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LAM 1 > Endotoxemia > Flashcards

Endotoxemia Flashcards

1
Q

What are the 3 main components of a gram-negative bacterial endotoxin?

A
  • Polysaccharide O-region
  • Lipid A region
  • Core (acidic polysaccharide region)
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2
Q

Which disease are usually associated with the development of endotoxemia in the horse?

A

Gram-negative bacterial infections

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3
Q

What are 2 times gram-negative endotoxins are released?

A
  • During both cell death

- Small extent during rapid multiplication phase

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4
Q

What are 6 possible etiologies of endotoxemia?

A
  • Any GIT disturbance
  • Metritis, placentitis
  • Pleuropneumonia
  • Bacterial pleuritis and/or peritonitis
  • Septicemia (neonates)
  • Possibly with wound infections
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5
Q

What is the most common etiology of endotoxemia?

A

Any GIT disturbance

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6
Q

Why is endotoxemia seen with pleuropneumonia but not often with pneumonia?

A

Pleuropneumonia involves a larger surface area so more endotoxins get absorbed.

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7
Q

Where does the highest amount of endotoxin likely come from?

A

GI disturbance

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8
Q

Why, if produced constantly, are horses not endotoxic at all times?

A

Not enough endotoxin crossing the GIT mucosa going into circulation to cause endotoxemia.

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9
Q

Why is the integrity of the GIT mucosa important?

A

Prevents large amounts of endotoxin from gaining the circulation.

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10
Q

What can endotoxins be bound to within the GIT allowing it to be removed from the body?

A

Bile salts

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11
Q

What are 3 possible disposition locations of endotoxin from the GIT once it reaches circulation?

A
  • Bind to circulating LPS antibodies present
  • Removed by RES in the liver
  • Bind to circulating LBP (LPS binding protein)
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12
Q

What is an acute phase LPS binding protein that acts as a shuttle?

A

LBP

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13
Q

What cells are targeted by endotoxins in the horse?

A

Pulmonary intravascular macrophages

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14
Q

What is the first parameter altered by endotoxemia?

A

Increase in pulmonary arterial pressure.

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15
Q

What are 3 responses triggered by endotoxemia?

A
  • Vasoactive substances released
  • Endothelial disruption
  • Systemic inflammatory response syndrome (SIRS)
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16
Q

How does the release of vasoactive substances caused by endotoxemia affect the body?

A

Alteration of flow

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17
Q

What are 2 forms of endothelial disruption seen with endotoxemia?

A
  • Increased vascular permeability

- Hypercoagulability

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18
Q

What are 3 events resulting from mediator production as a result of SIRS caused by endotoxemia?

A
  • Neutrophil adhesion
  • Monocyte/macrophage activation
  • Platelet adhesion
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19
Q

What is considered to be the horse shock organ?

A

Lungs

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20
Q

In general, endotoxemia results in the activation of what 5 host responses?

A
  • Inflammatory mediators
  • Kinins (altered clotting balance)
  • Oxygen radicals
  • Complement cascade
  • Coagulation cascade
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21
Q

Failure of the circulatory system to maintain adequate blood flow is known as what?

A

Shock

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22
Q

What are 2 main categories of shock?

A
  • Pump failure

- Circuit failure

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23
Q

What is an example of a pump failure form of shock?

Is this common in horses?

A
  • Cardiogenic shock

- Not as common in horses

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24
Q

What are 4 examples of circuit failure forms of shock?

A
  • Hypovolemic shock
  • Hemorrhagic shock
  • Distributive (maldistributive) shock
  • Obstructive shock
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25
Q

What are 4 variations of distributive (maldistributive) shock?

A
  • Septic shock
  • Anaphylactic shock
  • Adrenal insufficiency
  • Neurogenic shock
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26
Q

Septic shock is also known as what?

A

Endotoxemic shock

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27
Q

What does SIRS stand for?

A

Systemic inflammatory response syndrome

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28
Q

What is sepsis?

A

SIRS induced by infection

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29
Q

What is septic shock (endotoxemic shock)?

A

Sepsis associated with organ dysfunction, hypoperfusion or hypotension.

30
Q

What does MODS stand for?

A

Multiple organ dysfunction syndrome

31
Q

What does CARS stand for?

A

Compensatory anti-inflammatory response syndrome

32
Q

What does MOFS stand for?

A

Multiple organ failure syndrome

33
Q

What are the 2 clinical phases of shock?

A
  • Hyperdynamic state

- Hypodynamic state

34
Q

Typically early on with endotoxemia, there is what type of vascular state?

A

Vasoconstricted state

35
Q

As the endotoxemia progresses, there is a tendency toward what type of vascular state?
What is an example of a mediator of this state?

A
  • Progressive vasodilatory state

- Prostacyclin

36
Q

How do the mucus membranes appear in a hyperdynamic state of shock?
In a hypodynamic state?

A
  • Injected, brighter

- Congested, toxic line, darker color

37
Q

How is the CRT during a hyperdynamic state of shock?

During a hypodynamic state?

A
  • Likely normal

- Prolonged

38
Q

How is the pulse during a hyperdynamic state of shock?

During a hypodynamic state?

A
  • Strong

- Weak, thready

39
Q

How do the extremities feel during a hyperdynamic state of shock?
During a hypodynamic state?

A
  • Warm

- Normo to hypothermic

40
Q

What is the temperature of the patient like in a hyperdynamic state of shock?
In a hypodynamic state?

A
  • Likely elevated

- Typically subnormal

41
Q

Is tachycardia seen during a hyperdynamic state, hypodynamic state or both?

A

Both

42
Q

Is tachypnea seen during a hyperdynamic state, hypodynamic state or both?

A

Both

43
Q

What is the gold standard test in research for detecting endotoxemia?

A

Limulus test

44
Q

Are portable endotoxin tests available?

A

Yes for humans

45
Q

What is seen with an endotoxemia CBC?

A
  • Neutropenia
  • Leukopenia
  • Lymphocytes WNL
46
Q

What is seen with a stress leukogram?

A
  • Leukocytosis
  • Neutrophilia
  • Lymphopenia
47
Q

What is seen on a CBC with both stress and endotoxemia?

A
  • Total WBC WNL
  • Neutrophils WNL
  • Lymphopenia
48
Q

Why might a CBC be done for endotoxemia?

A

To evaluate the presence and/or severity of cardiovascular compromise and organ dysfunction.

49
Q

What does APACHE stand for?

What is is?

A
  • Acute physiology and chronic health evaluation

- Scoring system developed for quantifying the severity of the illness for the intensive care patients.

50
Q

What is the first thing to do with an endotoxemia case?

A

Remove the cause.

51
Q

What are 2 things that might need to be removed surgically from the GIT when treating endotoxemia?

A
  • Devitalized gut tissue

- Gut content

52
Q

Do giving bacteriostatic antimicrobial drugs affect the endotoxin levels of in horses?

A

Yes in foals but no in adults.

53
Q

What 2 antimicrobials can be given to foals to treat endotoxemia?
Are these given separate or together?

A
  • Ceftiofur and Amikacin

- Given together

54
Q

What is the next major step after the source of endotoxemia has been removed?

A

Provide CVS support

55
Q

What is given in the fluid if TP levels are less than 4.2 g/dL?

A

Hetastarch

56
Q

What might need to be added to fluid given to foals with endotoxemia?

A

Glucose

57
Q

What are 3 fluids that may be given for CVS support of endotoxemia?

A
  • High volume crystalloids
  • Hypertonic saline
  • Combination
58
Q

What are 2 things that may be given to neutralize circulating endotoxins?

A
  • Endoserum (anti-endotoxin ABs) as a preventative

Polymixin B infusions as a therapeutic to bind toxins

59
Q

What is the DOC for the inhibition of endotoxin associated inflammation and mediators?

A

Flunixin meglumine in low doses.

60
Q

What are 3 other NSAIDs that can be given for the inhibition of endotoxin associated inflammation and mediators?

A
  • Phenylbutazone
  • Ketoprofen
  • Ibuprofen
61
Q

What can be given with flunixin meglumine (banamine) that might limit the amount of mediators produced?

A

Pentoxyfylline

62
Q

What is an anti-oxidant that can be given to reduce enema associated with endotoxemia?

A

DMSO

63
Q

DMSO is an anti-inflammatory that inhibits what?

A

IL-8 and neutrophilic adhesion

64
Q

What does DMSO reduce?

A

Platelet aggregation

65
Q

When dealing with GI conditions, is a high or low dose generally used?

A

Low dose

66
Q

What is a drug that can be used to reduce post-op ileus?

A

Lidocaine

67
Q

What is an anti-oxidant that is an xanthine oxidase inhibitor that may reduce free radical production?

A

Allopurinol

68
Q

What can be used in the face of altered coagulability that can be seen with endotoxemia?

A

Heparin

69
Q

What are 6 possible clinical manifestations or complications associated with endotoxemia?

A
  • GIT problems
  • Laminitis
  • Renal failure
  • Coagulopathies
  • Hepatopathies
  • Respiratory distress
70
Q

Is renal failure common in horses?

What is it often caused by?

A
  • No

- Nephrotoxic drugs

71
Q

What is a potential complication of endotoxemia that can cause facial edema?
Which form is more dangerous?

A
  • Jugular thrombosis

- Bilateral

72
Q

Why are horses more sensitive to DIC?

A

AT3 levels are already on the low end as a species.

LAM 1 (8 decks)

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