8/8/2019 Septic Shock is Treated Initially With a Combination of Antibiotics and Fluid Replacement

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Septic shock is treated initially with a combination of antibiotics and fluid replacement. The antibiotic is chosen basedon the bacteria present, although two or more types of antibiotics may be used initially until the organism is identified.Intravenous fluids, either blood or protein solutions, replace the fluid lost by leakageSeptic shock is a possible consequence of bacteremia, or bacteria in the bloodstream. Bacterial toxins, and theimmune system response to them, cause a dramatic drop in blood pressure, preventing the delivery of blood to theorgans. Septic shock can lead to multiple organ failure including respiratory failure, and may cause rapid death. Toxic

shock syndrome is one type of septic shock.

During an infection, certain types of bacteria can produce and release complex molecules, called endotoxins, thatmay provoke a dramatic response by the body's immune system. Released in the bloodstream, endotoxins areparticularly dangerous, because they become widely dispersed and affect the blood vessels themselves. Arteries andthe smaller arterioles open wider, increasing the total volume of the circulatory system. At the same time, the walls ofthe blood vessels become leaky, allowing fluid to seep out into the tissues, lowering the amount of fluid left incirculation. This combination of increased system volume and decreased fluid causes a dramatic decrease in bloodpressure and reduces the blood flow to the organs. Other changes brought on by immune response may causecoagulation of the blood in the extremities, which can further decrease circulation through the organs.

Septic shock is seen most often in patients with suppressed immune systems, and is usually due to bacteria acquiredduring treatment at the hospital. The immune system is suppressed by drugs used to treat cancer, autoimmunedisorders, organ transplants, and diseases of immune deficiency such as AIDS. Malnutrition, chronic drug abuse, and

long-term illness increase the likelihood of succumbing to bacterial infection. Bacteremia is more likely withpreexisting infections such as urinary or gastrointestinal tract infections, or skin ulcers. Bacteria may be introduced tothe blood stream by surgical procedures, catheters, or intravenous equipment.

WHAT YOU SHOULD KNOWSeptic shock is a life-threatening reaction to a severe infection. During septic shock, the body tissuesand organs do not get enough blood and oxygen.

Causes

The problem may start with a small infection that overwhelms the body's defenses and spreads. Insome severe infections, the germs make harmful toxins that can cause fluid to leak from blood vesselsout into the tissues. The toxins may also prevent the heart from beating strongly enough. Together,these reactions lower blood pressure. Ifblood pressure gets too low, the body and its organs become

deprived of oxygen. The body tries to help itself, but without enough oxygen, it makes too much of

certain waste products. These extra wastes can do additional harm.Signs/Symptoms

If you develop a small infection in one part of the body, the symptoms may include redness, swelling,and tenderness. Signs that the infection has spread throughout the body are fever, fast breathing,dizziness, and fast heart rate .

Care

Septic shock is an emergency that requires treatment in the hospital. While there, you will getmedicine to treat your infection, plus IV fluids, oxygen, and possibly medicine to raise the bloodpressure.

Risks

Without treatment, septic shock is usually a killer. The sooner you receive treatment, the better yourchances of recovery.

8/8/2019 Septic Shock is Treated Initially With a Combination of Antibiotics and Fluid Replacement

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Gastrointestinal bleeding: Introduction

Gastrointestinal bleeding is an abnormal condition in which there is blood or bleeding that appearswith vomiting, from the throat, from the rectum, or blood that accompanies or is mixed in with feces.Gastrointestinal bleeding is a symptom of a wide variety of conditions. They include peptic ulcer,intestinal polyps, diverticula, inflammatory bowel disease, gastrointestinal prolapse, colorectalcancer, gastrointestinal abscesses, intestinal infections, constipation, or anal fissures.

Gastrointestinal bleeding can also be a side effect of certain medications, such as aspirin, heparin,Coumadin, and ibuprofen. Gastrointestinal bleeding can indicate a mild condition, such ashemorrhoids, or it can accompany a serious, even life-threatening condition, such as esophagealvarices. Gastrointestinal bleeding can appear in a variety of forms. Bright red bleeding may occurduring vomiting or blood may be mixed with material that is vomited up (vomitus). Blood in smallamounts may also be hidden in vomitus and not be visible to the naked eyes. Blood in vomitus mayalso have a dark, black or coffee-ground appearance. This is often diagnosed as uppergastrointestinal bleeding. Blood clots can also be present with upper gastrointestinal bleeding.Gastrointestinal bleeding can also appear in small amounts of bright red blood that is mixed withstool or that shows up on toilet paper after wiping. Bright red blood can also be discharged from therectum in small to massive amounts without an accompanying Another type of gastrointestinalbleeding occurs when there is blacken blood mixed in with stool. Stools may appear black andtarry, or maroon in color. Blood in the stool may also be in such small quantities that it cannot be

seen by the naked eye (fecal occult blood). Bleeding from the rectum or blood in the stool may bediagnosed as lower gastrointestinal bleeding or upper gastrointestinal bleeding, depending on thelocation in the gastrointestinal tract where bleeding occurs. There are many complications andsymptoms that can accompany gastrointestinal bleeding, depending on the underlying cause of thebleeding. Symptoms often involve the gastrointestinal system but can affect other body systems aswell. For more details about symptoms and complications, see symptoms of gastrointestinalbleeding. Diagnosing gastrointestinal bleeding and its underlying cause begins with taking athorough personal and family medical history, including symptoms, and completing a physicalexamination. A digital rectal examination and testing for fecal occult blood are generally performedat this time. A digital rectal examination involves inserting a finger into the rectum to feel for anyabnormalities and obtain a sample of stool. The stool sample is then tested for fecal occult blood,which can indicate invisible, hidden blood in the stool. Your health care provider may also examinethe rectum in the office using an anoscope, which is inserted a short way into the rectum to look for

causes of gastrointestinal bleeding, such as internal hemorrhoids. Blood tests include a completeblood count (CBC), which can determine if there is significant enough bleeding to cause anemia.Blood clotting tests may also be done to evaluate how well the blood clots. Making a diagnosis ofgastrointestinal bleeding may also include performing special imaging tests to see a picture of theinsides of the gastrointestinal tract. These may consist of some combination of tests, such as abarium X-ray, CT scan, MRI, and a variety of tests using video imaging technology. These includesigmoidoscopy or colonoscopy. These tests involve passing a small flexible tube fitted with acamera through the anus into the colon to look for abnormal areas and sites of bleeding. During thisprocedure, samples of tissue may be taken to be tested to confirm a diagnosis. The upper areas ofthe gastrointestinal tract can be examined in a similar way through the mouth and esophagus in anendoscopy procedure.

Treatment of gastrointestinal bleeding varies greatly depending on the underlying cause and avariety of other factors. Some conditions can be easily and successfully treated, while other mayrequire intensive treatment.