8/8/2019 Pa Tho Physiology of Sepsis Secondary to Typhoid Ileus

1/6

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

8/8/2019 Pa Tho Physiology of Sepsis Secondary to Typhoid Ileus

2/6

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

8/8/2019 Pa Tho Physiology of Sepsis Secondary to Typhoid Ileus

3/6

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

8/8/2019 Pa Tho Physiology of Sepsis Secondary to Typhoid Ileus

4/6

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

8/8/2019 Pa Tho Physiology of Sepsis Secondary to Typhoid Ileus

5/6

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

8/8/2019 Pa Tho Physiology of Sepsis Secondary to Typhoid Ileus

6/6

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