GI Disorders & Sepsis

Sepsis is a life-threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs. Various gastrointestinal (GI) disorders can increase the risk of developing sepsis. Here is a detailed overview of the risk factors and mechanisms by which GI disorders can lead to sepsis.

Common GI Disorders Associated with Sepsis

  1. Peritonitis:
    • Description: Inflammation of the peritoneum, the tissue lining the abdominal wall and covering abdominal organs, often due to bacterial infection.
    • Risk of Sepsis: Peritonitis can lead to the translocation of bacteria into the bloodstream, causing sepsis. It often results from perforation of the GI tract, which may occur due to conditions like peptic ulcer disease, diverticulitis, or bowel obstruction.

2. Diverticulitis:

  • Description: Inflammation or infection of small pouches (diverticula) that can form in the intestines.
  • Risk of Sepsis: Severe diverticulitis can cause perforation or abscess formation, leading to bacterial peritonitis and subsequent sepsis.

3. Inflammatory Bowel Disease (IBD):

  • Description: Chronic inflammation of the GI tract, including Crohn’s disease and ulcerative colitis.
  • Risk of Sepsis: Complications such as intestinal perforation, abscesses, and severe infections can increase the risk of sepsis in patients with IBD.

4. Bowel Obstruction:

  • Description: A blockage that prevents the contents of the intestines from passing normally.
  • Risk of Sepsis: Can lead to bowel ischemia, necrosis, and perforation, resulting in bacterial translocation and sepsis.

5. Peptic Ulcer Disease:

  • Description: Sores that develop on the lining of the stomach, lower oesophagus, or small intestine.
  • Risk of Sepsis: Complications like perforation and bleeding can lead to bacterial contamination of the abdominal cavity and sepsis.

6. Cholecystitis:

  • Description: Inflammation of the gallbladder, often due to gallstones blocking the cystic duct.
  • Risk of Sepsis: If untreated, cholecystitis can progress to gangrene or perforation, leading to sepsis.

Mechanisms Leading to Sepsis

  1. Bacterial Translocation:
    • Bacterial translocation occurs when bacteria from the GI tract cross the intestinal barrier and enter the bloodstream. This can happen due to increased intestinal permeability in conditions like IBD, bowel obstruction, or peritonitis.
  2. Impaired Immune Response:
    • Chronic GI conditions can weaken the immune system, making the body less capable of fighting off infections effectively, thus increasing the risk of sepsis.
  3. Inflammation and Tissue Damage:
    • Conditions like IBD and diverticulitis cause significant inflammation and tissue damage, which can facilitate bacterial entry into the bloodstream.
  4. Surgical Complications:
    • Surgeries for GI conditions, such as bowel resection or gallbladder removal, can sometimes result in postoperative infections leading to sepsis.

Key Indicators of Sepsis

  1. Vital Signs:
    • Fever or Hypothermia: A temperature greater than 38°C (100.4°F) or less than 36°C (96.8°F).
    • Tachycardia: A heart rate greater than 90 beats per minute.
    • Tachypnoea: A respiratory rate greater than 20 breaths per minute.
    • Hypotension: Systolic blood pressure less than 90 mmHg or a reduction of more than 40 mmHg from baseline.
  2. Signs of Infection:
    • Increased WBC Count: Leukocytosis (WBC >12,000/µL) or leukopenia (WBC <4,000/µL).
    • Altered Mental Status: Confusion, disorientation, or reduced level of consciousness.
    • Elevated Lactate Levels: Indicates tissue hypoxia and is a marker of severe sepsis.
  3. Organ Dysfunction:
    • Oliguria: Urine output less than 0.5 mL/kg/hr despite adequate fluid resuscitation.
    • Hypoxaemia: PaO2/FiO2 <300.
    • Coagulopathy: INR >1.5 or aPTT >60 seconds.
    • Thrombocytopenia: Platelet count <100,000/µL.

Clinical Red Flags

  • Acute Confusion: Sudden onset of confusion or altered mental status.
  • Mottled or Discoloured Skin: Indicates poor perfusion and potential circulatory failure.
  • Non-blanching Rash: May suggest meningococcal sepsis.
  • Shortness of Breath: Severe difficulty in breathing not attributed to other causes.

Sepsis Six Pathway:

  • A set of six interventions to be delivered within one hour of identifying sepsis, including administering high-flow oxygen, obtaining blood cultures, giving intravenous antibiotics, starting IV fluids, measuring lactate and haemoglobin, and monitoring urine output.