Corticotropin-releasing factor and acute post-operative gut function in truamatic abdominal injury and elective abdominal surgery

Shocked trauma patients in the Intensive Care Unit undergo a powerful, neuro-endocrine stress response driven by cytokine release and the hypothalamic-pituitary-adrenal axis. The response is activated under stress by corticotropin-releasing factor (CRF), the well-known 41 amino acid peptide neuro-hormone. Evidence from animal and human studies suggests that peripheral CRF is present in the gastrointestinal tract and associated with inflammatory changes. Critically ill patients frequently display somewhat unexplained gastrointestinal dysfunction including delayed gastric emptying, ileus and increased bowel permeability. The aim of the study was to investigate the role of CRF in critically ill adults with traumatic abdominal injury compared with elective surgical patients, and describe any association of CRF levels with alterations in acute post-operative gastrointestinal function. Eight patients with haemorrhagic shock following penetrating abdominal injury and seventeen patients undergoing elective surgery for hepato-biliary disease were studied for serial plasma and intestinal tissue CRF levels using radio-immunoassay. A RT-PCR technique was used to detect mRNA for CRF in intestinal tissue. Light microscopy was used to determine the quantity and distribution of mast cells in intestinal tissue. Post-operative gastric emptying was assessed using the paracetamol absorption test and intestinal permeability by measuring urinary lactulose:mannitol ratios following a bolus of these sugars. The study was approved by University of Cape Town Human Research Ethics Committee. Informed consent (retrospectively in the case of the trauma patients), was obtained from all subjects.

Grantor dc:publisher.institution

Department of Human Biology

Year dc:date.issued

2009

Author dc:creator

• Hill, Lauren

Advisor dc:contributor.advisor

• Kidson, Sue

Language dc:language.iso

eng

Handle dc:identifier.uri

http://hdl.handle.net/11427/3247

OAI identifier oai:identifier

oai:open.uct.ac.za:11427/3247