A 45-yrs-old man undergoes a Gastrectomy

Discussion in 'MRCS Forum' started by Lona., Oct 26, 2007.

  1. Lona.

    Lona. Guest

    A 45-yrs-old man undergoes a Gastrectomy for recurrent peptic ulcer disease. He has a history of excessive alcohol ingestion. Which nutritional substrate is depleted earliest?
    a- Branched-chain amino acids
    b- Non-branched-chain amino acids
    c- Ketone
    d- Glycogen
    e- Glucose
  2. Lona.

    Lona. Guest

    Answer: d- Glycogen. (Sabiston, 15/e, pp 60-62) The metabolic response to surgery (and other trauma) is a result of neuroendocrine stimulation that sharply accelerates protein breakdown, stimulates gluconeogenesis, and produces glucose intolerance. Glycogen stores are rapidly depleted because of a fall in insulin and a rise in glucagon levels in the plasma. The peripheral effects of the neuroendocrine secretion result in an increase in plasma levels of amino acids, free fatty acids, lactate, glucose and glycerol. In the liver, cortisol and glucagon stimulate glycogenolysis, gluconeogenesis, and increased substrate uptake.

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