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Maricris Lerit BSN 4-A MULTIPLE ORGAN DYSFUNCTION SYNDROME (MODS) MODS is progressive impairment of two or more organ

gan system. This is the result of an uncontrolled inflammatory response to severe injury or illness. It is the another phase in the progression of shock.

CLASSIFICATIONS OF MODS Primary MODS is the result of direct tissue insult, which then leads to impaired perfusion or ischemia. Secondary MODS is most often a complication of septic shock or SIRS. CaUSES Dead or injured tissue Infection Perfusion deficits For acutely ill patients advanced age , malnutrition and coexisting diseases increase the risk of MODS.

PATHOPHYSIOLOGY OF MULTIPLE ORGAN DYSFUNCTION SYNDROME The exact mechanism that triggers this syndrome is unknown. Gut hypothesis: = The most popular hypothesis to explain MODS in critically ill patients is the gut hypothesis. Due to: o splanchnic hypoperfusion o subsequent mucosal ischaemia

there occurs structural changes and alterations in cellular function. This results in: o increased gut permeability, o changed immune function of the gut and o increased translocation of bacteria. Hepatic dysfunction leads to toxins escaping into the systemic circulation and activating an immune response. This results in tissue injury and organ dysfunction. Endotoxin macrophage hypothesis

Gram-negative infections in MODS patients are relatively common, hence endotoxins have been advanced as principal mediator in this disorder. It is thought that following the initial event , cytokines are produced and released. Tissue hypoxia-microvascular hypothesis o As a result of macro- and microvascular changes insufficient supply of oxygen occurs. Hypoxemia causes organ dysfunction and cell death. Integrated hypothesis o Since in most cases no primary cause is found, the condition could be part of a compromised homeostasis involving the previous mechanisms.

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