30. Sepsis

Question 1

What is sepsis?

Answer 1

Life threatening organ dysfunction caused by a dysregualtion in host response to infection

Question 2

What components make up the SOFA score?

Answer 2

Reduced Pa02

Reducde GCS

Increasde bilirubin

Hypotension

Decreased platelets

Increased creatine/oliguria

Question 3

What components make up the QSOFA score?

Answer 3

RR>22

Altered cognition

Systolic blood pressure <100mmHg

Question 4

What is septic shock?

Answer 4

Sepsis

Requirement of vasopressors to keep MAP>65mmHg

Lactate >1.8mg/dL

Lack of hypovoleamia

Question 5

What are symtpoms of sepsis

Answer 5

Tachycardia

Tachypnoea

Fever

Reduced concious

reduced leukocytes, raised leukocytes

Question 6

What factors can contribute to sepsis?

Answer 6

Surgery

Drugs

co-existing pathologies

Biological variotion

Anaesthesia

Nutritional state

Question 7

What are the pro-inflammatory complexes that occur in sepsis

Answer 7

Complement activation

Excessive coagulation (DIC)

Pro cytokine response

Increased neutrophils

Platelets- pro inflamatory mediators

Question 8

Describe the process of sepsis

Answer 8

Excessive inflamation

Followed by/concurrently

Excessive immune supression

Question 9

What are pathogen associated molecular patterns (TAMPS)

Answer 9

Regions of the pathogen that induce sepsis

e.g. flagellum, sugar molecules, cell walls, double stranded DNA’s

Question 10

What are toll-like receptors?

Answer 10

Protein receptors that recognise the PAMPS and DAMPS

This allows for increasde trnascription of genes that helps the body induce an inflammatory response

Question 11

What are damaged associated molecular patterns (DAMPS)

Answer 11

Regions of the body cause an increased inflammaotry response

E.g. mitochondria DNA

Question 12

Describe the process of lipopolysacharide being recognised by a toll like receptor

Answer 12

TLR4 recognises the gram negative bacteria remenant that is lipopolysacharide

Requires CD14 (antigen) to bound to TLR4

Also Requries MD2-

Question 13

How is MYD88 related to TLR4

Answer 13

Intermediate complex that is acted upon by TLR4

Once MYD88 is switched on various pathways are activated until Nuclear factor kappa B is produced

Question 14

What is nuclear factor kappa B

Answer 14

Transcription factor that sits in the cytoplasm bound to an inhibitr

During an inflammatory process the inhibitor is degraded and a nuclear recognition site allows it to go into the nucleus

Question 15

Discuss the releas of complements during sepsis

Answer 15

Anaphylatoxins are released which punch holes in the cells

Left unco-ordinatded can cause damage

Complements also activate leucocytes, endothelial cells and platelets

Question 16

Discuss the processes that lead to DIC?

Answer 16

Immunothrombosis

Tissue factor production increases, clotting factors are consumed leading to micro-vascular thrombi

Loss of protein C (cleaves clots)

Question 17

What are NETS?

Answer 17

Neutrophil extracellular traps

Trap pathogens and can worsen co-agulation

Question 18

Discuss endothelial activation

Answer 18

Comprimising of the vascular barirer through the loss of glycocalyx

Cells can get through easily