What is Multiple Organ Failure?
Multiple organ failure is a serious general pathological condition characterized by a violation or lack of functioning of two or more systems of the body of a child, adolescent or adult.
She was isolated in a separate syndrome at the end of the last century. Researcher V. A. Gologorsky believes that when multiple organ failure occurs, changes in the body (disturbance) are of the same type, regardless of the reasons that led to this state of the body.
Causes of Multiple Organ Failure
The cause may be trauma, infection, tissue hypoperfusion, inflammation, hypermetabolism. These factors do not necessarily cause multiple organ failure. But any of them can lead to the development of multifocal pathophysiological processes. In cell damage mediators play an important role. Their amount during release depends on the severity of the damaging factor.
Pathogenesis during Multiple Organ Failure
In the pathogenesis of multiple organ failure in humans, important metabolic disorders play an important role. In the terminal stage of the disease, catabolism of muscle proteins is expressed. It occurs due to carbohydrates and fats if the patient is in a very serious condition, and if an irreplaceable energy deficit forms. A protein-dependent energy metabolism develops, which is based on the activation of proteolysis and the breakdown of structural proteins of vital organs, muscle tissue.
Activated viral and microbial toxins, as well as mast cells and macrophages secrete substances, which, in turn, can provoke tissue and cell damage. Free radical oxidation takes place in pathogenesis. It damages the cells.
In the development of multiple organ failure plays a role in the violation of the immune system, as well as septic processes. The most common causes of sepsis are gram-negative bacteria that enter the adult or child’s gastrointestinal tract into the bloodstream and organs. Therefore, researchers suggest that the gastrointestinal tract is a kind of generator of multiple organ failure.
In pathogenesis, an important role is given to:
- inflammatory mediators
- bacterial toxins
- homeostasis disorders
- endothelial damage
- microcirculation damage
In the body, there are phenomena of hypoxia and reperfusion, as a result of which aggregation and adhesion of neutrophils occur, and the endothelium is activated. Neutrophil mediators destroy the cell membrane in organs and tissues, which makes tissue hypoxia even worse. At the beginning of shock, the complement system, fibrinolysis, and coagulation are activated. Tissue trauma activates complement along the alternative path, and bacteria – along the classic and alternative paths.
The rate of production of pro-inflammatory cytokines is increasing. Tissue damage is increasing, which exacerbates the severity of multiple organ failure. In the initial stage of severe trauma, a large number of cells are activated that are synthesized by mediators that are toxic to tissues. A systemic inflammatory reaction occurs. Often systemic inflammation causes hypoxia and damage to organ function.
At the very beginning of the development of processes, the coagulation system is involved in the pathogenesis of multiple organ failure. Activation of the coagulation system and inhibition of fibrinolysis cause severe organ hypoperfusion.
Symptoms of Multiple Organ Failure
Symptoms manifested in multiple organ failure and their progress are caused, in most cases, by a combination of disorders in the respiratory and cardiovascular system, as well as disorders in the liver and kidneys of a person. Researchers identified 4 stages of the disease:
- latent (hidden)
- explicit
- decompensated
- terminal
It is difficult to diagnose multiple organ failure in time. A special study or retrospective analysis shows that even at the beginning of the disorders and the person there was a latent insufficiency of several or many organs. Modern methods for diagnosing this disease are imperfect.
The syndrome of multiple organ failure manifests itself in children with infectious diseases in their severe form. With a mild form of the disease, organ damage cannot be detected. But laboratory and instrumental methods can detect compensated or subcompensated multiple organ failure, which suggests that the condition may worsen, the functioning of these organs will become even worse in the future.
The growth of the toxic syndrome leads to the progression of bleeding disorders in the kidneys, skin, and liver; in extreme cases, ischemia and circulatory blockade develop, which are typical for the terminal stage of the disease. Also, in the blood of a person there is an accumulation of metabolites that have a toxic effect on the body, which is manifested in a violation of the excretory function of the kidneys, liver and gastrointestinal tract.
Violation of the biochemical processes of detoxification in the liver is proved by the accumulation of ammonia in the blood of children and adults with toxicosis. Free phenol is collected in the blood, in the liver it is bound to glucuronic or sulfuric acid, it must be excreted in the urine. An accumulation of medium-weight peptides in the blood indicates kidney failure.
The development of endotoxemia leads to a centralization reaction of systemic circulation, which also causes circulatory hypoxia of organs and tissues of the body. As for the lungs, respiratory distress syndrome occurs. Breathing is disturbed, the lungs swell, not enough oxygen enters the body. In humans, the pulse quickens and shortness of breath appears. Doctors can detect signs of cyanosis: pallor or blue skin, spotting on the skin. The limbs become cool.
As for the kidneys, with multiple organ failure there is a high risk of oliguria. Urine is retained in the body. If a person is an adult, he can notice it himself. If the child doesn’t “go to the toilet a little” a little, parents or his teachers can notice this. This symptom is manifested not only with multiple organ failure, therefore it is impossible to draw conclusions about the diagnosis solely from it.
If kidney function is impaired, protein, leukocytes and epithelium are found to be higher than normal in the urine, and red blood cells can also be found. When oliguria progresses, anuria develops.
As for the liver, with multiple organ failure cholestatic jaundice occurs. Manifestations are:
- bilirubin increase
- decreased number of bilirubin metabolites in urine and feces
- itchy skin
- sclera yellow
- itching of the skin gradually increases
- blood levels of bile acids and cholesterol are elevated
With multiple organ failure, DIC often occurs, in which diffuse blood coagulation is recorded. Microcirculation is blocked, which leads to changes of a dystrophic nature. DIC-syndrome can manifest itself as hemorrhagic syndrome, mainly the appearance of subcutaneous hematomas and bruising in the subcutaneous fat.
One of the manifestations of multiple organ failure in children and adults is increasing acute heart failure. OCH is considered one of the most severe circulatory disorders. The heart muscle loses its property of contraction, because pumping blood flowing through it is complicated at times, which leads inevitably to stagnation of blood. Asthma or pulmonary edema can become a consequence of developing AOS; all these conditions are extremely dangerous for human life.
With right ventricular failure as a manifestation of multiple organ failure, the liver can increase; all organs and tissues are poorly supplied with oxygen, swelling appears. It is becoming increasingly difficult for a person to breathe.
One of the manifestations of multiple organ failure is a stomach ulcer and 12 duodenal ulcer. In the upper abdomen, pains appear, which in most cases gradually increase. Peptic ulcer inevitably accompanies heartburn. Young children can not say about their feelings, because they can not suspect an ulcer on the above symptoms.
From the side of the central nervous system, multiple organ failure is manifested by lethargy, acute psychosis, and the extreme state is coma.
With multiple organ failure, DIC often occurs, in which diffuse blood coagulation is recorded. Microcirculation is blocked, which leads to changes of a dystrophic nature. DIC-syndrome can manifest itself as hemorrhagic syndrome, mainly the appearance of subcutaneous hematomas and bruising in the subcutaneous fat.
One of the manifestations of multiple organ failure in children and adults is increasing acute heart failure. OCH is considered one of the most severe circulatory disorders. The heart muscle loses its property of contraction, because pumping blood flowing through it is complicated at times, which leads inevitably to stagnation of blood. Asthma or pulmonary edema can become a consequence of developing AOS; all these conditions are extremely dangerous for human life.
With right ventricular failure as a manifestation of multiple organ failure, the liver can increase; all organs and tissues are poorly supplied with oxygen, swelling appears. It is becoming increasingly difficult for a person to breathe.
One of the manifestations of multiple organ failure is a stomach ulcer and 12 duodenal ulcer. In the upper abdomen, pains appear, which in most cases gradually increase. Peptic ulcer inevitably accompanies heartburn. Young children can not say about their feelings, because they can not suspect an ulcer on the above symptoms.
From the side of the central nervous system, multiple organ failure is manifested by lethargy, acute psychosis, and the extreme state is coma.
Treatment of Multiple Organ Failure
Multiple organ failure in many cases ends in death. To prevent death, timely and proper treatment is important. The treatment complex urgently needs to include methods of functional support of the vital organs:
- pacemaker
- mechanical ventilation
- cardiotonic preparations and vasopressors
Therapy includes methods of extracorporeal elimination of toxic substances:
- dialysis
- plasmapheresis
- hemosorption
- hemofiltration, etc.
These methods should be used until the functions of the human organs are restored, and the body will not be able to maintain its own homeostasis.
Prevention of Multiple Organ Failure
Specific methods of prevention are not developed.