| Abstract | Tijekom godina definicije sepse su se izmjenjivale, a definicija koja je danas u upotrebi
glasi da je sepsa disfunkcija organa uzrokovana nereguliranim odgovorom domaćina na
infekciju. Ključni pojmovi za razumijevanje sepse su sindrom sistemskog upalnog odgovora
(SIRS), sindrom kompenzacijskog upalnog odgovora (CARS), višestruko otkazivanje organa
(MODS) i septični šok. Kada uz SIRS nastupi MODS, dolazi do septikemije. Sepsu najčešće
uzrokuju crijevne gram negativne bakterije i najčešće nastaje zbog curenja sadržaja iz
gastrointestinalnog trakta i posljedično septičnog peritonitisa. Sepsa započinje upalom, a
kasnije se pogoršava s neuravnoteženim upalnim odgovorom. Patogeni mikroorganizmi
oslobađaju molekule (DAMP i PAMP) primjerice lipopolisaharide, endotoksine i egzotoksine
koji potiču oslobađanje citokina. Oni dovode do raznih promjena u organizmu poput
vazodilatacije, povećane permeabilnosti krvnih žila i mobilizacije upalnih stanica. Zbog njih
nastupa oštećenje endotelnih stanica i endotelnog glikokaliksa, a posljedično dolazi do
poremećaja koagulacijske kaskade,stvaranja mikrotromba i hipoksije tkiva. Klinička slika ovisi
o organskom sustavu u kojem je infekcija nastala. Kod pasa u sklopu hiperdinamskog odgovora
nastaje vrućica, hiperemija mukoznih membrana, tahikardija i naglašeni puls. U slučaju pojave
hipodinamskog odgovora dolazi do hipotenzije, blijedila mukoznih membrana i hipotermije.
Najčešće prvo nastupa hiperdinamski sindrom, a kasnije hipodinamski. Kod mačaka se javlja
hipodinamski sindrom gdje nastupa bradikardija, hipotermija, abdominalna bol i slabe kvalitete
bila. Dijagnostika sepse temelji se na dokazu mikroorganizma iz uzoraka poput krvi, urina,
izlijeva, iscjetka iz rane, sinovijalne tekućine i slično. Uz dokaz infekcije, da bi sepsa bila
potvrđena, 2 ili više parametra na SOFA skali moraju biti promijenjena. Promptni početak
liječenja uključuje terapiju tekućinama, primjenu antibiotika širokog spektra do dolaska
rezultata antibiograma, a potom ciljanu, vazopresore, antiemetike, analgetike, inhibitore
protonske pumpe, antiulkusne lijekova, terapiju kisikom i potporu hranjenju. |
| Abstract (english) | Over the years, the definitions of sepsis have evolved and the definition in current use
states that sepsis is an organ dysfunction caused by a dysregulated host response to infection.
Key terms for understanding sepsis are: systemic inflammatory response syndrome (SIRS),
compensatory anti-inflammatory response syndrome (CARS), multiple organ dysfunction
syndrome (MODS), and septic shock. When SIRS and MODS occur together, septicemia
develops. The most common cause of sepsis are gram negative bacteria from the intestinal tract.
For example, when there is a leakage of content that lead to septic peritonitis. Sepsis begins
with inflammation, and later progresses due to an imbalanced inflammatory response. Pathogen
microorganisms release molecules (DAMPs and PAMPs) such as lipopolysaccharides,
endotoxins and exotoxins, which stimulate the release of cytokines. These cytokines lead to
extensive changes in the host, such as vasodilatation, increased vascular permeability and
mobilization of inflammatory cells. As a result, endothelial glycocalyx becomes damaged,
leading to disturbances in the coagulation cascade, microthrombus formation and tissue
hypoxia. Clinical signs depend on the organ system where infection is located. In dogs, there is
hyperdynamic response which includes fever, hyperemia of mucus membranes, tachycardia and
a bounding pulse, there is also a hypodynamic response, where hypotension, pale mucus
membranes and hypothermia occur. Typically, the hyperdynamic syndrome appears first,
followed by the hypodynamic phase. In cats, a hypodynamic syndrome is more common,
presenting with bradycardia, hypothermia, abdominal pain and a weak pulse. The diagnosis of
sepsis is based on the detection of microorganisms from samples such as blood, urine, effusions,
wound exudate, synovial fluid and others. In addition to proving infection, two or more SOFA
score parameters must be altered. Treatment must begin quickly. It is important to stabilize the
patient with fluid therapy and administration of broad-spectrum antibiotics until antibiogram
results are available. Additionally, vasopressors, antiemetics, analgesics, proton pump
inhibitors, anti-ulcer drugs may be required and sometimes oxygen therapy or a feeding tube
may be necessary |
