Question

QUESTION 41 During SIRS, which mechanism causes most capillary damage? Lack of oxygen in the blood. Cytokine-induced activation of the blood clotting pathway. Type Il bacterial toxins. Cytokine-induced extracellular killing by neutrophils within blood vessels.

Answer 1

option B is the correct answer.

Systemic inflammatory response syndrome is an exagrated defense response of the body to a noxious stresser to localize and then eliminate the endogenous or exogenous source of the insult.Immune effector cells at the site releases cytokines,that causes the wound repair through local inflammation.There is a local vasodilation induced by nitric oxide and prostacyclin and disruption of the endothelial tight junction to allow margination and transfer of leucocytes into tissue space.The leakage of cells and protein rich fluid in extravascular space causes swelling and increased heat.There is a stimulation of growth factors and recruitment of macrophages and platelets as the level of pro-inflammatory mediators decreases to maintain homeostatis.When ths scale tips over towards pro-inflammatory SIRS resulting in progressive endothelial dysfunction,caogulopathy and activation of coagulation pathway.It results in end organ micro thrombosis,and a progressive increase in capillary permeability,eventually resulting in loss of circulatory integrity.Activation of interleukin which causes propagation of cytokine pathway,alteration of coagulation causing microcirculatory abnormalities,and release of stress hormones.This condition is a conglomeration of clinical manifestations of a triggering cause;so management focuses on the treatment of the primary triggering condition.