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Read e-book online Modern Surgical Care: Physiologic Foundations and Clinical PDF

By A. Miller Thomas

ISBN-10: 0824728696

ISBN-13: 9780824728694

Thoroughly up-to-date with contributions by way of international leaders in surgical procedure and the surgical procedure specialties, this reference assists surgeons within the prognosis and therapy of sufferers through contemplating illness as a derangement of ordinary body structure, hence permitting the medical professional to correlate the correct use of laboratory and radiologic modalities. prepared in accordance with particular organ structures, the e-book is definitely obtainable and displays the impression that clinical discoveries and technical advances have had on our knowing of the physiologic procedures in surgical sufferers.

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However, with the exception of glutamate dehydrogenase, these enzymes do not appear to exert a major physiologic role in humans (50,52). Three amino acids, serine, threonine, and histidine, are primarily deaminated nonoxidatively (Fig. 10) (47). The former two amino acids undergo nonoxidative deamination by dehydration, whereas histidine undergoes direct deamination. The non–a-amino groups of glutamine and asparagine are removed by hydrolytic deamination (47). Free ammonia, even in small concentrations, is poorly tolerated by cells.

Infection may further stimulate neuroendocrine reflexes through a direct action of endotoxin on the hypothalamus (70) or through secondary changes in blood volume, oxygen concentration, substrate concentrations, and pain. The primary substrate alterations that activate the neuroendocrine system are those induced by changes in the plasma glucose concentration. Plasma glucose alterations are sensed by receptors in the hypothalamus and the pancreas. A decrease in plasma glucose concentration stimulates the release of catecholamines, cortisol, growth hormone, and vasopressin through central mechanisms and stimulates the release of glucagon both by central pathways (autonomic nervous system) and peripheral pathways (direct pancreatic activation) (71).

However, a drop in blood flow increases the oxygen extraction by the chemoreceptor tissue, decreases the venous PO2, and through an unknown mechanism, activates the chemoreceptor (67). Consequently, a decrease in circulating volume or pressure not only inhibits baroreceptors and stretch receptors, but also activates chemoreceptors. Pain and emotion also activate the neuroendocrine system. The former acts through the projections of peripheral nociceptive receptors to the CNS, and the latter acts through projections from the limbic areas of the brain to the hypothalamus and lower brain stem nuclei (68).

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Modern Surgical Care: Physiologic Foundations and Clinical Applications (Two-Volume Set) by A. Miller Thomas


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