Transcript 19 Sepsis

The sepsis
Volodymyr Voloshyn
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A sepsis is the inadequate reaction of
macroorganism to the action of
microorganism at the acute mionectic
(decreasing) reactivity or paralysis of
the immune system.
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The features of sepsis which select him from
other infectious diseases:
1. A sepsis is the polyetiologic disease. It can be caused by
many microorganisms. But foremost are staphylococcuss.
Meningococcuss, clebsiels, blue pus stick and mixe infections
also.
2. Epidemiology feature: it consists in noncontagious of this
disease. A sepsis is not reproduced in the experiment.
3. Clinical feature: cyclic absence, it is impossible to select
periods which characterized other infectious diseases (no
incubation periods, clinical manifestation is same for different
agents).
4. Immunologically: immunity is absence (at hyperactivity &
unadequate reactions).
Pathanatomy: local & general changes haven't specific
peculiarities.
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ENTRANCES GATE
(and septic locus)
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Fig. Chronic abscess of pancreas
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Local manifestation:
Lymphangitis,
Lymphthrombosis,
Lymphadenitis
Phlebitis,
Thrombophlebitis,
Thrombobacterial emboly
Pathoanatomical general manifestations
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Apostematic nephrite
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Fig. Septic myocarditis
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Primary bacterial
endocarditis,
lingering form.
Aortic valves with
fibrin changes,
mucous
degeneration
niduses, superficial
sores and
calcinosis.
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Hemorrhagic
syndrome
+
jaundice
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Bone marrow
hyperplasia
Enlargment of
lymphonods
Septic
spleen
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According to etiology a sepsis is divided into:
staphylococcus
collibacylaric
salmonelly
tubercular
meningococcuss
streptococcus
mycotic
Classification according to motion:
Lightning
Subacute
Acute
Chronic
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Acording to infection
atrium:
therapeutic
(parainfection);
tonsillar;
surgical;
Uterine (ginecologic);
otogenic;
odontogenic
umbilical
cryptogenic
Acording to clinic-signs:
septicaemia,
septico-piemia,
septic (bacterial)
endocarditis
and chroniosepsis.
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Stages of pathogeny
Syndrome of system inflammatory answer
(destruction of endothelia, mediators
cascade).
Septic arterial hypotensia (TNF).
Septic shock (cardiac weakness, violation of
microcirculation).
Syndrome of polyorganic insufficiency (“shock
kidney”, distress-syndrome and other).
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Septicemia
Enlarged spleen.
Blood smear with immature
erythroblastic cells (arrows)
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Septicemia
Septic myocarditis
Hemorrhagy
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Septicopyemia
septic embolus is in lungs
Multiple abscesses (arrows)
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Septicopyemia
Septic thromboembol
in the veins of
mediastinum
Osteomyelitis
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Septic (bacterial) endocarditis
Primary bacterial
endocarditis,
subacute
lingering form.
Aortic valves
with fibrin
changes,
mucous
degeneration
niduses,
superficial sores
and calcinosis.
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Septic endocarditis
Septic thromboembol
Secondary septic endocarditis
on a background Fallo tetrady
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the changes in lungs and
kidney at septic shock
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Peripheral sings
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Libman's petechial spots
Osler's palmar nodules
fingers "drumsticks"
local necrosis in subcutaneous tissue
Jeynuay's spots (hemorrhages in the skin and subcutaneous tissue)
jaundice
The sepsis of newborn
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The sepsis of new-born, or neonatal sepsis, is
named a sepsis, arising up on the first month of
life. The neonatal sepsis selection as special
clinico-morphologic variant is depended on
contingently in a number of features,
characteristic for physiology and pathology of
new-born, including substantial alteration of
postnatal haemodynamics, special state of
immune and haemopoetic systems, exchange of
matters and adjusting of homeostasis, high risk of
intrawomb infecting and other.
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To the present tense fundamental in studies
about a sepsis there are the followings
moments:
A sepsis is an original infectious disease with an
ancycling & has not a specific exciter and
caused by the massive receipt of various
conventional-pathogenic microflora in the
gumoral environment of organism.
A sepsis is accompanied chaotic development
of polyorganics pathological processes, primary
localization, character and degree of expressed
of which, depend on the functional full value of
the phagocytes system and adequacy of SIA
(system inflammation answer).
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EPIDEMIOLOGY
Frequency of sepsis among new-born makes
from 0.1 to 0.8%.
The special problem is presented by children,
being in the separations of reanimation and
intensive therapies, and prematurely new-born,
among which frequency of development of sepsis
on the average 14% makes (from 8.6 % to 25 %
in premature (28 – 31 weeks).
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ETIOLOGY
The sepsis is a generalized infectious disease,
caused by conditioned-pathogenic bacterial
microflora.
Just with a sepsis does not follow to summarize
the viral infections of different etiology and septic
forms of pathogenic bacterial infections
(salmonellosis, disseminated tuberculosis and
other), that have separated rubrics.
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More often by Str. agalacticae, collibacilluss (E.
coli), rarer — other representatives families of
gram-negative colibacilluss.
At the late sepsis of new-born, which develops
after 3 days of life and is usually by investigation
of the intranatal or postnatal infecting of foetus
and new-born, a lead role the B-streptococci
group plays.
At the postnatal sepsis of new-born the leading
etiologic role have staphylococcuss and
representatives of colibacilluss family,
streptococci groups, enterococci groups and
other.
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NOSOTROPIC FEATURES
The fundamental moment of pathogeny of new-born sepsis
there are ways of infecting, which have substantial
distinctions at the innate and postnatal variants of disease.
At innate sepsis infecting new-born carried out to or during
births.
At a postnatal sepsis the entrances are umbilical vessels,
skin covers, outward mucous membranes, lungs and
gastroenteric way.
The signs of violation of vaginal biocenosis there are more
than at the half of pregnant women (52%). The signs of
bacterial vaginosis were in 25,4%, heterospecific bacterial
kolpitis in 15%, caused conditioned-pathogenic microflora.
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Classification of new-born sepsis:
A. Depending on time and terms of development:
1- Early neonatal sepsis
2- Late neonatal extrahospital sepsis
3- Hospital (nozokomial).
B. Depending on the gate of entrances (localization of
primary septic focus)
Umbilical
Lung
Enterogenny
Dermic
Rinopharingea
Otogeny
Urogeny
Abdominal
Post-cannulation
C. Other Clinical forms
Septicaemia
Septicopyaemia
Septic shock
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Secondary septic endocarditis
on a background Fallo tetrady
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Septic (bacterial-toxic) shock is the special nosotropic variety of
septic process, caused the massive bacteria entering in the
circulatory system, them blasted fragments or toxic products of vital
functions from making progress niduses festering inflammations
(festering meningitis, pneumonia, hypodermic phlegmona, fibrinosisfestering peritonitis, festering osteomielitis and other). The
inadequate antibakterial drugs using lead to this very often.
The clinical picture of septic shock shows up sudden arterial low
blood pressure, resistant to adreno-mimetic introduction, that can
arise up not only at bacterial sepsis, but also at any other infectious
disease. In this situation in clinical practice more often use the
diagnosis — "infectiously-toxic shock" which depending from etiologic
factor can be bacterial, viral, mikotic and mixed (bacterial-viral,
bakterial-mikotic and other).
At the same time in majority supervisions of septic shock the gramnegative sticks, streptococci, enterococci are sown from blood of
patients. Lethality at development of shock exceeds 40%.
The shock are characterized by the expressed displays of intravessels
blood aggregation syndrome, which is marked in 10—15% cases of
sepsis new-born, thus with identical frequency at septicaemia and
septicopyaemia. This complication flows with development of
trombocytopenia, coagulopathies of consumption and depressions of
fibrinolysis.
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Candida gastric ulcer.
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Paratherapeutic (cannulation) sepsis.
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THE END again!
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