Surgery notes

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Major risk factor for type 2 diabetes is obesty Central/abdominal obesty carries greatest risk. Intra abdominal(visceral) fat breakdown is less inhibited by insulin ➡️ more lipolysis ➡️ more free fatty acids ➡️ decreased glucose transport into cells. These free fatty acids modify insulin receptors ➡️ insulin resistance ➡️ hyperglycemia.

Cortisol secretion is subjected to circadian rhythm. Its highest level will be early in the Morning around 6 AM. More than 90% of cortisol is bound to corticosteroid binding globulin. Cortisol Inhibits fibroblast activity ➡️ decrease collagen synthesis, poor wound healing, striae and thin skin.

Cortisol suppresses the immune response via 1) it sequesters lymphocytes in lymph nodes and spleen. 2)blocks neutrophil migration. 3)blocks histamine release form mast cells. 4) decreases eosinophil count. 5)Inhibits NF-KB It's an important transcription factor that controls the the synthesis of inflammatory mediators and cause inflammation. On CBC ➡️ Lymphopnea Neutrophilia