Chapter 159 SIRS, Sepsis, and MODS

Question 1

What is the old definition of septic shock?

Answer 1

Patients with sepsis and persistent arterial hypotension that is non-responsive to intravascular volume expansion.

Question 2

What is the new consensus definition of sepsis?

Answer 2

Life-threatening organ dysfunction caused by a dysregulated host response to infection.

Question 3

In the new definition, organ dysfunction is identified as _____________.

Answer 3

Any acute change in total sequential organ failure assessment (SOFA) score more than 2 points as a result of the infection.

Question 4

What is the new definition of septic shock?

Answer 4

Persisting hypotension requiring vasopressors to maintain MAP > 65 mmHg and having a serum lactate 2 mmol/L despite adequate volume resuscitation.

Question 5

T/F: DAMPS result from sepsis

Answer 5

F: non-infectious SIRS, tissue damage results in the expression or release of DMAPs (damage-associated molecular patterns) on/from host cells.

Question 6

T/F: PAMPS result from non-infectious SIRS.

Answer 6

F: In patient with sepsis, PAMPS (pathogen-associated molecular patterns) expressed by pathogen, stimulate PRRS (pattern recognition receptors) such as TLRs (toll like receptors) in the host.

Question 7

What triggers respiratory dysfunction in SIRS/sepsis?

Answer 7

1. leukocyte infiltration and fluid leak into alveoli
2. impaired blood flow in the pulmonary circulation associated with thrombosis
3. diffusion impairment and ventilation/perfusion mismatch

Question 8

What are the features of early decompensatory phase of shock in dogs?

Answer 8

pale mm, prolonged CRT, weak pulses

Question 9

What are the features of hyperdynamic shock or vasodilatory shock?

Answer 9

hyperemic mm, rapid CRT, strong or bounding pulses

Question 10

What causes hyperglycemia in SIRS/sepsis?

Answer 10

stress hyperglycemia (decreased insulin sensitivity due to high circulating concentration of cortisol and catecholamines.

Question 11

What causes ionized hypocalcemia in SIRS/sepsis?

Answer 11

hypovitaminosis D

Question 12

What causes hyperbilirubinemia in SIRS/sepsis?

Answer 12

intrahepatic cholestasis, hemolysis

Question 13

What are empirical hoice of antibiotics for abdominal sepsis of GI origin?

Answer 13

amoxicillin + sublactam for gram positive aerobic and anaerobic coverage

enrofloxacin for gram negative aerobic coverage (For aniamls with recent exposure to antimicrobials or a high local burden of fluoroquinolone-resistant E.coli: Amikacin (if normal renal function) or cefotaxmine (if azotemic) would be more appropriate empiric antimicrobials for treatment of gram negative aerobes.