SIRS, sepsis, MODs, DIC

Question 1

what 4 things are you thinking about to trigger concerns about SIRS?

Answer 1

• increased HR
• increased RR
• increased temp
• increased WBCs

Question 2

what is SIRS? what is it caused by? what was it previously known as?

Answer 2

systemic inflammatory response syndrome
* A self-amplifying dysregulated systemic inflammatory response
* Triggered by
◦ Bacterial toxins
‣ Lipopolysaccharide derived from G-ve bacteria
‣ S aureus
‣ Burns, Neoplasia, Pancreatitis (non equine)
* Can result in coagulopthies

• Previously referred to as endotoxaemia
  ◦ Inflammation leading to cell death and apoptosis
  ‣ LPS has some direct roles
  ‣ Includes non-LPS bacteria

Question 3

what is sepsis?

Answer 3

SIRS plus a culture proven infection

Question 4

what is severe sepsis?

Answer 4

spesis with organ hypoperfusion or dysfunction

Question 5

what is septic shock?

Answer 5

Severe sepsis (organ hypoperfusion or dysfunction) + systemic hypotension
* Common in foals, rare in adult horses
* Occurs in small animals

Question 6

what is MODS?

Answer 6

multi-organ dysfunction syndrome
* Altered organ function in an acutely ill animal such that haemostasis cannot be maintained without intervention
◦ Classified as either primary or secondary

Primary
* Resulting from well-defined insult where organ dysfunction occurs early and is a direct consequence of the insult itself – burns and neoplasia

Secondary
* Organ failure not in direct response to the insult but as a consequence of a host response (SIRS)

Question 7

what is DIC?

Answer 7

Disseminated intravascular coagulation (DIC)
”Consumptive coagulopathy”
Pathological activation of coagulation
* Microvascular clotting
* Haemorrhagic diathesis
* Consumption of procoagulants
Associated with
* SIRS, SEPSIS, SEPTIC SHOCK
* MODS
◦ Systemic neoplasia
◦ Enteritis and colitis

Question 8

what are the clinical signs of DIC in equines?

Answer 8

In large animals, DIC is usually manifested by thrombosis rather than spontaneous haemorrhage
* Petechial haemorrhages
* Bleeding following trauma
◦ Venupuncture
◦ Surgical sites
◦ Nasogastric intubation

Question 9

what is the diagnositc criteria for DIC?

Answer 9

3 out of 5 abnormalities of:
* Thrombocytopoaenia
* Prolonged prothrombin time
* Prolonged activated partial thromboplastin time
* Increased fibrin degradation products
* Decreased antithrombin 3
* (low fibrinogen - not used very often as ref range < 4g/l)