Clinical Medicine

New PDF release: Modern Surgical Care: Physiologic Foundations and Clinical

By Miller T.A.

Thoroughly up-to-date with contributions via international leaders in surgical procedure and the surgical procedure specialties, this reference assists surgeons within the prognosis and remedy of sufferers through contemplating disorder as a derangement of ordinary body structure, hence permitting the health care provider to correlate the fitting use of laboratory and radiologic modalities. prepared in keeping with particular organ structures, the booklet is definitely obtainable and displays the effect that clinical discoveries and technical advances have had on our figuring out of the physiologic techniques in surgical sufferers.

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Additional resources for Modern Surgical Care: Physiologic Foundations and Clinical Applications. Volume 1

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When the protein intake is excessive, the amino acids resulting from proteolysis are catabolized to nitrogen and a carbon skeleton. The nitrogen is converted to urea, and the carbon skeleton is converted to glucose, lipid, or carbon dioxide, depending on the needs of the cell and the redox state present. Similarly, when glucose is needed but unavailable, excess ingested proteins or existing body proteins are degraded. Although it may be imperceptible, the use of existing body protein for energy or gluconeogenesis always results in the loss of some cellular function.

As a result, most hormones not only activate the enzymes necessary for one metabolic pathway, they also inhibit the enzymes necessary for the opposing process. Thus epinephrine, through an a-mechanism, activates glycogen phosphorylase and inactivates glycogen synthetase, whereas insulin inactivates glycogen phosphorylase and activates glycogen synthetase. The coordinated control of metabolism also requires that a hormone not have opposing actions in different tissues. Thus by increasing amino acid uptake in skeletal muscle and decreasing amino acid degradation in the liver, insulin promotes the availability of an abundant substrate supply for the enzymes of protein synthesis it activates.

The acetyl-CoA that results from the oxidation of fatty acids can be used in one of the three available pathways (Fig. 13) (58,60). The first involves the intramitochondrial oxidation of acetyl-CoA through the TCA cycle to two molecules of carbon dioxide and 12 HEPs. Thus the total oxidation of a 20-carbon fatty acid, for example, yields: 169 HEPs ¼ ½ð10  5Þ þ ð10  12Þ À 1Š The second pathway involves the ketogenic pathway in the liver (Fig. 14). Through the action of the enzyme thiolase, two molecules of acetyl-CoA combine to form acetoacetyl-CoA in a freely reversible reaction.

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Modern Surgical Care: Physiologic Foundations and Clinical Applications. Volume 1 by Miller T.A.


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