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Quick Test posted on 8.25.11:
| Hormonal Response to Injury
| Hormones are chemically classified as polypeptides (e.g., cytokines, glucagon, and insulin), amino acids (e.g., epinephrine, serotonin, and histamine), or fatty acids (e.g., glucocorticoids, prostaglandins, and leukotrienes). Most hormone receptors generate signals by one of three major pathways, which overlap. Specifically, these receptor pathways are (1) receptor kinases such as insulin and insulin-like growth factor receptors, (2) guanine nucleotide-binding or G-protein receptors such as neurotransmitter and prostaglandin receptors, and (3) ligand-gated ion channels which permit ion transport when activated. Upon activation of membrane receptors, secondary signaling pathways are often utilized to amplify the initial stimuli. Hormone signals are further mediated by intracellular receptors with binding affinities for both the hormone itself, as well as for the targeted gene sequence on the DNA. These intracellular receptors may be located within the cytosol or may already be localized in the nucleus, bound to the DNA. The classic example of a cytosolic hormonal receptor is the glucocorticoid (GC) receptor (Figure). Intracellular GC receptors are maintained in the cytosol by linking to the stress-induced protein, heat shock protein (HSP). When the glucocorticoid ligand binds to the GC receptor, the dissociation of HSP from the receptor activates the receptor-ligand complex and is transported to the nucleus.
|  | | Fig. 2-3. Simplified schematic of steroid transport into the nucleus. Steroid molecules (S) diffuse readily across cytoplasmic membranes. Intracellularly the receptors (R) are rendered inactive by being coupled to heat shock protein (HSP). When S and R bind, HSP dissociates, and the S-R complex enters the nucleus, where the S-R complex induces DNA transcription, resulting in protein synthesis. mRNA = messenger RNA. |
| Virtually every hormone of the hypothalamic-pituitary-adrenal (HPA) axis influences the physiologic response to injury and stress, but some with direct influence on the inflammatory response or immediate clinical impact should be highlighted.
|  | | Fig. 28-1. Technique of appendectomy. A: Incision. B: After delivery of the tip of the cecum, the mesoappendix is divided. C: The base is clamped and ligated with a simple throw of the knot. The next step—inversion of the stump—is optional. D: A clamp is placed to hold the knot during inversion with a purse-string suture of fine silk. E: The loosely tied inner knot on the stump assures that there is no closed space for the development of a stump abscess. |
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