Gambaran Radiologi Ileus Obstruktif dan Ileus Paralitik.pptx
Pa Tho Physiology of Sepsis Secondary to Typhoid Ileus
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Transcript of Pa Tho Physiology of Sepsis Secondary to Typhoid Ileus
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8/8/2019 Pa Tho Physiology of Sepsis Secondary to Typhoid Ileus
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PATHOPHYSIOLOGY OF SEPSIS SECONDARY TO TYPHOID ILEUS
Factors:
contaminated food and/or drinkno typhoid vaccine
environment
gram (-) bacteria
Salmonella typhi
Survive gastric pH
Small intestine (ileus)
Penetrates mucosa of small intestine to midlayer
Engulfed by macrophages/ monocytes into the epithelial cells in the Peyers patches
endotoxin
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Release of inflammatory cytokines:
Tumor Necrosis Factor
Interleukin-1
others
Endothelial
damage
Peripheral
vasodilation
Selective
vasodilationIncrease
capillary
permeability
microemboli
fever Maldistribution of
circulatory blood
volume
Decrease cellular
oxygen supply
Decrease tissue perfusion
Reticuloendothelial system
liver spleen Bone marrow Gall
bladder
hapatomegaly
Blood chem:
decrease ALT
and AST
spleenomegaly
leukopenia
lymphocytosis
anemia
Ongoing
exposure
CBC:WBC- 1.6
CBC:
RBC- 3.8
HGB- 117
HCT- 0.36
CBC:
Lymphocytes-0.64
Impaired
cellular
metabolism
GI
Impaired
immunologic
function
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ischemia
Necrosis and
ulceration
Gastric/ intestinal
bleeding
Bowel
perforationAbdominal pain
SFA:Dilated loop of
bowel
Coffee groundgastric aspirate
constipation Persistence ofprecipitating cause
Persistent hypotension
Symphatetic Nervous System stimulation
Baseline BP: 60/60
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Alpha adrenergic receptor
stimulation
Beta adrenergic receptor
stimulation
Widespread vasoconstriction myocardium
capillaries
hydrostaticpressure
Fluid shift
IV to IT
Decrease
circulatoryvolume
Dry skin
Slow capillary
refill
renal
RAAS
Increase
arteriolear
constriction
lungs viscera
Pulmonary
arterioles
constriction
hypoxemia
Decrease oxygenavailability
Crackles
DOB
tachypnearetractions
Decrease
myocardial
contractility
Increase
heart rate
Heart rate
>90
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Urinalysis:
(+) Albumin
Progressive tissue hypoxia Renal tubular ischemia
Renal dysfunction
Albumin not reabsorbed
Pallor
Cyanosisrestlessness
Anaerobic metabolism
Metabolic lactic acidosis Increase capillary
permeability
Precapillary spinchterdilation
Pooling and stasis of blood
in capillary bed
Increase capillary hydrostatic
pressure
Movement of fluid from IV to IT
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Blood
chemistry:
Albumin- 3.2
Decrease venous return Movement of plasma
proteins from IV to IT
Decrease cardiac output
hypotension
Peripheral
vasoconstriction
Further tachycardia
Decrease coronary blood flow
Myocardial depression
Decrease cardiac output and heart rate
Decrease cerebral blood flow
Severe cerebral ischemiaFailure of vasomotorcenter to stimulate
sympathetic nervous
system
Respiratory
arrest
Cardiac
arrest
DEATH