Endotoxemia Flashcards
What is the name of endotoxemia some people argue it should be called? Why?
SIRS- sudden inflammatory response syndrome
Because essentially that is what is happening in the host the endotoxins is causing uncontrollable inflammation resulting in a clinical syndrome of shock
What are the 5 stages of the pathophysiology of endotoxemia?
Stage one physical barriers are breached- due to damage of the intact endothelium in the face of a gram - infection within the large intestine and the cecum= systemic absorption
Stage two endotoxins gains circulation and stimulates macrophages- lipid binding protein binds LPS can increase 100 fold and act as a shuttle (liver, macs, lipoproteins, **IVM triggers the widespread inflammatory response
- cd-14LBP with TLR4 is responsible for production of inflammatory mediators (tnf il 1,6)
- giving rise to the myd88 promediator prod tnf il1
- trip activation (anti inflammatory process) DOES NOT HAPPEN IN PONY
Stage 3 neutrophils bind to endothelial cells and they become activated *leukopenia platelet aggregation
Stage 4 organ perfusion is compromised as endotoxemia progresses hypercoagulability vasculature vasoconstrictive to vasodialation then there is damage to the endothelium and leaks protein
Early on in endotoxemia what clinical signs would you expect opposed to later?
Hyper dynamic FIRST- injected mucous membranes, strong pulses, warm extremities, increased temp heart rate and respiration
Hypodynamic LATER- (what you’ll see) congested mm, prolong CRT, weak pulses, cold extremities, increase heart rate increase respiration
What would you expect to find on a CBC of an animal with endotoxemia
Leukopenia, neutropenia, and normal lymphocytes
***careful with stress could send the neutrophils and white blood cells into normal limits (they would increase in stress and marginate due to the endotoxins)
How would you diagnose a horse with endotoxemia
Clinical signs CBC
Horse side test Etox test
How are you going to treat an endotoxemic case
Prevent with the use of linseed oil?
Tx goal is to remove the cause including preventing the movement of endotoxins into circulation
Antimicrobials - TMS, amino glycosides *foal potentially worsen
In GIT case- remove the dead gut and dump the colon
Circulatory support- LRS
Neutralize the endotoxins- endoserum IV + POLYMIXIN B (bind bact)
Inhibit the synthesis of mediators- flunixin, lidocaine, DMSO, allopurinol
What is endotoxins?
What’s the “bad part”?
It is the heat liable LPS component of the gram - cell wall
Endotoxins is generated by the death and rapid multiplication of gram -
-gram negatives remember are staph strep strangles
LPS has two regions hydrophilic O region and a hydrophobic A region ***bad part a Micelle will be made by lipid A hiding it from the immune system
