Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PICS)
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Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PICS)

Learn about Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PICS) which is characterized by extended ICU stays, complicated post-discharge courses, and failure to recover to preinjury status. Understand how it is linked to persistent inflammation and suppressed immunity, impacting severely injured patients.

Created by
@Ceegee

Questions and Answers

What is the purpose of the pro-inflammatory phase in systemic inflammatory response syndrome?

To restore tissue function and eradicate invading microorganisms

What is the role of Compensatory anti-inflammatory response syndrome (CARS) in the body?

To prevent excessive pro-inflammatory activities and restore homeostasis

What is sepsis characterized by?

Life-threatening organ dysfunction due to dysregulated response to infection

In uncomplicated trauma patients with systemic inflammatory response, what kind of response is observed?

<p>Balanced pro and anti-inflammatory mediators</p> Signup and view all the answers

What are PAMPS in the context of systemic inflammation following trauma?

<p>Pathogen Associated Molecular Patterns</p> Signup and view all the answers

What is the main purpose of the inflammatory response to injury?

<p>To eradicate invading microorganisms and restore tissue function</p> Signup and view all the answers

In the context of injuries, what can an overwhelming inflammatory response lead to?

<p>Multiple organ failure</p> Signup and view all the answers

Which proteins are classified as DAMPs (Damage-Associated Molecular Patterns)?

<p>HMGB1 Protein and S100 Proteins</p> Signup and view all the answers

What are the two phases of the Systemic Response to Injury according to the text?

<p>SIRS and CARS</p> Signup and view all the answers

How does an overwhelming inflammatory response impact patient survival in case of major insults?

<p>It increases the risk of multiple organ failure</p> Signup and view all the answers

What is implicated as the cause of multiple organ failure in patients with severe trauma?

<p>Systemic inflammatory response</p> Signup and view all the answers

What increases the risk of infectious complications and poor outcomes in patients experiencing traumatic injury?

<p>Immune suppression</p> Signup and view all the answers

What happens if an infection is left untreated in a patient with a confirmed or suspected infection?

<p>Organ failure and death</p> Signup and view all the answers

Which response is involved in reducing the harmful effects of the proinflammatory response after trauma?

<p>Anti-inflammatory response</p> Signup and view all the answers

What is activated by traumatic injury and leads to a systemic inflammatory response?

<p>Innate immune system</p> Signup and view all the answers

What are the clinical features of the injury-mediated Systemic Inflammatory Response (SIR) mentioned in the text?

<p>Increased body temperature, heart rate, respirations, and white blood cell count</p> Signup and view all the answers

Which of the following molecules are considered Damage Associated Molecular Patterns (DAMPs) according to the text?

<p>Endogenous ligands released passively from healthy cells</p> Signup and view all the answers

What is the relationship between the degree of the Systemic Inflammatory Response (SIR) and injury severity?

<p>The SIR is directly proportional to injury severity</p> Signup and view all the answers

Which protein is highlighted as the best characterized Damage Associated Molecular Pattern (DAMP) in the text?

<p>High Mobility Group Box 1 Protein (HMGB1)</p> Signup and view all the answers

What is the purpose of the systemic inflammatory response following trauma according to the text?

<p>To optimize the healing potential of an organism</p> Signup and view all the answers

What is the common denominator among the survivors of severely injured patients, according to the text?

<p>Suppressed host protective immunity</p> Signup and view all the answers

Which phase is necessary for a normal recovery after injury, according to the text?

<p>Systemic inflammation followed by a return to homeostasis</p> Signup and view all the answers

What is the main characteristic of Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PICS)?

<p>Failure to regain/recover to preinjury status</p> Signup and view all the answers

What can an excessive counter regulatory anti-inflammatory response syndrome following a lesser inflammatory response lead to, as mentioned in the text?

<p>Prolonged immunosuppressed state</p> Signup and view all the answers

In the context of trauma and injury, what is the convalescence period mediated by?

<p>Counter regulatory anti-inflammatory response syndrome</p> Signup and view all the answers

What is the primary cause of mortality and morbidity for individuals under the age of 45?

<p>Trauma</p> Signup and view all the answers

Which molecules serve as danger queues to the immune system, distinguishing unhealthy cells from healthy ones?

<p>DAMPs</p> Signup and view all the answers

In the context of infections, what do PAMPs stand for?

<p>Pathogen Associated Molecular Patterns</p> Signup and view all the answers

What is one of the key functions of the immune system in relation to infections?

<p>Limit infection through immune responses</p> Signup and view all the answers

What is the consequence of a minor insult to the host in terms of inflammation response?

<p>Localized inflammatory response that is transient</p> Signup and view all the answers

What is the main purpose of acute inflammation in response to injury?

<p>To initiate the healing process and remove harmful stimuli</p> Signup and view all the answers

What is the duration of symptoms typically associated with Acute Inflammation?

<p>Few days</p> Signup and view all the answers

Which type of injury can lead to the onset of Chronic Inflammation according to the text?

<p>Insidious damage</p> Signup and view all the answers

What is the primary role of Mast cells in the inflammatory response to injury?

<p>Mediate vasodilation and vascular constriction</p> Signup and view all the answers

In the context of systemic inflammation, what do Platelets do when bacteria and pathogens enter a wound?

<p>Secrete blood-clotting proteins at the site</p> Signup and view all the answers

Which of the following is NOT an example of Acute Inflammation according to the text?

<p>Chronic Kidney Disease (CKD)</p> Signup and view all the answers

What is the trigger for Mast cells to secrete factors that mediate vasodilation and vascular constriction?

<p>Presence of bacteria and pathogens in the wound</p> Signup and view all the answers

How does Chronic Inflammation differ from Acute Inflammation in terms of duration?

<p>Chronic Inflammation can persist for months to years</p> Signup and view all the answers

Which protein acts as the key 'sensing' component of the NLRP3 inflammasome complex?

<p>HMGB1 Protein</p> Signup and view all the answers

What is the main characteristic of RAGE (Receptor for Advanced Glycation End-products) mentioned in the text?

<p>Highly expressed in lung tissue only</p> Signup and view all the answers

Which molecules are classified as Damage-Associated Molecular Patterns (DAMPs) according to the text?

<p>Heat Shock Proteins</p> Signup and view all the answers

What is the primary role of PRRs (Pattern Recognition Receptors) in the context of innate immune activation?

<p>Sense endogenous DAMPs and exogenous PAMPs</p> Signup and view all the answers

Which receptor is highly expressed in leukocytes and functions as a transmembrane receptor for advanced glycation end-products?

<p>RAGE</p> Signup and view all the answers

Which family of receptors is important for sensing damaged cells and cell debris through DAMPs or PAMPs as ligands?

<p>NLR</p> Signup and view all the answers

What is the first human Toll-like Receptor (TLR) identified in the text?

<p>TLR4</p> Signup and view all the answers

Which protein serves as a Damage-Associated Molecular Pattern (DAMP) according to the text?

<p>HMGB1 Protein</p> Signup and view all the answers

What is the function of S100 proteins according to the text?

<p>Promote apoptosis and autophagy</p> Signup and view all the answers

What role does Mitochondrial DNA play in the activation of the immune system?

<p>Leads to inflammasome and STING activation</p> Signup and view all the answers

Which receptor is involved in sterile inflammation activation in addition to microbial infection response?

<p>RAGE</p> Signup and view all the answers

Which process is triggered by CIRP (Cold Inducible RNA-binding Protein) acting as a DAMP?

<p>Activation of the complement system</p> Signup and view all the answers

What is the main function of STING (Stimulator of Interferon Gene Pathway) in the cellular response?

<p>Associated with endoplasmic reticulum signaling</p> Signup and view all the answers

In what way do formyl peptides from dysfunctional mitochondria contribute to inflammation?

<p>Trigger proinflammatory cytokine release</p> Signup and view all the answers

Which cellular components are potent activators of inflammatory pathways according to the text?

<p>T cells, macrophages, and dendritic cells</p> Signup and view all the answers

What is the role of biglycan in the immune response according to the text?

<p>Activates the intracellular inflammasomes</p> Signup and view all the answers

How are proteoglycans related to the inflammatory response mentioned in the text?

<p>They are downstream effectors of TLR signaling</p> Signup and view all the answers

Which proteins passively participate in the regulation of intracellular calcium when released from damaged cells?

<p>S100 Proteins</p> Signup and view all the answers

What is the unique feature of S100 Proteins in terms of cellular response after trauma?

<p>Regulate calcium levels</p> Signup and view all the answers

How do extracellular matrix molecules contribute to inflammation according to the text?

<p>Activate inflammasomes</p> Signup and view all the answers

Which molecule is composed only of the extracellular domain and can bind to and sequester RAGE ligands without signaling events?

<p>sRAGE</p> Signup and view all the answers

What is the best-described type of Pentraxin among the Soluble Pattern Recognition Molecules (sPRM)?

<p>Serum amyloid protein (SAP)</p> Signup and view all the answers

Which group of molecules is synthesized at sites of injury & inflammation by macrophages & dendritic cells according to the text?

<p>Pentraxins</p> Signup and view all the answers

What type of molecules have a conserved mode of action defined by complement activation, agglutination, neutralization, and opsonization?

<p>Pentraxins</p> Signup and view all the answers

Which receptor expressed on multiple cell types implicated in the immune inflammatory response and atherosclerosis is described in the text?

<p>RAGE</p> Signup and view all the answers

What is the primary role of Heat Shock Proteins during times of inflammation and oxidative stress?

<p>Function as molecular chaperones for proper protein folding</p> Signup and view all the answers

Which pathway is responsible for releasing Heat Shock Proteins from intact cells?

<p>Secretory lysosomes pathway</p> Signup and view all the answers

What is the main function of Heat Shock Proteins once they are outside the cell?

<p>Bind to pattern-recognition receptors to modulate the inflammatory response</p> Signup and view all the answers

Which characteristic distinguishes the Complement System among other proteins in blood serum?

<p>Accounting for 10% of globulin fraction</p> Signup and view all the answers

What is the primary role of Mitochondrial DAMPs in alerting the immune system?

<p>Signal tissue damage to activate immunity</p> Signup and view all the answers

What is the primary function of Damage Associated Molecular Patterns (DAMPs) according to the text?

<p>Activate specific cell receptors intracellularly</p> Signup and view all the answers

Which molecule is specifically mentioned as being structurally diverse and immunologically active among DAMPs in the text?

<p>Fatty Acids</p> Signup and view all the answers

What is the main significance of HMGB1 Protein in the context of trauma and inflammation?

<p>Serves as a marker for future organ dysfunction</p> Signup and view all the answers

How do Extracellular Matrix Molecules contribute to the systemic inflammatory response following trauma?

<p>Promote tissue repair and healing</p> Signup and view all the answers

Which family of receptors is important for recognizing damaged cells through DAMPs or PAMPs in the body's immune response?

<p>Pattern Recognition Receptors (PRRs)</p> Signup and view all the answers

What is a key difference between NLRs and TLRs in recognizing inducers of the inflammatory response?

<p>NLRs sense intracellular threats, while TLRs sense extracellular threats</p> Signup and view all the answers

'RAGE' stands for 'Receptor for Advanced Glycation End-products.' What is a key role of RAGE in the inflammatory response according to the text?

<p>Activates pro-inflammatory pathways</p> Signup and view all the answers

'S100 Proteins' are mentioned in the text. What is their specific contribution to immune responses?

<p>'Sensing' damaged cells and cell debris through PRRs</p> Signup and view all the answers

'Mitochondrial DAMPs' are discussed in the context of the text. How do these molecules contribute to inflammation?

<p>'Mitochondrial DAMPs' activate pro-inflammatory pathways</p> Signup and view all the answers

What is one of the main roles of Pattern Recognition Receptors (PRRs) in the context of immunity and inflammation following trauma?

<p>Sensing danger signals from damaged cells or pathogens</p> Signup and view all the answers

What is the primary role of acetylcholine secreted from preganglionic sympathetic fibers innervating the adrenal medulla?

<p>Triggers the 'fight or flight' response</p> Signup and view all the answers

What effect does hyperglycemia and decreased insulin release have following the activation of the sympathetic nervous system?

<p>Stimulation of α-adrenergic receptors</p> Signup and view all the answers

Which of the following statements regarding catecholamines is correct based on the text?

<p>Enhance TNF-α production</p> Signup and view all the answers

In the context of the inflammatory response to injury, what is one of the effects of overproduction of proinflammatory mediators?

<p>End organ failure</p> Signup and view all the answers

What stimulates the endocrine response to injury by triggering afferent nerve stimuli after an injury?

<p>Pain, anxiety, and injury</p> Signup and view all the answers

What is the primary role of the Adrenal Medulla in the context of the systemic response to injury?

<p>Releasing epinephrine to support the sympathetic nervous system response</p> Signup and view all the answers

Which of the following hormones is most directly involved in the CNS regulation of inflammation in response to injury?

<p>Histamine</p> Signup and view all the answers

In the H-P-A Axis, what is the primary function of CRH (Corticotropin-Releasing Hormone)?

<p>Initiating the release of ACTH (Adrenocorticotropic Hormone) from the pituitary gland</p> Signup and view all the answers

What is the main function of ACTH (Adrenocorticotropic Hormone) in the context of systemic response to injury?

<p>Triggering cortisol production from the adrenal cortex</p> Signup and view all the answers

How does the Sympathetic Nervous System contribute to the systemic response to injury?

<p>Activating the fight-or-flight response through epinephrine release</p> Signup and view all the answers

What is the role of heat shock proteins (HSP) in regulating the glucocorticoid receptor?

<p>Maintaining the receptor in the cytosol until ligand binding</p> Signup and view all the answers

Which hormone is released by the anterior pituitary gland in response to stress-induced protein regulation?

<p>Vasopressin</p> Signup and view all the answers

What is a key feature of adrenal insufficiency?

<p>Atrophic adrenal glands due to exogenous steroid administration</p> Signup and view all the answers

How does cortisol exert its anti-inflammatory effects on proinflammatory gene transcription?

<p>By inhibiting TLR ligation</p> Signup and view all the answers

In what cellular location is the glucocorticoid receptor sequestered before ligand binding?

<p>Cytosol</p> Signup and view all the answers

Which neurotransmitter is the primary one of the parasympathetic system as mentioned in the text?

<p>Acetylcholine</p> Signup and view all the answers

What signaling occurs in response to inflammation that involves the Hypothalamic-Pituitary-Adrenal axis?

<p>Release of glucocorticoids</p> Signup and view all the answers

Which component of the Central Nervous System feeds back to the periphery to regulate inflammatory signaling events?

<p>Hypothalamus</p> Signup and view all the answers

What is one of the main responses triggered by vagal stimulation in the context of inflammation regulation as per the text?

<p>Constricts pupils</p> Signup and view all the answers

Which system releases catecholamines in response to injury according to the text?

<p>Sympathetic Nervous System</p> Signup and view all the answers

Which substance is NOT directly reduced by cholinergic stimulation in tissue macrophages?

<p>Interleukin IL-10</p> Signup and view all the answers

What behavioral changes are associated with CNS inflammatory stimuli mentioned in the text?

<p>Reduced appetite</p> Signup and view all the answers

Which part of the brain produces vagal nerve impulses that modulate cells in the brain stem for parasympathetic activity?

<p>Dorsal motor nucleus [CN X]</p> Signup and view all the answers

What complex signaling system enhances immune defense and rapidly mobilizes substrates in response to traumatic injury?

<p>Hypothalamic-Pituitary-Adrenal Axis</p> Signup and view all the answers

Which neural fibers provide direct input to trigger CRH release by interconnecting with neurons projecting to the hypothalamus?

<p>Afferent vagal fibers</p> Signup and view all the answers

What is the primary role of epinephrine (EPI) in the body following severe injury?

<p>Increases lipolysis in adipose tissues</p> Signup and view all the answers

How does the activation of the adrenergic system contribute to the hypermetabolic state observed following severe injury?

<p>By increasing NE and E secretion and promoting metabolic processes like gluconeogenesis</p> Signup and view all the answers

What effect does epinephrine have on insulin resistance in skeletal muscles?

<p>Induces insulin resistance</p> Signup and view all the answers

In what way does epinephrine influence glucagon and insulin secretion following a traumatic injury?

<p>Decreases glucagon levels and promotes insulin release</p> Signup and view all the answers

How does adrenaline contribute to the metabolic response in adipose tissues during severe injury?

<p>Increases lipolysis</p> Signup and view all the answers

Which hormone acts on the anterior pituitary to stimulate the secretion of ACTH?

<p>CRH</p> Signup and view all the answers

What is the primary function of ACTH in response to injury?

<p>Synthesizing glucocorticoids</p> Signup and view all the answers

Which of the following hormones contributes to cortisol release in the injured patient?

<p>Vasoactive intestinal peptide</p> Signup and view all the answers

What is the major glucocorticoid essential for survival during significant physiologic stress in humans?

<p>Cortisol</p> Signup and view all the answers

In the H-P-A Axis, what does CRH stand for?

<p>Corticotrophin-Releasing Hormone</p> Signup and view all the answers

Which part of the adrenal glands does ACTH act on to synthesize and secrete glucocorticoids?

<p>Zona Fasciculata</p> Signup and view all the answers

What is the primary role of cytokines in the inflammatory response according to the text?

<p>Facilitating immunocyte proliferation</p> Signup and view all the answers

In the context of trauma and sepsis, what may be the consequence of an exaggerated pro-inflammatory cytokine response?

<p>Sepsis shock</p> Signup and view all the answers

Which of the following statements about eicosanoids is true based on the text?

<p>They mediate cell migration</p> Signup and view all the answers

What is the function of fatty acid metabolites in the systemic response to injury according to the text?

<p>Promoting wound healing</p> Signup and view all the answers

Regarding plasma contact systems, what do they primarily contribute to in the inflammatory response mentioned in the text?

<p>Coagulation cascade activation</p> Signup and view all the answers

Which enzymes convert arachidonic acid to prostaglandin E₂ (PGE₂) in the context of systemic response to injury?

<p>COX-2</p> Signup and view all the answers

Which of the following is NOT listed as a mediator that can generate a pro-inflammatory response against various stimuli?

<p>Acetylcholine</p> Signup and view all the answers

Which of the following is an oxidation derivative of arachidonic acid according to the text?

<p>Prostacyclin</p> Signup and view all the answers

Which nucleated cells are noted in the text as not storing eicosanoids within themselves?

<p>Lymphocytes</p> Signup and view all the answers

Which fatty acid metabolite is mentioned in the text as part of the class of mediators encompassing eicosanoids?

<p>Arachidonic Acid</p> Signup and view all the answers

Which fatty acid metabolite is associated with being a precursor of inflammatory mediators like leukotrienes and prostaglandins?

<p>Arachidonic acid</p> Signup and view all the answers

What is the primary lipid source in enteral nutrition formulas, acting as a substrate in the text?

<p>Arachidonic acid</p> Signup and view all the answers

Which fatty acid metabolite is highlighted in the text for its anti-inflammatory properties in diseases like rheumatoid arthritis and lupus?

<p>Eicosapentaenoic acid</p> Signup and view all the answers

Which fatty acid metabolite minimizes ischemia/reperfusion injury in various tissues based on the text?

<p>Eicosapentaenoic acid</p> Signup and view all the answers

Which major effector mechanism of the innate immune system is thought to act as the first line of defense against pathogens by binding and clearing them from circulation?

<p>The Complement System</p> Signup and view all the answers

Which immune cells are characteristically similar to neutrophils in terms of migration and release of cytoplasmic granules that are cytotoxic?

<p>Eosinophils</p> Signup and view all the answers

What is the primary function of Helper T-Lymphocytes according to the text?

<p>Mediators of adaptive immunity</p> Signup and view all the answers

Which of the following is a major activator for eosinophils as highlighted in the text?

<p>IL-3, IL-5</p> Signup and view all the answers

What is the consequence of reduction in monocyte surface TNFR expression with failure to recover as mentioned in the text?

<p>Sepsis</p> Signup and view all the answers

Which toxic mediators are released subsequent to the activation of immune cells as discussed in the text?

<p>Histamine</p> Signup and view all the answers

What is the role of lipoxin in the inflammatory response?

<p>Inhibits chemotaxis</p> Signup and view all the answers

Which of the following eicosanoids is responsible for promoting vasoconstriction and platelet aggregation?

<p>TXA2 (thromboxane A2)</p> Signup and view all the answers

How do glucocorticoids affect COX-2 activity in the context of inflammation?

<p>Inhibit COX-2 activity</p> Signup and view all the answers

Which of the following inhibits the end products of eicosanoid pathways?

<p>Glucocorticoids</p> Signup and view all the answers

What is the primary function of leukotrienes in the inflammatory response?

<p>Mediate capillary leakage</p> Signup and view all the answers

What is the primary role of the Plasma Contact System in the context of the systemic response to injury?

<p>Promoting the release of inflammatory mediators like bradykinin</p> Signup and view all the answers

How do Eicosanoids contribute to the immediate results of mast cell activation?

<p>Causing vasodilation and capillary leakage</p> Signup and view all the answers

What is the main function of Cytokines during the systemic response to injury?

<p>Promoting immunocyte recruitment to the site of injury</p> Signup and view all the answers

How are Fatty Acid Metabolites involved in the pathophysiology of sepsis?

<p>Contributing to the systemic inflammatory response through immune cell activation</p> Signup and view all the answers

What is the significance of Cytokines in the context of thermal injury?

<p>Enhancing systemic inflammatory responses and fever induction</p> Signup and view all the answers

Which substance is a potent mediator of vasoconstriction and is elaborated by vascular epithelial cells in response to various stimuli?

<p>Endothelins</p> Signup and view all the answers

What is the primary role of PAF-Acetyl hydrolase?

<p>Activating platelet activating factor</p> Signup and view all the answers

Platelet-Activating Factor is a natural phospholipid constituent of cell membranes that is minimally expressed under normal physiologic conditions due to:

<p>Reduction of PAF-Acetyl hydrolase levels</p> Signup and view all the answers

What is the most potent endogenous vasoconstrictor synthesized primarily by endothelial cells?

<p>ET-1</p> Signup and view all the answers

What is the role of Atrial Natriuretic Peptide in the body?

<p>Preventing reabsorption of Na</p> Signup and view all the answers

'Platelet-Activating Factor' under normal physiologic conditions is minimally expressed due to:

<p>Reduction of PAF-Acetyl hydrolase levels</p> Signup and view all the answers

Which substance is implicated in inducing vasodilation and fluid and electrolyte excretion in the body?

<p>Atrial Natriuretic Peptide</p> Signup and view all the answers

What is the primary function of Endothelins in the body?

<p>Mediating vasoconstriction</p> Signup and view all the answers

Which peptide is a 21 amino acid potent mediator of vasoconstriction primarily produced by endothelial cells?

<p>ET-1</p> Signup and view all the answers

What is the consequence of reduced levels of PAF-Acetyl hydrolase in the body?

<p>Elevated Platelet-Activating Factor expression</p> Signup and view all the answers

What is the main role of cytokines at the site of infection according to the text?

<p>Mediate the eradication of invading microorganisms</p> Signup and view all the answers

In the context of inflammatory stimuli, what may an exaggerated pro-inflammatory cytokine response lead to?

<p>Septic shock</p> Signup and view all the answers

What is the outcome of exaggerated responses involving both pro- and anti-inflammatory cytokines according to the text?

<p>End-organ failure</p> Signup and view all the answers

Which cellular responses are mediated by cytokines according to the text?

<p>Cell migration</p> Signup and view all the answers

What function do anti-inflammatory cytokines primarily serve in response to proinflammatory cytokines?

<p>Oppose their actions</p> Signup and view all the answers

Which cell type releases Tumor Necrosis Factor Alpha (TNF-α) rapidly due to the abundance of stores within granules?

<p>Mast cells</p> Signup and view all the answers

What is the primary immediate result of activated Mast cells in the inflammatory response?

<p>Vasodilation</p> Signup and view all the answers

Which of the following is NOT an item produced by activated Mast cells during the inflammatory response?

<p>Prostaglandins</p> Signup and view all the answers

What role do Inflammatory mediators play in promoting neutrophil migration to an injured tissue?

<p>Promote cell adherence to vascular endothelium</p> Signup and view all the answers

Which molecule is secreted rapidly by Mast cells and is crucial for neutrophil recruitment and pathogen clearance?

<p>Tumor Necrosis Factor Alpha (TNF-α)</p> Signup and view all the answers

What is the primary role of Natural Killer cells in the immune system?

<p>Releasing cytoplasmic granules that are cytotoxic</p> Signup and view all the answers

Which immune cells preferentially migrate to sites of parasitic infections and allergen challenge?

<p>Eosinophils</p> Signup and view all the answers

Which cytokines are major activators of Eosinophils?

<p>Interleukin-3 (IL-3) and Interleukin-5 (IL-5)</p> Signup and view all the answers

Which cells release inflammatory mediators and are mediators of adaptive immunity?

<p>B cells</p> Signup and view all the answers

What is the characteristic feature of Eosinophils similar to neutrophils?

<p>Migration to endothelium</p> Signup and view all the answers

What is the primary function of Thrombomodulin in the context of vascular endothelium under physiologic conditions?

<p>Inhibit blood clotting</p> Signup and view all the answers

How do endothelial cells contribute to the procoagulant shift mentioned in the text?

<p>By decreasing production of anticoagulant factors</p> Signup and view all the answers

Which molecule is responsible for facilitating O2 delivery and immunocyte migration to the site of injury, potentially contributing to cytotoxicity and organ dysfunction?

<p>Chemoattractant</p> Signup and view all the answers

Which molecule recruits circulating neutrophils to endothelial surfaces through adhesion factors, potentially leading to tissue injury?

<p>Selectins</p> Signup and view all the answers

What is the consequence of prolonged neutrophil activation and mediator release according to the text?

<p>Lead to tissue injury</p> Signup and view all the answers

What is the main role of monocytes in the immune response to infection and injury?

<p>Differentiation into macrophages</p> Signup and view all the answers

What occurs following experimental endotoxemia in humans in relation to CD95 expression?

<p>Reduced CD95-mediated apoptosis</p> Signup and view all the answers

Which cells are considered the first responders in acute inflammation?

<p>Neutrophils</p> Signup and view all the answers

What is the primary stimulus for neutrophil maturation according to the text?

<p>Granulocyte Colony-Stimulating Factor (GCSF)</p> Signup and view all the answers

How do neutrophils contribute to the inflammatory response upon exposure to inflammatory stimuli?

<p>Phagocytosis and release of lytic enzymes</p> Signup and view all the answers

Which enzyme converts arachidonic acid to prostaglandin E₂ (PGE₂) primarily involved in generating a pro-inflammatory response?

<p>COX-2 (cyclooxygenase 2)</p> Signup and view all the answers

Which molecule is NOT a part of the eicosanoids class of mediators mentioned in the text?

<p>Histamine</p> Signup and view all the answers

Which type of cells are mentioned as NOT secreting eicosanoids in the text?

<p>Lymphocytes</p> Signup and view all the answers

Which molecule is the precursor of inflammatory mediators like leukotrienes and prostaglandins?

<p>Arachidonic acid</p> Signup and view all the answers

Which neurotransmitter mentioned is NOT involved in generating a pro-inflammatory response against various stimuli?

<p>Acetylcholine</p> Signup and view all the answers

Which of the following is NOT a function of cytokines in the inflammatory response?

<p>Inhibiting chemotaxis</p> Signup and view all the answers

What is the primary role of leukotrienes derived from arachidonic acid in the inflammatory response?

<p>Promoting vasoconstriction</p> Signup and view all the answers

Which of the following substances is responsible for the anaphylactic response to allergens in the cell-mediated immune response?

<p>Mast cells</p> Signup and view all the answers

What contributes to the overproduction of proinflammatory mediators in the inflammatory response?

<p>Severe injury or infection</p> Signup and view all the answers

Which molecule is formed as a result of eicosanoids activation and has a role in inhibiting chemotaxis?

<p>Lipoxin</p> Signup and view all the answers

What is the main trigger for the endocrine response to injury after trauma?

<p>Afferent nerve stimuli</p> Signup and view all the answers

Which type of substance is TNF-alpha and what effect does it have following acute injury or infection?

<p>Proinflammatory cytokine inducing muscle catabolism</p> Signup and view all the answers

What stimulates the release of tumor necrosis factor-alpha in response to bacteria or endotoxin?

<p>Neuroendocrine response</p> Signup and view all the answers

Which molecules are responsible for inducing fevers through prostaglandin activity in the hypothalamus?

<p>IL-1 and TNF-alpha</p> Signup and view all the answers

What is the ultimate validation for nutritional support, according to the text?

<p>Improvement in clinical outcome and restoration of function</p> Signup and view all the answers

Which metabolic state serves as the standard to which metabolic alterations after acute injury and critical illness are compared?

<p>Unstressed fasting state</p> Signup and view all the answers

How many kcal/kg/day does a normal healthy adult require, drawn from carbohydrate, lipid, and protein sources?

<p>22-25 kcal/kg/day</p> Signup and view all the answers

What is the primary goal of nutrition in surgical patients, based on the text?

<p>Preventing or reversing catabolic effects of disease or injury</p> Signup and view all the answers

What is the principal source of fuel during short-term fasting, according to the text?

<p>Fats</p> Signup and view all the answers

What purpose does the estimation of energy requirements serve in the context of nutrition for surgical patients?

<p>To establish baseline metabolic needs for each patient</p> Signup and view all the answers

Why is overall nutritional assessment important in surgical patients, according to the text?

<p>To determine nutrient deficiencies or excess</p> Signup and view all the answers

What characterizes the initial hours following surgical or traumatic injury in terms of metabolism?

<p>Reduced total body expenditure and urinary nitrogen excretion</p> Signup and view all the answers

Which phase of recovery in surgical patients is characterized by enzymatic preference for readily oxidizable substrates like glucose?

<p>Repair phase</p> Signup and view all the answers

What is the foundation upon which metabolic and nutritional support can be implemented for surgical patients?

<p>Understanding alterations in amino acid, carbohydrate, and lipid metabolism</p> Signup and view all the answers

In the context of trauma patients, what is a primary goal of surgical nutrition and support?

<p>Preserving vital organ function and supporting injured tissue repair</p> Signup and view all the answers

What characterizes the metabolic response during the phase of recovery in surgical patients?

<p>Augmented metabolic rates and preference for glucose as substrate</p> Signup and view all the answers

What aspect lays the foundation for the implementation of metabolic and nutritional support in surgical patients?

<p>Understanding alterations in amino acid, carbohydrate, and lipid metabolism</p> Signup and view all the answers

What is a key feature characterizing substrate use following adequate resuscitation and stabilization of injured patients?

<p>Reprioritization to preserve vital organ function and support tissue repair</p> Signup and view all the answers

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