-Classification of Haemostatic Disorders -SHOCK --- Introduction - Types ---Hypovolemic ++++Haemorrhage ++++Burns ++++Dehydration ---Cardiogenic ++++Myocardial infarction ++++Cardiac tamponade ++++Pulmonary embolism ---Distributive ++++Septic shock ++++Anaphylactic shock ++++Neurogenic shock -Pathophysiology -Clinical features

1. CLASSIFICATION
OF HAEMOSTATIC
DISORDERS AND
SHOCK
PRESENTED BY:
DR. URVASHI SODVADIYA

2. CONTENTS
• Classification of Haemostatic Disorders
• SHOCK
 Introduction
 Types
 Hypovolemic
 Cardiogenic
 Distributive
 Pathophysiology
 Clinical features

3. HAEMOSTASIS
Vascular spasm Platelet plug Coagulation

4. HAEMOSTATIC DISORDER
Bleeding disorder
Disorder of
coagulation
system
Disorder of
Primary
haemostasis
Vessel wall
abnormality
Platelet
abnormality
Vessel wall
abnormalhgghghg
hity
Vessel wall
abnormalhgghghg
hity
Inherited
Acquired
Thrombotic disorder
Acquired
Inherited

5. Disorder of Primary
haemostasis
Vessel wall
abnormality
Platelet abnormality
Acquired
Due to decreased
amount of
connective tissue :
scurvy , cushing
syn.,steroid therapy
Due to vasculitis
:Henoch-schonlein
purpura,infection,
drug reaction
Miscellanos:si
mple easy
bruising
Plasma cell
neoplasm
:amyloidosis
Congenital
 Hereditary haemorrhagic
telangiectasia
 Ehler-Danlos syndrome
 Marfan syndrome
Qualitative
Quantitative
 Thrombocytopenia
- ITP
-drug induced
-congenital
 Thrombocytosis
 Inherited: Glanzmann
thrombasthenia ,wiskott-
Aldrich syndrome
 Acquired: Uremia ,drugs

6. Disorder of coagulation
system
AcquiredCongenital
 Haemophilia A
 Von Willebrand
disease
 Other coagulation
factor deficiency
( IX ,XI,V)
 Vit K deficiency
 Liver disease
 DIC

7. Thrombotic disorder
Acquired
Inherited
 Deficiency of
antithrombotic factors
-- Antithrombin III deficiency
-- Protein C deficiency
 Increased prothrombotic
factors
-- Activated protein C
resistance (mutation in
factor V)
 Prothrombin G20210A
 Fibrinolytic system defect

8. SHOCKSHOCK

9. ISCHEMIA

10. SHOCK Blood flow
Cellular injury
Multiple organ damage
If not
treated
immediately

11. SHOCK IS DEFINED AS…
• “ systemic hypotension either due to reduced cardiac
output or reduced effective circulating blood volume”
Blood
pressure

12. BLOOD
PRESSURE
Resistance to
flow
Cardiac
output
Heart Rate
Stroke
Volume
End systolic
volume
End diastolic
volume

13. CLASSIFICATION

14. Primary (initial)
shock
secondary (true)
shock
Sudden reduction of venous return to
heart
Neurogenic vasodilation & consequent
peripheral pooling of blood
Circulatory imbalance between
“Oxygen supply & requirement”
at cellular level

15. CLASSIFICATION
Oligemic
(Hypovolemic)
Cardiogenic
• Haemorrhage
• Burns
• Dehydration
• Myocardial
infarction
• Cardiac
tamponade
• Pulmonary
embolism

16. Distributive
shock
• Septic shock
• Anaphylactic
shock
• Neurogenic shock

17. HYPOVOLAEMIC SHOCK
Low Volume Blood
Low Cardiac output
Loss of blood loss of plasma
Massive haemorrhage Severe burns
Non haemorrhagic
SEVERE
DEHYDRATION
BURNS
Plasma leakage
from damaged
micro-circulation
Hypovolaemia
SURFACE AREA
Haemorrhagic
Loss of blood volume from
ruptured blood vessels
Loss of 500 ml (10%) of blood
-- asymptomatic
Loss of even 20% blood volume
-- enough to produce
hypovolaemic shock

18. • Because loss of blood volume from body leads to..
BLOOD
PRESSURE
End systolic
volume
End diastolic
volume
Resistance
to flow
Cardiac
output
Cardiac
dfffoutput
Stroke Volume
Heart Rate
It releases:
• Catecholamnes like
-epinephrine
-norepinephrine
• ADH
• Angiotensin II
VASOCONSTRICTION
OF BLOOD VESSLES
Heart Rate

20. DECRESED
blood flow
Cold &
Clammy skin

21. CARDIOGENIC SHOCK
Heart Produced by
Myocardial infarction
MOST
COMMONLY
LESS
COMMONLY
Rupture of cardiac
valve
Cardiac tamponade due
to haemopericardium

22. “PUMP FAILURE”Key feature
Heart muscle
cells die
Contraction of
heart

23. BLOOD
PRESSURE
Heart Rate
Cardiac
output
End diastolic
volume
End systolic
volume
Resistance
to flow
Stroke Volume
Mortality
rate : 80%

24. Obstruction of
heart
#can’t fill enough
Fluid in
pericardial sac
Physically
constricts heart
from expanding &
contracts normally
Reduces stroke
volume
OBSTRUCTIVE
SHOCK
Reduces blood flow
Cold and clammy skin

25. An excessive amount of leakiness of
blood vessels
OR
An excessive amount of vasodilation /
widening of peripheral blood vessels
DISTRIBUTIVE SHOCK

26. BLOOD
PRESSURE
Heart Rate
Cardiac
output
End diastolic
volume
End systolic
volume
Resistance
to flow
Stroke Volume
Vasodilation

27. SEPTIC SHOCK
Pathogens in
blood
LESS
COMMONLY
MOST
COMMONLY
• E. Coli
• Pseudomonas
• Klebsiella
• Staph. aureus
• Strepto. pneumoniae

28. Toxic Shock Syndrome
In women
Certain brands of
tempons
Toxin of staph.
aureus
Presence of Mg
Mg is absorbedby
fibers of tempons
LARGE AMOUNT OF TOXIN

29. CASCADE OF SEPSIS
Proliferation of bacteria
Directly Releases
toxins into
blood stream
ENDOTOXIN EXOTOXIN

30. Derived from
gm –ve bacteria
Responsible for
events that
automatically
leads to low
perfusion

31. Releases NO

32. MAST CELLS
Release of histamine

33. Macrophage Neutrophil
• TNF
• IL-1
PAF & ROS
Release of more
inflammatory
molecule
Increases vascular
permeability
Increases vascular
permeability

34. Procoagulant : TF
Blood coagulation
Anticoagulants
Net increase
in blood
clotting
Decrease
perfusion

35. WIDESPREAD
VASODILATION
VERY LOW
RESITANCE
Skin warm
and flushed
IN BLOOD
FLOW

36. Widespread
vasodilation
Vascular
permeability
Microvascular
clotting
Perfusion to
all vital organ

37. ANAPHYLACTIC SHOCK
Allergic reaction
Type I hypersensitivity
DEATH
MOST
COMMONLY:
Upper airway
obstruction
2nd MOST
COMMONLY:
Mycardial or
cerebral hypotension

38. NEUROGENIC SHOCK
Lowers Blood
Pressure
Peripheral
vasodilation &
pooling of blood
Damaged neural system

39. CLINICAL FEATURES
 Skin : pale & cold
 Pulse : fast and
thread
 Respiration shallow
 Blood pressure : low
 Oliguria
 tachycardia
Hypovolaemic &
Cardiogenic shock
 Skin : warm &
flushed
 Bounding pulse
Septic shock

40. References
 Robbins & Cotran Pathologic Basis of Disease,9th
edition,Vinay Kumar,Abul K.Abbas,Jon C. Aster
 Essential Pathology,4th edition,Harsh
Mohan,Sugandha Mohan
 Bailey & Love’s Short Practices of Surgery,26th
edition,Williams,Bulstrode,O’connell

41. THANK YOU !

42. THANK
YOU!