Multi-organ dysfunction syndrome

Question 1

What is multi-organ dysfunction syndrome?

Answer 1

Manifests as organ dysfunction affecting more than one organ leading to failure of homeostasis. It literally is as simple as what it says on the tin: defined simply as simultaneous dysfunction of more than one organ. Don’t overthink or over-read it!

Question 2

What is the aetiology of MODS? (x2)

Answer 2

• Infection (systemic insult or sepsis): in particular, Gram negative activate complement and macrophages that release cytokines, lead to endothelial damage and subsequent oedema. There is also coagulation cascade activation. All these processes lead to organ dysfunction
• Systemic inflammatory response syndrome (SIRS): trauma, burns, pancreatitis, ischaemia, failure of transplanted organ, systemic hypoxia from shock

Question 3

What is the pathophysiology of MODS?

Answer 3

UNCLEAR. Sepsis and SIRS are characterised by release of endogenous compounds such as TNF-alpha and ILs which leads to inflammatory response development of failure of distant organs. As each organ sequentially fails, they activate and propagate a systemic inflammatory response associated with endothelial damage and oedema.

Question 4

What is the epidemiology of MODS: Common?

Answer 4

It is the leading cause of mortality in ICUs.

Question 5

What are the signs and symptoms of MODS? (x5)

Answer 5

• STAGE 1: mild respiratory alkalosis, oliguria, hyperglycaemia
• STAGE 2: tachypnoea, hypocapnia, hypoxia, moderate liver dysfunction
• STAGE 3: shock, acid-base disturbances, coagulation abnormalities
• STAGE 4: anuria, and patient develops ischaemic colitis and lactic acidosis
• Temperature may also rise above 38 or fall below 36

Question 6

What are the investigations for MODS?

Answer 6

Sepsis-Related Organ Failure Assessment (SOFA)