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Among these, tumor necrosis factor-alpha (TNF-␣) is the earliest and one of the most potent mediators of the subsequent host response. The sources of TNF-␣ synthesis include monocytes/macrophages and T cells, which are abundant in the peritoneum and splanchnic tissues. Kupffer cells represent the single largest concentrated population of macrophages in the human body. Surgical or traumatic injuries to the viscera may have profound influences on the generation of inflammatory mediators and homeostatic responses such as acute phase protein production (Fig.

The ebb phase is associated with neuroendocrine hormone appearance, including catecholamines and cortisol. Less is known about the microendocrine mediator response. It is difficult to separate the immune cell mediator response from responses to fluid or volume resuscitation and tissue reperfusion and reoxygenation. The flow phase is ushered in by compensatory mechanisms resulting from volume repletion and cessation of initial injury conditions. The metabolic response associated with the flow phase serves to direct energy and protein substrates both to preserve organ function and repair damaged tissues.

Whole-body energy expenditure decreases during prolonged fasting. This reduction in resting energy expenditure is a consequence of decreased sympathetic nervous system activity and reduced skeletal muscle activity, as well as reduced secretory enzyme production and intestinal energy needs. Metabolism after Injury The metabolic consequences of injury differ in many fundamental ways from those of simple starvation. Well-defined changes in hormone levels and associated substrates accompany injury.

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