Pathology: shock

Question 0

Shock 3 possible mechanisms

Answer 0

Pump failure of heart
Loss of circulating fluid
Loss of peripheral vascular tone

Question 1

Shock

Answer 1

State of HYPOPERFUSION of tissue with blood

Question 2

Shock - what would happen?

Answer 2

Collapse of circulation

Disproportion of circulating blood volume and vascular space

Question 3

Shock results in

Answer 3

Tissue anoxia
Multi- organ failure
Cardiorespiratory failure

Question 4

Type of shock

Answer 4

1. Cardiogenic schock - pump failure of heart
2. Hypovolemic shock - “not enough volume” (blood)
3. Hypotonic shock - “not enough tone” (peripheral tissue)

Question 5

Cardiogenic shock

Answer 5

• results from heart pump failure
• most commonly follows infarction and destruction of large portion of functioning myocardium
• loss of contractile elements
• inability to pump
• may also follow myocarditis/valvular disease, conduction block or arrythmia

Question 6

Hypovolemic shock

Answer 6

• loss of circulatory volume

- can be due to massive hemorrhage or fluid loss (burns, vomiting, diarrhea)

Question 7

3. Hypotonic shock

Answer 7

• Results from the loss of vascular tone
• Blood pool in peripheral vessels
• Can be due to Anaphylatic shock, neurogenic stimuli (trauma/pain/cord injury), bacterial infection

Question 8

Events of shock

Answer 8

• Series of events, acting synergistically causing vicious cycles that if uninterrupted result in death
• early stages are treatable and reversible
• Once serious organ failure ensures, shock becomes irreversible
• can lead to ARDS (acute respiratory distress syndrome)

Question 9

ARDS

Answer 9

Acute Respiratory Distress Syndrome
“shock lung”
result of shock whereby lungs cannot unction properly
Pump failure, vasodilation, lead to low blood pressure
Leads to stagnation of blood in pulmonary circulation
Causes pulmonary edema

Question 10

ARDS - what happens tissue levels

Answer 10

Acute Respiratory distress syndrome

• breaks down alveolar-capillary unit of lungs
• leads to loss of lung function
• contributes to hypoxia/anoxia
• Anoxia of tissues leads to release of cytokines including TNF and IL-1
• Cause increased permeability of blood vessels and vasodilation

Question 11

what kind of cytokines Anoxia trigger?

Answer 11

TNF (Tumor necrosis factor) and IL-1 trying to increase permeability of blood vessels and vasodilation

Question 12

Clinical correlations of shock Three stages

Answer 12

1. Early or compensated shock
2. Decompensated but reversible shock
3. Irreversible shock

Question 13

1. Compensated shock

Answer 13

Set of adaptive characteristics to compensate

1. Tachycardia (increase heart rate)
2. Peripheral artery vasoconstriction (palour)
3. Reduced urine production to preserve volume of circulating blood
4. Blood pressure is normal
5. No serious signs of organ ischemia

Question 14

2. Decompensated shock

Answer 14

Results when early compensatory mechanisms fail

• hypotension (Blood pressure and cardiac output drop progressively)
• tachypnea (shortness of breath (SOB)/increased respiratory rate)
• Oliguria (less peeing renal fluid output decrease)
• Acidosis (Metabolic state: renal excretory failure and retention of metabolites) More acidic. Ph is dropping.

Question 15

Irreversible shock

Answer 15

End result of decompensated shock marked by
- circulatory collapse
- marked hypoperfusion (loss of blood flow) of vital organs
-loss of vital functions
Great distress, grave apprehension, unconsciousness, death, DIC (disseminated intravascular coagulation)

Question 16

DIC

Answer 16

Disseminated intravascular coagulation

Widespread clot formation due to Hypercoagulability of blood, fluid loss and hemoconcentration

Question 17

hypoprofusion

Answer 17

decrease the flow of the blood through organs