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