Archive for the 'Sepsis' Category

23 Feb

Organ Interactions in the Adult Respiratory Distress Syndrome during Sepsis: Completing the Circle: Effects of Pulmonary Injury and Infection on the Liver

Completing the Circle: Effects of Pulmonary Injury and Infection on the Liver Lungs injured by blood-borne mechanisms during extrapulmonary sepsis are not passive bystanders in multiple organ dysfunction during ARDS, but instead may play active, sustaining roles in its evolution. The thesis has been advanced that pulmonary capillary endothelial injury alters pulmonary metabolism of vasoactive […]

21 Feb

Organ Interactions in the Adult Respiratory Distress Syndrome during Sepsis: Intermediary Role of the Liver in Protein Synthesis and Metabolism

Intermediary Role of the Liver in Protein Synthesis and Metabolism Synthesis of essential plasma proteins by hepatocytes in the acute-phase response plays a key role in modulating hepatic reticuloendothelial system phagocytic performance and controlling substrate fluxes during the hypermetabolism accompanying ARDS with multiple systems organ failure. The liver is a principal source of soluble fibronectin. […]

20 Feb

Organ Interactions in the Adult Respiratory Distress Syndrome during Sepsis: Metabolic Inactivation of Inflammatory Mediators by Hepatocytes

Metabolic Inactivation of Inflammatory Mediators by Hepatocytes Changes in normal hepatic parenchymal cell performance and hepatobiliary excretory function can significantly compromise host defense (Fig 1). Beside Kupffer cells, hepatocytes also clear endotoxin from the circulation under certain circumstances. Furthermore, hepatocytic clearance of two major endotoxin-induced inflammatory mediators limits their intravascular half-life. Hagmann et al found […]

15 Feb

Organ Interactions in the Adult Respiratory Distress Syndrome during Sepsis: Activated Hepatic Macrophages

Activated Hepatic Macrophages: Endogenous Mediator Release The pivotal role of the liver as a regulator of systemic host defenses affecting sepsis-induced acute pulmonary injury with multiple systems organ failure is not limited to its “import” or passive filtering function. Macrophages are target cells for endotoxin, and the liver contains most fixed tissue macrophages in the […]

14 Feb

Organ Interactions in the Adult Respiratory Distress Syndrome during Sepsis: Hepatic dysfunction

In addition to gut factors, severe hepatic dysfunction can independently influence both the gut-liver axis of intestinal endotoxin control and clearance of phlogistic substances of systemic origin. A clinical sepsis syndrome may result, with associated tissue hypoxia and multiple organ failure. Acute, fulminant, or end-stage hepatic failure thus represents a paradigm of impaired host defense. […]

06 Feb

Organ Interactions in the Adult Respiratory Distress Syndrome during Sepsis: Impact of the liver

Several anatomic factors account for the impact of the liver on control of systemic endotoxemia and bacteremia: (1) its strategic location immediately downstream from the large gastrointestinal (GI) reservoir of these substances; (2) the characteristics of the splanchnic circulation—receiving 25 percent of the cardiac output and comprising 20 to 25 percent of the systemic blood […]

05 Feb

Organ Interactions in the Adult Respiratory Distress Syndrome during Sepsis: Control of Systemic Endotoxemia and Bacteremia

Control of Systemic Endotoxemia and Bacteremia: Role of Hepatic Mononuclear (Kupffer) Cells Circulating Gram-negative bacterial endotoxin has been extensively implicated in the mediation of early pathogenetic events relevant to sepsis-induced ARDS with multiple systems organ failure. There are a variety of mechanisms, including direct cytotoxic effects of endotoxin on endothelial cells, induction of endothelial cell […]

03 Feb

Organ Interactions in the Adult Respiratory Distress Syndrome during Sepsis

Role of the Liver in Host Defense Respite increasing sophistication in antimicrobial therapy and intensive care support of failing organs, mortality in critically ill patients with the adult respiratory distress syndrome (ARDS) and progressive multiple systems organ failure accompanying Gram-negative bacterial sepsis still exceeds 60 percent and shows no sign of decreasing, However, the pathophysiologic […]

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