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Path Shock
KYCOM Block 11
52
Pathology
Graduate
10/30/2013

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Cards

Term
define shock
Definition
cardiovascular collapse
Term
5 causes of shock
Definition
hemorrhage
trauma of burns
MI
pulmonary embolism
sepsis
Term
MOA of shock
Definition
systemic hypoperfusion due to reduced CO and VO

hypotension, impaired tissue perfusion, cellular hypoxia

initially cellular injury is reversible but over time it becomes irreversible
Term
5 types of shock
Definition
cardiogenic
hypovolemic
septic
neurogenic
anaphylactic
Term
what causes cardiogenic shock
Definition
myocardiacal pump failure
Term
what are 2 examples of cardiogenic shock
Definition
MI
ventricular arrhythmia
Term
what are 5 signs of cardiogenic shock
Definition
hypotension
weak rapid pulse
cool, clammy, cyanotic
Term
what are the two areas of dysfunction in cardiogenic shock
Definition
systolic dysfunction
diastolic dysfunction
Term
what is the progression of systolic dysfunction in cardiogenic shock
Definition
ventricular ischemia, structural compormize, or dysrhythmia causes

systolic dysfunction which causes

decrease in SV which causes

decrease in CO which causes

cellular oxygen delivery decrease
Term
what is the progression of diastolic dysfunction in cardiogenic shock
Definition
decreased filling in diastole causes

pulmonary hypertension and edema which causes

decreases oxygenation of blood which causes

tissue hypoxia
Term
what is the caue of hypovolemic shock
Definition
loss of blood or plasma volume
Term
what are three examples of causes of hypovolemic shock
Definition
hemorrhage
burns
trauma
Term
what are 5 signs of hypovolemic shock
Definition
hypotension
weak rapid pulse
cool, clamy, cyanotic
Term
what is the MOA of hypovolemic shock
Definition
relative or absolute hypovolemia leads to

decreased BV, venous return, SV, CO which causes

decreased cellular oxygen delivery
Term
define septic shock
Definition
shock caused by systemic microbe infection
Term
what usually causes septic shock
Definition
gram negative endotoxin producing bacilli
Term
how do microbes cause septic shock
Definition
LPS released when cell wall is degrated from inflammatory response
Term
why is antibiotic treatment difficult in septic shock
Definition
antibiotics could make things worse initially by breaking up LPS
Term
define septic shock
Definition
shock caused by systemic microbe infection
Term
what usually causes septic shock
Definition
gram negative endotoxin producing bacilli
Term
how do microbes cause septic shock
Definition
LPS released when cell wall is degrated from inflammatory response
Term
why is antibiotic treatment difficult in septic shock
Definition
antibiotics could make things worse initially by breaking up LPS
Term
what are 6 microbes that commonly cause septic shock
Definition
E. coli
salmonella
shigella
pseudomonas
neisseria
haemophilus
Term
explain the progression of septic shock
Definition
infection > systemic inflammatory response syndrome > sepsis > severe sepsis > septic shock
Term
what are 4 signs of septic shock
Definition
skin is initially warm and flushed due to peripherial vasodilation
electrolyte imbalance
metabolic acidosis
decreased urine output
Term
what are the three main venues septic shock causes damage through
Definition
endothelial damage
release of inflammatory cytokines and acute phase reactants
CNS endocrine activation
Term
how does endothelial damage contribute to the symptoms of septic shock (3)
Definition
increased capillary permeability
microemboli
activation of the coagulation system
Term
what inflammatory cytokines cause damage iin septic shock (4)
Definition
IL1, TNF, NO, PAF
Term
what acute phase reactants cause damage in septic shock (3)
Definition
complement,
prothrombin
plasminogen
Term
how do cytokines and acute phase reactants cause problems in septic shock
Definition
myocardial depression
vasodilation/hypotension and increased permeability causes decreased contractin and CO
microemboli
Term
what CNS and neuroendocrine activation occurs in septic shock
Definition
selective vasoconstriction
hypermetabolic state that increases oxygen demand
Term
what are the overall results on the body in septic shock
Definition
combination of vasodilation and constriction
increased permeability
increased cell demand
microemboli

all lead to poor distribution of blood volume which decreases delivery of oxygen to tissues
Term
what causes neurogenic shock
Definition
anasthetic accident or spinal cord injury causes loss of vascular tone and peripherial pooling of blood
Term
what is the MOA of neurogenic shock
Definition
loss of sympathetic tone initiates parasympathetic response which decreased HR and CO

loss of sympathetic tone causes vasodilation which decreases BP, venous return, SV, CO and thus O2 delivery to tissues
Term
what causes anaphylatic shock
Definition
IgE mediated hypersensitivity causes vasodilation and increased vascular permeability
Term
what are the three stages of shock
Definition
nonprogessive
progressive
irreversible
Term
what are the activated compensatory mechanisms in the nonprogressive stage of shock
Definition
baroreceptor reflex
catecholamines
fever
sympahtetic stimulation
ADH
RAAS
Term
what does fever in the nonprogressive stage of shock lead to
Definition
increased BMR
Term
explain the sympathetic response in nonprogresive shock
Definition
anterior pituitary releases ACTH which tells adrenal cortex to release glucorticouds which increases blood sugar to meet metabolic need
Term
how is ADH activated, what does it do
Definition
low BP activates causing ADH release from pituitary which increases water reabsorption in kidney increasing BV
Term
explain the RAAS
Definition
decreased flow to kidney causes renin secretion initiating RAAS which releases angiotensin causing adrenal cortex to release aldosterone which causes reabsorption of Na and water to increase BV
Term
what is the overall affect of the compensatory mechanisms in the nonprogressive stage of shock
Definition
tachycardia
peripherial vasoconstriction
renal conservation of blood
increased BMR to give more energy to organs
anaerobic metabolism
Term
why is there anaerobic metabolism in nonprogressive shock
Definition
energy made is not supplied by enough O2 so it is made through carb breakdown
Term
what are the signs of the progressive stage of shock (6)
Definition
heart cannot make enough CO for the body
BP falls and patient becomes cold and clammy (hot in septic shock)
urine output is absent
pulses are fast and week
respiration falls
loss of conciousness
Term
what classifies the irreversible stage of shock
Definition
cardiac, hepatic, renal, respiratory, pancreatic, GI, hematological, neurological failure
no response to treatment
death is imminent
Term
what is the morphology of shock in the brain (2)
Definition
ischemia
enceohalopathy
Term
what is the morphology of shock in the heart (3)
Definition
coagulative necrosis
subendocardial hemorrhage
contraction band necrosis
Term
what is the morphology of shock in the kidney (4)
Definition
tubular necrosis
oliguria
anuria
electrolyte imbalance
Term
what is the morphology of shock in the lungs
Definition
only has symptoms in sepsis or trauma which causes alveolar damage
aka shock lung
Term
what is the prognosis of shock
Definition
varies with origin and duration
80-90% young healthy people with hypovolemic shock survive
75% of people with cardiogenic shock associated with MI or sepsis from gram negative bacilli die
Term
what is multiorgan dysfunction syndrome
Definition
dysfunction of physiological effects of shock
Term
what are the 5 effects in multiorgan dysfunction syndrome
Definition
cardiac depression
respiratory disreess
renal failure
disseminated intravascular coagulation
organ failure
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