SIRS/ Sepsis and MODs

Question 1

T/F: SIRS may be a primary condition.

Answer 1

false- always a secondary condition to an underlying dz process

Question 2

What is the definition of sepsis?
A) Term for widespread systemic inflammation caused by underlying infectious or noninfectious dz process
B) Systemic inflammatory response to infection
C) Local bacterial infection causing toxin release and inflammation
D) None of the above

Answer 2

B- can occur d/t bacteria, viruses, fungi, or protozoa

SIRS= term for widespread SYSTEMIC inflammation caused by underlying infectious OR noninfectious dz process

Question 3

What is the condition that SIRS can lead to resulting in death?

Answer 3

multiple organ dysfunction syndrome

Question 4

Which of the following is false regarding SIRS in dogs?
A) Must have three of the four criteria (hyper or hypothermia, tachycardia, tachypnea, neutrophilia or penia/increased bands)
B) Bradycardia is not typically associated with SIRS in dogs
C) Requirements for classification of SIRS is different in cats than dogs
D) All are truew

Answer 4

A= must have TWO/FOUR
cats= must have 3/4

Question 5

T/F: Cats with SIRS can present brady or tachycardic.

Answer 5

true! different from dogs

also have wider temperature ranges and wider WBC ranges (also lack of bands)

Question 6

Which of the following are common causes non-infectious causes of SIRS?
A) Pancreatitis
B) Heat stroke
C) Burns
D) Trauma
E) All of the above

Answer 6

E

Question 7

T/F: Sepsis can occur without SIRS but SIRS cannot occur without sepsis.

Answer 7

false! can have SIRS without sepsis, but if sepsis is present then SIRS is present

Question 8

Which of the following is a hallmark of SIRS?
A) Perfusion abnormalities
B) Disruption of microcirculation
C) Organ damage
D) all of the above

Answer 8

D

inappropriate of shunting from the vital organs to the periphery occurs> kidney damage, GIT damage= diarrhea

Question 9

Give the term for the following definition:

Sepsis induced hypotension persisting despite adequate fluid therapy causing profound circulatory, cellular, metabolic abnormalities

Answer 9

Septic shock- key is persistent hypotension despite ADEQUATE fluid therapy = need vasopressors

if this is present= increases mortality rate

Question 10

SIRS + infection + new organ dysfunction=

Answer 10

Sepsis

Question 11

Which of the following are released eliciting an immune response even when infection is not present?
A) DAMP
B) MAMP
C) PAMP
D) all of the above

Answer 11

DAMP= occur when there is immune mediated dz or trauma (cytokines from tissue injury) (can exaggerated infection)

PAMPs/MAMPs= on microbes> what the host recognizes and mounts immune response to > cause tissue damage and then DAMP release

all of these bind to TLRs which cause an immune response> can lead to SIRS

Question 12

Which of the following is false regarding comparison of sepsis in dogs vs cats?
A) Cats have more of a blunted response, appear lethargic, bradycardic, and hypothermic
B) Dogs have a hyperdynamic response presenting us tachycardic, hyperemic (red mm), and pyrexic
C) Dogs more often become icteric than cats
D) All are true

Answer 12

C- cats get icteric!

Question 13

T/F: Shock occurs when oxygen delivery (DO2) is not enough to meet cellular metabolic needs.

Answer 13

True

Question 14

What is the mainstay treatment of hypovolemia?
A) Vasopressors
B) IV fluid therapy
C) Blood transfusion
D) None of the above

Answer 14

B= MAINSTAY
goal of treatment of sepsis= hemodynamic optimization, includes fluids, transfusions and vasopressors (if needed)»need to optimize oxygen delivery!

Question 15

What are the shock doses of IV fluids for dogs vs cats? Why are we more conservative with cats?

Answer 15

dogs= 80-90 mL/kg; cats= 50-60 ml/Kg…more susceptible to fluid overload –> administer 1/4-1/3 dose and then reassess

Question 16

T/F: If an animal is in sepsis antibiotics should not be given until the culture and sensitivity results come back.

Answer 16

False- do not delay!, choose empirically based on knowledge of common isolates and patient risk factors for resistance

Question 17

The presence of altered organ function in an acutely ill patient such that homeostasis could not be maintained w/out intervention

Answer 17

MODS

associated with progression of uncontrolled systemic inflammation and DIC

Question 18

Can you list all of the organ systems included in the MODs criteria?

Answer 18

Renal, hepatic, CVS, respiratory, coagulation, GI, CNS

Question 19

T/F: Mortality with animals suffering from sepsis is the same in animals with one organ system failure versus MODS.

Answer 19

false- much higher with MODS

Question 20

Order the following list in sequence of occurrence.

1. Mods
2. SIRS
3. Ischemia reperfusion injury
4. Mortality

Answer 20

2-> 3-> 1->4

Question 21

At what point does SIRS become MODS?

Answer 21

activation and dysregulation of inflammatory cascade, microvascular ischemia and reperfusion injury> Organ dysfunction and failure

(Coagulation and inflammation is activated when endothelial damage occurs and tissue factor is exposed)

Question 22

Know the Hit models

Which of the following is occurring in this scenario: A dog underwent aspiration pneumonia during recovery from GDV surgery, in the following days it came in for persistent regurgitation and x-rays revealed a functional ileus, the dog developed acute respiratory distress syndrome.

A) 1-hit model
B) 2-hit model
C) sustained-hit model

Answer 22

B

aspiration pneumonia was the first hit
SIRS triggered by the aspiration pneumonia was the second hit
the SIRS resulted in ARDS (the functional ileus + ARDS= MODS)

Question 23

MODs that resulted due to septic peritonitis fits into which model?
A) 1-hit model
B) 2-hit model
C) sustained-hit model

Answer 23

A= result of massive initial hit that led to SIRS and then MODS
another example= trauma

Question 24

A drug resistant bacterial infection resulting in MODs would fall under which of the following models?
A) 1-hit model
B) 2-hit model
C) sustained-hit model

Answer 24

C

Question 25

Which of the following is a mechanism of organ dysfunction?
A) Ischemia/reperfusion injury
B) Compartment syndrome
C) Bacterial translocation and endotoxemia
D) Endothelial cell activation and chemotaxis
E) Idiosyncratic drug reactions/toxicities

Answer 25

ALL OF THEM

anything that causes GI ulceration is a risk factor for bacterial translocation and endotoxemia ie NSAIDS, toxins, MCT, IBD

Question 26

What cells get activated when the liver drains the GIT after a break in the barrier resulting in a massive inflammatory response?

Answer 26

Kupffer cells

Question 27

How can ARDS result in acute kidney injury?

Answer 27

acute lung injury results in hypoxia and hypercapnia>results in decreased renal perfusion, blood gas disturbances, and inflammation