MODS
Terms
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- Primary MODS
- Organ Damage results directly from a specific cause such as ischemoa or inadequate tissue perfusion.
- Causes of Primary MODS
- Shock, Trauma or major surgery
- Sign Symptoms of MODS
- Stress and inflammatory responses may be mild and undetectable.
- Secondary MODS
- The next time there is an injury, ischemia or infection, the primed cells are activated, producing an exaggerated inflammatory response.
- Progression on secondary MODS
- The inflammatory response enters a self perpetuating cycle causing damage and vasolilation
- DIC
- Dissiminating intervascular coagulation
- MODS 24 hours after resuscitation
-
Low grade fever
Tachycardia
Dyspnea
Altered Mental Status
General hypermetabolic, hyperdynamic state. - MODS within 24 to 72 hours
- Pulmonary failure begins.
- MODS within 7 to 10 days
-
Hepatic failyre begins
Intestinal failure begins
Renal Failure begins - MODS after 21 days
- Death
- Bacteria
-
Single cell organisms with a cell membrane and cytoplasm but no organized nucleus.
Cause many common infections, and usually respond to antibiotic treatment - What does Bacteria Do?
-
Bacteria release toxins
-exotoxins are secreted during bacteria growth
-endotoxin are released when the bacteria die. - Sepsis, Septicemia
- The systemic release of toxins.
- Viruses
-
The most insidious
Smaller than bacteria and cause most infections - Virus structure
- No organized cellular structure except a protein coat (capsid) surrounding the internal genetic material (RNA and DNA)
- What do Viruses do?
-
Do not produce toxins
-they replicate and may cause a malignancy
-they may attack immune cells and destroy the ability to ward off infection. - Virus treatment
- They are difficult to treat and are usually treated symptomatically. Antibiotics are given to treat secondary infections.
- Fungi
- Dont usually cause anything more serious than minor skin infections (thrush is fungal infection)
- Parasites
-
are more common in developing nations than in the united states. treatment depends on the organism and its location.
(Giardia is a parasitic infection). Can be treated with antiparasitic medication. - Prions
- Most recently reconized class of infectious agents. They are similar to viruses but do not have protective capsids. (they affect neurologic tissue)
- Anatomic Barriers
-
Epithelium
Sebacious Glands
Sweat tears saliva
Mechanical responses-respiratory, urinary, GI - 3 lines of defense
-
Anatomic (external, nonspecific)
Inflammatory Response (internal, nonspecific)
Immune response (internal, specific;recognizes diseases and has antibodies) - Inflammatory Response
- Works quickly, the cleaning system, no memory, multiple plasma protein systems, multiple cell types
- Immune response
-
Very specifis
Has memory (long term), has antibodies, uses lymphocytes (one blood cell type), one plasma protien system. - Natural Immunity vs. Acquired Immunity
- Natural part of Genetic Makeup. Acquired developes as an outcome of the immune response: active-exposure, Passive:transferred from one person to another.
- Primary vs. Secondary Response
-
Primary: initial development of antibodies on response to the 1st exposure.
Secondary: swift, strong response of the immune system to repeated exposures to an antigen. - Humoral Immunity
- Humoral immunity is the long term immunity to am antigen provided by antibodies produced by B lymphocytes. Can not fight off all infections by themselves. Need both T and B cell counts to stay healthy.
- Cell Mediated Immunity
- Cell mediated immunity is short term immunity to an antigen provided by T lymphocytes.
- T Lymphocytes
-
Found in the thymus gland. old memory and killer cells directly attack incoming antigens.
Do not produce any antibodies
Recognize the presence of a foreign antigen and attack it directly. - B Lymphocyes
-
White Blood Cells
Respond to antigens and produce anibodies that attack the antigen.
Develop a memory for the antigen
Confer long term immunity to specific antigens - What are Lymphocytes
-
circulated throughout the body as part of the lymph system.
-B lymphocytes
-T lymphocytes
-Secretory lymphocytes
Are generated from stem cells in the bone marrow. - Components of Lymph System
- Consists primarily of interstitial fluid carrying proteins, bacteria and other substances.
- Location of Lymphatic System
-
Carries through lyphatic vessels are parralel but separate from blood vessels
2 lymph ducts in Thorax: Right(smaller drains right arm, right head & right side of thorax)and thoracic duct(larger in the left thorax drains the rest of the body) - Lymph Ducts
- Ducts drain into the right and left subclavian veins. Lymph is returned from the blood through the tissues to the lymph system.
- Induction of the immune response
- The immune response must be triggered or induced.
- Intigens and Immunogens
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Antigens that are able to trigger the immune response are immunogens.
Not every antigen can trigger an immune response. - Characteristics of Antigenetic Immunogenisity
-
Sufficient foreigness
Sufficients size
Sufficient complexity
Presence in sufficient amounts -
Histocompatibility Locus Antigens
HLA -
The body recon=gnizes if a substance is self or nonself made as a result of certain antigens that are present in almost all cells of the body except RBCs
This determines compatibility of tissues and organs that will be grafted or transplanted from a donor. - The Rh System
-
Present -Rh positive
Absent - Rh Negative
Problems may occir with pregnancy
-usually with the 2nd pregnancy
Incompatibility can cause severe problems
-hemolytic disease in infants - ABO System
-
The ABO blood group consistes of only 2 antigens named A & B
People with blood type A carry A antigens
B type B antigens
O carry no antigens (universal donors) - Type O
- Can give bood but can not receive blood.
- Blood Groups
-
O (no antigens, Anti-A & Anti_b antibodies)
AB (A and B antigens, no antibodies)
B(B antigen, Anti-A antibody)
A(A antigen, Anti-B antibody) - What B cells do
-
B cells specialize through the processes of clonal diversity and clonal release
Developing through maturing of white blood cells
Precursor develops receptors for every possible type of antigen may encounter.