Shock

melian.yates
Mind Map by melian.yates, updated more than 1 year ago
melian.yates
Created by melian.yates over 6 years ago
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Doctorate Pathology Mind Map on Shock, created by melian.yates on 23/10/2013.
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Resource summary

Shock
1 Types
1.1 Cardiogenic
1.1.1 Failure of the heart to pump properly
1.1.1.1 Causes:
1.1.1.1.1 Death of Cardiac muscle
1.1.1.1.1.1 Ex. Disease of blood vessels
1.1.1.1.1.1.1 Thrombosis
1.1.1.1.2 Arrhythmia
1.1.1.1.3 Obstruction of blood flow leaving heart
1.1.1.1.3.1 Ex. PTE (Pulmonary thromboembolism)
1.1.1.1.4 Primary Cardiac Disease
1.1.1.1.4.1 Ex. DCM, HCM
1.1.1.1.4.1.1 DCM: Dogs
1.1.1.1.4.1.2 HCM: Cats
1.1.1.1.4.2 Cardiomegaly
1.1.1.1.4.2.1 Tricuspid valve dysplasia
1.1.1.1.4.2.1.1 Myocardial fibrosis
1.1.1.2 Decrease in SV & CO
1.2 Hypovolemic
1.2.1 Shock due to reduced circulating blood volume
1.2.1.1 Causes:
1.2.1.1.1 Blood Loss
1.2.1.1.1.1 Haemorrhage
1.2.1.1.1.1.1 Blood volume = 7% of BW
1.2.1.1.1.1.1.1 Ex. 5kg Cat: 5 *.07 = 0.35L = 350mL blood
1.2.1.1.2 Fluid loss
1.2.1.1.2.1 Vomiting, Diarrhea, Burns
1.2.1.2 Hypotension & Hypoperfusion
1.2.1.3 Recovery possible under certain circumstances
1.2.1.3.1 If caught early => Fluid Therapy
1.2.1.3.2 Can lose 10% of fluid volume
1.3 Blood Maldistribution
1.3.1 Blood pools in peripheral tissues due to a decrease in peripheral resistance in blood vessels
1.3.1.1 Blood volume is unchanged, but the VASCULAR SPACE increases so that effective circulating blood volume decreases
1.3.1.2 Types:
1.3.1.2.1 Neurogenic Shock
1.3.1.2.1.1 Damage to CNS (usually spinal cord)
1.3.1.2.1.1.1 Loss of autonomic signals to smooth muscle in blood vessel walls
1.3.1.2.1.1.1.1 Vasodilation
1.3.1.2.1.1.1.1.1 Blood pooling in veins
1.3.1.2.1.1.1.1.1.1 Need resistance to keep blood flowing
1.3.1.2.2 Anaphylactic Shock
1.3.1.2.2.1 Food
1.3.1.2.2.1.1 Pollen
1.3.1.2.2.1.1.1 Bee stings
1.3.1.2.2.2 Mast cell degranulation
1.3.1.2.2.2.1 Histamine
1.3.1.2.2.2.1.1 Leaky dilated blood vessels
1.3.1.2.2.2.1.1.1 Drop in BP & Reduced perfusion
1.3.1.2.2.2.1.1.1.1 Hypovolemia & Hypoperfusion
1.3.1.2.2.2.1.1.2 Oedema
1.3.1.2.3 Septic Shock
1.3.1.2.3.1 Most common form of maldistributive shock
1.3.1.2.3.2 Mediated by vascular & inflammatory mediators in response to bacterial & fungal infection
1.3.1.2.3.2.1 Trigger: Gram -ve Bacteria => LPS (Endotoxin)
1.3.1.2.3.2.1.1 Binds TLR4 & CD14 (Monocyte derived cells: Dendritic cells & Macrophages)
1.3.1.2.3.2.1.1.1 Cytokine release: IL-1 & IL -6
1.3.1.2.3.2.1.2 Factor XII
1.3.1.2.3.2.1.2.1 Coagulation
1.3.1.2.3.2.1.2.1.1 Thrombosis +
1.3.1.2.3.2.1.3 Low Dose:
1.3.1.2.3.2.1.3.1 Activation of Macrophages, Endothelial cells & Complement
1.3.1.2.3.2.1.4 Medium Dose:
1.3.1.2.3.2.1.4.1 Raised TNF & IL-1 => Pyrexia
1.3.1.2.3.2.1.5 High Dose:
1.3.1.2.3.2.1.5.1 Vasodilation, Hypotension, Reduced myocardial contractility (Reduced CO) & Hypoperfusion
1.3.1.2.3.2.1.5.1.1 BV injury (release of too many cytokines)
1.3.1.2.3.2.1.5.1.1.1 => DIC
1.3.2 Pooling, stagnation, Hypoxia
2 Stages
2.1 1) Compensated
2.1.1 Increase in CO & Vasoconstriction to maintain BP & tissue oxygenation
2.1.1.1 Tachycardia
2.1.1.2 Via Stimulation of SNS
2.1.1.2.1 Adrenaline
2.1.2 Control of H2O balance
2.1.2.1 GRF drops => Increase H2O absorption
2.1.2.1.1 RAAS
2.1.2.1.1.1 ADH
2.2 2) Progressive
2.2.1 Compensatory Mechanisms cannot cope with prolonged or severe drop in blood volume
2.2.1.1 Hypoperfusion & Cell injury
2.2.1.1.1 Low O2 => Cell metabolism shifts to Anaerobic respiration
2.2.1.1.1.1 Lactic Acid production & reduced ATP
2.2.1.1.1.1.1 Cell membrane damage, Lysosomal enzyme release
2.2.1.1.1.1.1.1 => Tissue Necrosis
2.2.1.1.1.1.2 ATP needed to maintain cellular membranes
2.3 3) Irreversible
2.3.1 Mechanisms aimed at Vasoconstriction are overwhemled
2.3.1.1 Widespread Vasodilation & Organ failure
3 Clincal Features
3.1 Hypotension
3.2 Weak pulse & Tachycardia
3.3 Hyperventilation
3.4 Decreased urine production
3.5 Peripheral vasoconstriction (During compensation)
3.6 Lesions
3.6.1 Congestion & pooling of blood
3.6.2 Oedema & Haemorrhage
3.6.2.1 Petechial
3.6.2.2 Ecchymotic
3.6.3 Thromobosis (Microscopic)
3.6.3.1 Coagulation cascade
3.6.4 Cellular Necrosis (Microscopic)
3.6.4.1 Ex. Myocardial cells, Neurons, Hepatocytes, Renal Tubules

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