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Lecture 12 Stress and surgical nourishment 物理的:外傷、 火傷、手術 Stressor Action of the inside of the body organ system on cause of causing stress ,that is, to stressor Cerebral limbic system Discharge neurotransmitter and neuromodulator 化学的:感染、 中毒、無酸素 心理的:不安、 緊張、怒り Hypothalamus CRH secretion Pituitary ACTH Secretion Adrenal cortex Glucidic cortisol secretion Immunity system Automatic nervours system Noradrenaline secretion Adrenal medulla Adrenaline and noradrenaline secretion A surgical operation is a typical stress. The correspondence method becomes the example of all stresses Absorption protein Operation Protein Nitrogen receipts and disbursemen ts after it operates Fever after operation (up to 38c) Relieving pain equilibrium Primary healing of operation wound Intestine activity positive Removing the stitches 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 > 10 days Yasuo KAGAWA. “Nourishment biochemistry” KAGAWA Nutrition publishing, 1970, p.263 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 Adrenal cortex 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 Hypothalami Adrenocortical hormone Aldosterone Glucidic cortisol Androgen (male hormone) Adrenal medulla Adrenal gland Kidney Adrenal medullary hormone Adrenaline (epinephrine) Noradrenaline (norepinephrine) Fluid infusion and transfusion treatment in intraoperative period Abdomen general surgery Intraoperative period management Figure 2 Coexisting illness and density of serum albumin Frequency of Coexisting illness Contrast (Stomach, Colon) Gullet Pancreas Serum albumin Organization Fatty acid glycerol Amino acid Protein Lipid Oxygen bilirubin Ammonia Cholesterol bile Toxic substance Detoxi cation Keto protist substance hepatic artery Energy product monosaccharide Urine Lactic acid Glycogenic substance Portal vein kidney Alanine Ketone body Blood of sugar Plasma protein, lipid Review of alimentary system Hepatic vein Role of liver Liver Processing Storing Transportation Bile secretion Glucose Digestive tube 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 1 24 0.8 Rest 1.10 26 0.6-1.0 Light 1.25 30 1.0 Middle 1.50 36 1.2 Heavy 1.75 42 1.4 Fundamental If 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 Stomach Outer of the body Walls of the abdomen Source)PEG Doctor’s network PEG (Hospitalization plan) 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 Day before operation Explanation Explanation Test Test Drip Day of operation Day after operation Explanation when Agreement hospitalization Please take a stamp From doctor We explain the method Of PEG administration Please ask Uncertin point Explanation when hospitalization X rays Electrocardiogram X rays Blood test Blood test Start drip for 24 Intradermal testing Drip for 24 hoursDrip for 24 hours Drip for 24 hours of antibiotic Hours Gauze exchange Of PEG Meal 2 days after operation Fast Fast Fast Gauze exchange Of PEG begins the moisture injection on two days after it operates Cause of burn of serious illness (in-patient) Bomb Electricity Chemical High temperature solid High temperature liquid Fire (Data: Tokyo burn emergency liaison council assembly) Structure of skin and level of burn hair Depth of burn Epidermal Corium Sweat gland Hair pus Hypodermissubcutaneous tissue 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) 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) 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) 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) Reaction by stress Adrenal cortex Internal secretion system Hypothalamus (corticosteroid ) secretion increase Sympathetic nervous system Sympathetic nervous system Automatic Nervous system Cortisol Tension Facilitation Adrenal cortex An adrenaline secretion increase Immune system Immunocompetent cell Living body cell Various symptoms of the whole body (Stress disease) Stressor anterior pituitary gland 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 Nervous system Obesity, Diabetics, hyperthyroidism 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 Otorhinolaryngology area Ophthalmologic field chronic rheumatism , writer's cramp Meniere's disease, allergic rhinitis , tinnitus Asthenopia, Ptosis, blepharospasm Appearance of disease of depression Inherited constitution Gene related to character such as serotonin dopamine Upbringing Potential cerebral infarction, Medicine, Disease Weakness to stress Cause of body, medicine Bereavement with parents of early days. Cruelty. Disregard Stress Depression Multipronged understanding is necessary Lose job, Overwork, Promotion, Death of a familiar person, Moving, Divorce Probability of depression appearance of disease Gene-environmental interaction or more Non cruelty Possibility + 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) Treatment method of stress symptom Drug therapy Antianxiety medicine Antidepressant medicine Mental therapy Counseling Sleeping medicine Autonomous training therapy Autonomic adjustment medicine Behavior therapy Treatment medicine of physical illness etc etc. 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