24 hours
Drip for 24 hours
Intradermal testing of antibiotic
Drip for 24 hours
Start drip for 24 Hours
Gauze exchange Of PEG
Gauze exchange Of PEG
Meal
Fast
Fast
Fast
begins the moisture injection on two days after
it operates
13
Cause of burn of serious illness (in-patient)
Electricity
Chemical
Bomb
High temperature solid
High temperature liquid
Fire
(Data Tokyo burn emergency liaison council
assembly)
14
Structure of skin and level of burn
hair
Depth of burn
Epidermal
Corium
Sweat gland
Hair pus
Hypodermis- subcutaneous tissue
15
Treatment of burn (by Doctor)
It is an inhalation of oxygen, and an airway
management in the burn of the respiratory tract
and CO intoxication
Body fluid replenishment in 10 or more of area
of body surface with drip
After an enough washing, the wound of the burn is
disinfected
Excising the pollution organization (Debridman)
Covering with ointment and dressing (prevent of
infection)
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
Prevention of cicatrice (pressure, internal
medicine)
16
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
17
Symptom that appears from the first stage of
stress (order of frequency)
Easy tiring eyes
Easy stiff shoulders
Pain in the back and waist
not possible to get up pleasantly in the morning
The head is not refreshing (The head is heavy)
Orthostatic dizziness
Dreaming very often
Feel cold hands and legs often
Food often weighs heavy on the stomach
Investigation psychosomatic medicine (Nihon
University)
18
Symptom that appears in state of chronic
stress (order of frequency)
Tiredness cannot be taken easily
When something is done, it becomes tired at once
The belly puts, it hurts, and there are often
diarrhea and constipation
It is angry with a few and seems to get irritated
Meeting person became troublesome
The working nature doesn't happen
It is sore and often gets rough in the mouth
It catches a cold well and it doesn't recover
easily
The tongue becomes white
Recently, weight has decreased
It is not possible to go to sleep easily after it
awakes at midnight
The favorite one doesn't think that it eats too
much either
Investigation psychosomatic medicine (Nihon
University)
19
Reaction by stress
Adrenal cortex
anterior pituitary gland
Cortisol (corticosteroid ) secretion increase
Stressor
Internal secretion system
Hypothalamus
Sympathetic nervous system Tension Facilitation
Sympathetic nervous system
Various symptoms of the whole body (Stress
disease)
Automatic Nervous system
An adrenaline secretion increase
Adrenal cortex
Immune system
Living body cell
Immunocompetent cell
20
Sickness that is often psychosomatic disease
Alimentary system
gastric ulcer , irritable bowel syndrome,
ulcerative colitis
Circulatory organs system
essential hypertension, Low blood pressure,
Angina, Arrhythmia
Respiratory system
bronchial asthma, hyperventilation syndrome
Urinary systerm
Bed-wetting, Impotence,Nervous pollakisuria
Internal secretion system
Obesity, Diabetics, hyperthyroidism
Nervous system
Headache, Dizziness, Cold character, Chronic
fatigue
Obstetrics and gynecology area
Dysmenorrhea syndrome, Perimenopausal symptom,
Frigidity
Dermal system
Neurodermatitis, Atopic dermatitis, Round
alopecia, Essential hyperhidrosis
Bone muscle system
chronic rheumatism , writer's cramp
Otorhinolaryngology area
Meniere's disease, allergic rhinitis , tinnitus
Ophthalmologic field
Asthenopia, Ptosis, blepharospasm
21
Appearance of disease of depression
Gene related to character such as serotonin
dopamine
Inherited constitution
Upbringing
Weakness to stress
Potential cerebral infarction, Medicine, Disease
Bereavement with parents of early days. Cruelty.
Disregard
Stress
Cause of body, medicine
Lose job, Overwork, Promotion, Death of a
familiar person, Moving, Divorce
Depression
Multipronged understanding is necessary
22
Gene-environmental interaction
Probability of depression appearance of disease
Possibility
or more
Non cruelty
Heavy cruelty
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)
23
Treatment method of stress symptom
Drug therapy
Mental therapy
Antianxiety medicine Antidepressant
medicine Sleeping medicine Autonomic adjustment
medicine Treatment medicine of physical
illness etc.
Counseling Autonomous training
therapy Behavior therapy etc
24
Invitation to self-destroyed life The 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.
    (Communication 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 alcohol)
  • 8. I like staying up late. (It's my free time)
  • 9. I stick to small thing (I always complains and
    bully someone)
  • 10. Attention "Quiet murderer" etc. of the
    checkup are disregarded. (I will know myself)

?Maihichi life? 8, 1994 p.24
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