LRINEC Scoring System

Question 1

LRINEC score for Necrotizing fascitis …

Answer 1

Nac wash التحشيشة*
*في كله max score 2 ماعدا
Glucose 1
Crp 4
* Wbcs,hb هما اللي فيهم تدريجات
يلا نبدأ
*Na level:
<135 mmol/L: 2 points
*Creatinine:
>1.6 mg/dl: 2 points
*WBC:
<15,000/cu.mm: 0 points
15,000-25000/cu.mm: 1 point
>25,000/cu.mm: 2 points
*Acute phase reactant (CRP):
≥150: 4 points
*Sugar:
>180 mg/dl (10 mmol/l): 1 point
*Hemoglobin:
>13.5 g/dl: 0
11-13.5 g/dl: 1
<11 g/dl: 2
متنساش…

Question 2

Causes of hyperbillrubeinemia in sepsis:
*Hemolysis
*Ishemic hepatitis
*Hepatocellular dysfunction
*DILI
*Billiary infection
*Sepsis induced cholestasis

Answer 2

1-Hemolysis:
Sepsis (especially due to Gram-negative organisms or malaria) can cause hemolysis, increasing unconjugated bilirubin.

2-Hepatocellular dysfunction (sepsis-associated liver injury)
Hypoperfusion and endotoxemia impair hepatocyte function, leading to decreased conjugation and excretion of bilirubin.
3-Ischemic hepatitis (“shock liver”)
Hypoperfusion lead to decrase blood supply lead to hepatic ischemia.
4-Drug-induced liver injury
Antibiotics and other drugs used during sepsis may cause hepatotoxicity or cholestasis.
5-Disseminated intravascular coagulation (DIC)
Microthrombi in hepatic vasculature impair liver function.
6-Infection-induced biliary obstruction
Conditions like cholangitis or cholecystitis can cause obstructive jaundice.
7-Sepsis-associated cholestasis
Inflammatory cytokines (e.g., TNF-α, IL-6) impair bile secretion by hepatocytes and cholangiocytes.