Small Ani. Med- SIRS and Sepsis

wilsbach's version from 2016-05-02 06:10

SIRS= systemic inflammatory response syndrome!!

Question Answer
what does SIRS happen? The body’s systemic response to an insult that is *infectious OR *non-infectious in origin
what is bacteremia?presence of live bacterial organisms in the blood stream
what is Sepsis?the clinical syndrome caused by infection and the hosts inflammatory response to it; can be bacterial, viral, protozoal, fungal
what makes it "Severe" sepsissepsis complicated by dysfunction of one or more organs
what is Septic shock?acute circulatory failure and persistent arterial hypotension (despite fluid resuscitation) with sepsis
what is Multiple Organ Dysfunction Syndrome? physiologic derangements of organ systems associated with progressive uncontrolled systemic inflammation and disseminated intravascular coagulation
**SIRS is a clinical state rather than a disease process. there has to be at least 2 (or 3 if youre a cat) abnormal parameters in the 4 things here...temp, HR, RR, WBC count
what triggers the clinical state of SIRS?Any disease state known to cause widespread release of pro-inflammatory endogenous mediators & subsequent inflammation (sepsis, trauma, burn wounds, major sx, pancreatitis)
what are the major consequences of SIRS?Homeostatic disruption, Multiple organ failure (MODS), shock, death. ** The magnitude of the inflammatory response alone can trigger any of these!
Infectious causes of SIRS (septic SIRS) can include infections with Gram positive & gram negative bacteria, fungi. These can trigger SIRS because.. They have Activators of white blood cells (specific things which trigger this) such as: Lipoloysaccharide (gram -), Lipoteichoic acid (gram +), Peptidoglycan (both -/+), Flagellin (both -/+), Mannan (fungi)
leukocyte activation as a response to infection leads to what? why does this happen? what are the consequences?Activation of leukocytes from bacterial/fungal antigen leads to release of inflammatory mediators (TNF α, Interleukin 1, 6, bradykinin, etc) which cause a PROTECTIVE response. HOWEVER--- EXCESSIVE ACTIVATION leads to: tissue damage, mult organ failure, death
What is going on in Compensatory anti-inflammatory response (CARS)?There is a Release of anti-inflammatory mediators (IL-10, TGF-β, IL-13) which ATTEMPTS to control the pro-inflammatory state. If this system is excessively stimulated, it can lead to immune paralysis and inc susceptibility of infections (incld nosocomial)
things that can cause SIRS in animals include..Sepsis, Heat stroke, Pancreatitis, Immune disease, Neoplasia, Severe polytrauma, Burns
how do SIRS and sepsis relate?SIRS is an important part of sepsis, but SIRS can happen without sepsis (Can be inflammatory not just infectious)
how do you differentiate septic SIRS vs non-septic SIRS?Culture is one option (takes a while, wont detect viral or protozoal, media makes a diff)... You can also look at BIOLOGICAL MARKERS though, which May help to identify the presence or lack of bacterial infection in patients with clinical signs of SIRS.
**2 biological markers which can help you differentiate between infectious and non-infectious SIRS? C-reactive protein (CRP), Procalcitonin
what is C-reactive protein? what does it tell you?it is a Acute-phase protein made in hepatocytes In response to inflammatory cytokine release.HOWEVER, May be elevated secondary to other inflammatory causes (Trauma, surgery, pancreatitis) and has a long half life. Therefore not the ideal marker
what is Procalcitonin? What does it tell you? Precursor molecule to calcitonin, Produced by thyroid gland, In sepsis comes from leukocytes that have been stimulated by cytokines & endotoxins and Peak levels for up to 24 hours. May be useful in identifying “bacterial” sepsis (not so much for viral)...might be able to used as a guide to starting abx
Clinical signs of SIRS +/- sepsis?Signs may be non-specific (Vary depending on underlying disease process) but can see Loss of appetite, Depression, “Injected” hyperemic mucus membranes, Bounding peripheral pulses, Compensated hyper dynamic state, Vomiting, diarrhea
what are common lab parameters to see with SIRS? Hyper/hypoglycemia, hypoalbuminemia, elevated ALT, AST, Tbili (Potentially many other changes /abnormalities such as Acid-base, electrolytes, renal values……..)
Why is glucose high or low with SIRS?due to Altered carbohydrate metabolism! There is increased gluconeogenesis in early phases (hyperglycemia), and then Hypoglycemia occurs later as Excessive utilization exceeds production
why is there hypoalbuminemia in SIRS?Reduced 2’ to acute-phase protein production. Loss due to vascular permeability
why are there inc liver enzymes/Tbili with SIRS?Changes in perfusion and oxygen delivery (in the DOG, LIVER IS THE SHOCK ORGAN) and cholestasis can lead to elevated Tbili
mainstays of therapy?Treat underlying disease process!! Supportive care, abx pending culture/sensitivity results if bacterial infection present OR suspected (what type of antibiotics?- depends on what it is. remember super broad everything coverage would be BAM- baytril, amoxicillin, and metro). Also O2, GI support, glucose, fluids, albumin, vasopressors, coag support, elyte balance, nutrition