SIRS Aystemic Inflamatory Response Syndrome / Never heard of it connected to liver disease

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http://en.wikipedia.org/wiki/Systemic_inflammatory_response_syndrome            \

                                       

In medicine, systemic inflammatory response syndrome (SIRS) is an inflammatory

state affecting the whole body, frequently in response to infection, but not

necessarily so. It is related to sepsis, a condition in which individuals both

meet criteria for SIRS and have a known or highly suspected infection.

The latest finding shows that SIRS in trauma patients may be caused by immune

reaction to mitochondria massively released into bloodstream from dying cells at

the site of injury.

 

 Classification

SIRS is a serious condition related to systemic inflammation, organ dysfunction,

and organ failure. It is a subset of cytokine storm, in which there is abnormal

regulation of various cytokines.[citation needed] SIRS is also closely related

to sepsis, in which patients satisfy criteria for SIRS and have a suspected or

proven infection.[2][3][4]

 Definition

SIRS was first described by Dr. R. , of the University of Toronto,

at the Nordic Micro Circulation meeting in Geilo, Norway in February of 1983.

The intent of creating an encompassing definition was to bring together the

multiple etiologies or post episode organ dysfunction (fibrin deposition,

platelet aggregation, coagulopathies, leukocyte lysosomal release) into a family

of negatively synergistic responses to injury and/or infection which can

collectively lead to micro circulatory dysfunction. The implication of such a

definition suggested that recognition of the activation of one of the above

noted humoral pathways suggests that additional processes are also active. The

aggregate of such path-physiology would lead to clinical conditions such as

renal failure and/or pulmonary edema.

Criteria for SIRS were established in 1992 as part of the American College of

Chest Physicians/Society of Critical Care Medicine Consensus Conference.[2] The

conference concluded that the manifestations of SIRS include, but are not

limited to:

* Body temperature less than 36°C or greater than 38°C

* Heart rate greater than 90 beats per minute

* Tachypnea (high respiratory rate), with greater than 20 breaths per minute;

or, an arterial partial pressure of carbon dioxide less than 4.3 kPa (32 mmHg)

* White blood cell count less than 4000 cells/mm³ (4 x 109 cells/L) or greater

than 12,000 cells/mm³ (12 x 109 cells/L); or the presence of greater than 10%

immature neutrophils (band forms)

SIRS can be diagnosed when two or more of these criteria are

present.[3][4][5][6]

The International Pediatric Sepsis Consensus has proposed some changes to adapt

these criteria to the pediatric population[7].

Fever and leukocytosis are features of the acute-phase reaction, while

tachycardia is often the initial sign of hemodynamic compromise. Tachypnea may

be related to the increased metabolic stress due to infection and inflammation,

but may also be an ominous sign of inadequate perfusion resulting in the onset

of anaerobic cellular metabolism.

In children, the SIRS criteria are modified in the following fashion:[8]

* Heart rate > 2 standard deviations above normal for age in the absence of

stimuli such as pain and drug administration, OR unexplained persistent

elevation for greater than 30 minutes to 4 hours. In infants, also includes

Heart rate < 10th percentile for age in the absence of vagal stimuli,

beta-blockers, or congenital heart disease OR unexplained persistent depression

for greater than 30 minutes.

* Body temperature obtained orally, rectally, from Foley catheter probe, or

from central venous catheter probe > 38.5 °C or < 36 °C. Temperature must be

abnormal to qualify as SIRS in pediatric patients.

* Respiratory rate > 2 standard deviations above normal for age OR the

requirement for mechanical ventilation not related to neuromuscular disease or

the administration of anesthesia.

* White blood cell count elevated or depressed for age not related to

chemotherapy, or greater than 10% bands + other immature forms.

Note that SIRS criteria are very non-specific,[9] and must be interpreted

carefully within the clinical context. These criteria exist primarily for the

purpose of more objectively classifying critically-ill patients so that future

clinical studies may be more rigorous and more easily reproducible.

As an alternative, when two or more of the systemic inflammatory response

syndrome criteria are met without evidence of infection, patients may be

diagnosed simply with " SIRS. " Patients with SIRS and acute organ dysfunction may

be termed " severe SIRS. "

 Complications

SIRS is frequently complicated by failure of one or more organs or organ

systems.[2] The complications of SIRS include:

* Acute lung injury

* Acute kidney injury

* Shock

* Multiple organ dysfunction syndrome

 Causes

The causes of SIRS are broadly classified as infectious or noninfectious. As

above, when SIRS is due to an infection, it is considered sepsis. Noninfectious

causes of SIRS include trauma, burns, pancreatitis, ischemia, and hemorrhage.[2]

Other causes include:[citation needed]

* Complications of surgery

* Adrenal insufficiency

* Pulmonary embolism

* Complicated aortic aneurysm

* Cardiac tamponade

* Anaphylaxis

* Drug overdose

Treatment

Generally, the treatment for SIRS is directed towards the underlying problem or

inciting cause (i.e. adequate fluid replacement for hypovolemia, IVF/NPO for

pancreatitis, epinephrine/steroids/benadryl for anaphylaxis).[1] Selenium,

glutamine, and eicosapentaenoic acid have shown effectiveness in improving

symptoms in clinical trials.[10] Other antioxidants such as vitamin E may be

helpful as well.[11]