uncontrolled systemic inflammation

Question 1

What is the systemic response to a severe infection?

Answer 1

Cytokines and inflammatory mediators released into blood

Can lead to severe sepsis, septic shock, disseminated intravasular coagulation and multi-organ dysfunction syndrome

Question 2

What are the criteria for Systemic inflammatory response syndrome (SIRS)?

Answer 2

Any of the following 2
Fever more than 38 or less than 36
HR higher than 90 BPM 
Respiratory rate more than 20 breaths pm 
PaCO2 less than 32 mmHg
Abnormal WBC count (>12,000 or <4,000)

Question 3

What is a band cell?

Answer 3

Immature neutrophil

Question 4

When would band cells appear in the blood?

Answer 4

When there is an inc need for neutrophils but its exceeds the bone marrow’s ability to make them
Usually half formed

Question 5

What is acute phase response?

Answer 5

Release of various proteins from liver in response to stimulation from IL-6 and other cytokines

Question 6

What is sepsis?

Answer 6

SIRS due to documented infection

Question 7

What is severe sepsis?

Answer 7

Sepsis with any sign of organ dysfunction

Question 8

Define septic shock.

Answer 8

Infection-induced hypotension that is unresponsive to attempts at volume expansion (IV fluids)

Question 9

What is disseminated intravascular coagulation (DIC)?

Answer 9

Systemic activation followed by depletion of clotting factors and subsequent hemorrhage

Question 10

Define multi-organ dysfunction syndrome.

Answer 10

Varying degrees of organ impairment secondary to SIRS

Question 11

What is compensatory anti-inflammatory response (CARS)?

Answer 11

Unregulated anti-inflammatory response leading to immune suppression and inc risk of infection

Question 12

What is acute respiratory distress response (ARDS)?

Answer 12

Inflammation to the lungs
Inflam moderators cause inc vascular permeability and up-regulation of adhesion molecules
Fluid, protein and neutrophils leave lung and enter alveoli
Results in hypoxia and bilateral pulmonary infiltrates

Question 13

What role does TNF-alpha play in sepsis/DIC?

Answer 13

Inc vascular permeability
Up-regulates adhesion molecules on endothelial cells
Induce expression of tissue factor on endothelial cells

Question 14

What role does IL-1 play in sepsis/DIC?

Answer 14

Induce fever

Up-regulate adhesion molecules on endotheial cells

Question 15

What role does IL-6 play in sepsis/DIC?

Answer 15

Release of acute phase proteins from liver

Induce expression of tissue factor on endothelial cells

Question 16

C5a and C3a lead to release of mediators from ____.

Answer 16

Mast cells

Question 17

System release of bacterial toxins and inflammatory mediators can lead to systemic inc in vascular permeability which in turns leads to;

Answer 17

Hypotension and pulmonary edema (ARDS)

Question 18

What leads to activation of clotting systems?

Answer 18

Cytokines and endotoxins

Question 19

If the system becomes hypotensive and clotting systems are activated what could that lead to?

Answer 19

Decreased organ perfusion (MODS) and ischemic necrosis (plague)