1. Body Response to Trauma
Dr. Hassan Bukhari
Depart of Surgery
Sept. 18, 2011

2. Objectives By the end of this discussion, you will be able to:
Define Stress (body) response to trauma
Identify different types of response to trauma
Recognize the manifestation of stress response
Apply your understanding of this response in patient’s care

3. Contents MCQ / scenarios – based lecture
Definition of stress (body) response to trauma
Types of systemic response to trauma
Sympathetic
Hormonal / metabolic
Immunological

4. Body (stress) response
Defined as a group of hormonal, metabolic and immunological changes following injury or trauma

5. Systemic response* Sympathetic nervous system activation Hormonal
Pituitary hormones secretion
Insulin resistance
Immunological
Cytokines production
Acute phase response
Neutrophil leukocytosis
Lymphocyte prolifiration
*Br J Anaesth 2000.

6. Hypothalamic –Pituitary adrenal (HPA) system

8. MCQ # 1
Secretion of all the following hormones will increase following trauma EXCEPT:
1- Cortisol
2- Vassopressin (VP)
3- Glucagon
4- Insulin
5- Growth Hormone (GH)
6- Aldosterone
7- Prolactin ✓

9. Hormonal / Metabolic response
The endpoint effect of this response is
Catabolism  provide energy
Protein break down (late)
Lipolysis
Inhibit glucose uptake by cells
Retaining of water and salt  maintain fluid volume and CV stability.

10. Pituitary gland hormones?
Origin
Level
ACTH
Ant Pituitary  GH ~~
Prolactin
TSH, LH 
Vasopressin
Post pituitary

11. Adrenal gland hormones?
Origin
Level
Cortisol
Cortex 
Aldosterone ~~
Epinephrine
Medulla
Norepinephrine

12. Other hormones Hormones Origin Level Insulin Pancreas  Glucagon 
Thyroxin
Thyroid

13. MCQ # 2
All are the endpoints of hormonal secretion following trauma EXCEPT:
1- Glycogenolysis
2- Gluconeogenesis
3- Hypoglycemia
4- Proteinolysis
5- Lipolysis ✓

14. Systemic response* Sympathetic nervous system activation Hormonal
Immunological
Cytokines production
Acute phase reaction
Neutrophil leukocytosis
Lymphocyte prolifiration
*Br J Anaesth 2000.

15. Immunological Response
Cell-Mediated response
Macrophages will release cytokines
Cytokines
Are Proteins (Interleukins and interferons)
Major role in local and systemic effects
Promotes acute phase response

17. MCQ # 3 What is true and false about cytokines following trauma?
1- IL-1, IL-6 and TNF-α are the most important cytokines
2- They are released from lymphocytes
3- TNF-α is the main cytokines responsible for acute phase response
4- IL-1 and IL-6 reduce cortisol secretion
5- The level of C-reactive protein (CRP) and fibrinogen is increased
6- The Level albumin and transferrin is increased ✓ ✗ ✗ ✗ ✓ ✗

18. Two important Syndromes
Systemic inflammatory response syndrome (SIRS)
Inflammatory mediators
Compensatory anti-inflammatory response syndrome (CARS)
Anti-inflammatory mediators
SIRS
CARS

19. SIRS
Defined as generalized inflammatory response triggered by infectious and noninfectious events.
Clinical manifestation (at least 2 out of 4)
HR >90
RR > 20
Temp > 38°C or <36°C
WBC >12,000 or < 4000.
This syndrome is opposed by CARS

20. SIRS vs. CARS

21. MCQ # 4
All are clinical manifestation of body response to trauma EXCEPT:
1- Tachycardia
2- Fever
3- Tachypnea
4- vasodilatation
5- leukocytosis ✓

22. Immunological Response

23. Any Question

24. In Summary Definition of stress (body) response to trauma
Types of systemic response to trauma and its effects
Sympathetic
Hormonal / metabolic
Immunological
Clinical manifestation
SIRS vs. CARS

25. References
Desborough JP. The Stress Response to Trauma and Surgery. Br J Anaesth 2000, 85:
Asensio JA, Trunkey D. Current Therapy of Trauma and Surgical Critical Care. Philadilphia: Mosby-Elsevier,2008