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29 Cards in this Set
- Front
- Back
SIRS needs >=2 of these 4 conditions
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-Temperature >38oC or <36oC
-Tachycardia (Heart rate >90 beats/min) -Hyperventilation (Respiratory rate >20 breaths/min or PaCO2 <32 mm Hg) -WBC count >12,000/mm3, <4000/mm3, or >10% immature (band) forms |
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Sepsis - definition, manifestation
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-A systemic inflammatory response to a documented infection.
-Manifestations are the same as SIRS |
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severe sepsis/SIRS - associations, clinical findings
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-organ dysfunction, hypoperfusion or hypotension.
-lactic acidosis, oliguria or an acute alteration in mental status |
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septic/SIRS shock - definition?
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-Hypotension despite adequate fluid resuscitation along with organ dysfunction
-An acute alteration in mental status |
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multiple organ dysfunction syndrome - definition?
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Presence of altered function in more than one organ such that homeostatis cannot be maintained without intervention
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mortality rates in sepsis
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SIRS 2: 7%
SIRS 3: 10% SIRS 4: 17% Sepsis: 16% Severe Sepsis: 20% Septic Shock: 46% |
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risk factors for developing sepsis?
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Cytotoxic agents
Immune: immunosuppressive agents, AIDS Malnutrition: Alcoholism, Malignancy, Diabetes mellitus |
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increase in sepsis cases b/c of?
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transplant recipients
use of aggressive invasive procedures in patient management and diagnosis resistant organisms elderly patients |
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Role of TLR1/6 TLR2
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recognize gram-positive bacteria
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Role of TLR3
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recognize double stranded RNA
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Role of TLR4
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Recognition of LPS, pili, RSV F protein
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Role of TLR5?
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recognition of gram negative flagellin
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Role of TLR9?
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recognize unmethylated CpG DNA
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unmethylated CpG is associated with?
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-intracellular viral DNA from pathogens
-oncogenes |
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chemokine - definition?
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chemotactic cytokine
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cytokines - examples, produced where, released how?
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-proteins, peptides, or glycoproteins
-produced widely throughout the body by cells of diverse embryological origin -secreted by immune system |
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pyrogen - definition
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cytokine that induces elevation in body temperature (via hypothalamus)
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TLR agonists affect liver and hypothalamus via?
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-macrophages and epithelial cells
-IL1, IL6, TNF-alpha |
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acute phase reactants from liver include
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-C-reactive protein
-mannose binding lectin -surfactants -complement components |
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neurophil and monocyte infiltration at infection caused by
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-chemokines
-adhesion molecule expression on neutrophils, monocytes, endothelial cells |
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adhesion molecule expression on neutrophils, monocytes, endothelial cells increased by
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IL1, IL6, TNF-alpha
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TLR agonists cause systemic inflammatory response with these three pathways?
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-cytokines
-complement system -coagulation |
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cytokine suppression caused by?
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vagus n. innervating spleen (autonomic nervous system, cholinergic)
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cytokine promotion caused by?
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catecholamines (adrenergic)
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adrenergic definition
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having to do with adrenaline (epinephrine) and/or noradrenaline (norepinephrine)
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therapies for sepsis syndrome and septic shock include?
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-antibiotics
-adequate fluid administration -oxygen -vasopressors (norepinephrine) -activated protein C (rhAPC) |
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DIC - molecular pathway, results in
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-TLR agonist, tromplastin (Tissue Factor), thrombin, fibrin clots
-hypoperfusion, tissue ischemia, coagulation necrosis, organ dysfunction |
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candidate genes for sepsis outcome modulation include?
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TNFa,TNFb
IL-1 receptor antagonist, IL-6, IL-10 TLR4, TLR2 CD14 |
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protein C maintains hemostasis by?
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feedback inhibition of prothrombin to thrombin conversion
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