Pathology subject, Topic shock ( Definition, Types of shock, Etiology, Pathogenesis, Stages, Clinical feature )

1. Shock Pathology
Dr. Priyanka patil
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2. •Definition
•Type of shock
•Etiology
•Pathogenesis
•Stages
•Clinical feature

3. Definition
• An acute reduction of effective circulating
blood volume -hypotension
• An indequet perfusion of cells and tissues-
hyperfustion
Shock is a life- threating clinical
syndrome of cardiovascular collapse
characterised by

4. Two type of
shock
1.True or ( secondary) shock
• is a circulatory imbalance between oxygen supply
and oxygen requirements at the cellular level and
is also called as circulatory shock.
2. Intial or ( primary ) shock
• Is used for transient and usually a benign
vasovagal attack resulting from reduction of
venous retrun to the heart

5. Etiology
1.Hypovolemic shock
• This form of shock result form inadequate
circulatory blood volume by various etiologic factors
that may be either from the loss of whole blood ( i.e
red cell mass and plasma ) from haemorrhage or
from the loss of plasma volume alone
• The major effect in this are due to decreased cardiac
output and low intracardiac pressut

6. • The severity feature depends upon of blood
volume Los
• Type
1.Compensated : < 1000ml
2.Mild : 1000 – 1500ml
3.Moderate : 1500- 2000ml
4.Severe : > 2000 ml
• Major clinical feature are
1. Tachycardia- increased heart rate
2.Hypotension- low blood pressure
3.Oliguria to anuria – low urinary output
4.Aginated to confused to lethargic alternation in
mental state .

7. 2. Cardiogenic
shock
Result form
• . Severe left ventricular dysfunction_ cause
myocardial infarction from
• Leads to decrease tissue perfusion and movement
of fluid form pulmonary vascular bed into
pulmonary interstitial fluid leading to interstitial
pulmonary odema and later alvelar pulmonary
oedema

8. 3 Septic shock
• Septic shock result from bacteria or fungal
infection
• Microbes gain entry into the body from various
route most often via respiratory tract infection
May be a result oF 1. gram negative
septicaemia _ endotoxic shock
2. Gram positive septicaemia _ exotic shoch

9. Pathogenes
is
1.Reduced effective circulatory blood volume due
to
• Acute loss of blood as in _ hypovolemic shock
• Decreased cardiac output without actual loss of
blood as in _ cardiogenic and septic shock
• Leads to venous return to the heart leading
decreased cardiac output .
2. Reduced oxygen supply cause anoxia leading
cell injury leads to activation of body defence
mecanism

10. Stages
Shock is divided Into 3 types
1.Compensated shock ( non – progressive intial
reversible )
-In the early stages of shock an attempt is made to
maintain adequate cerebral and coronary blood
supply by redistribution of blood so that the vital
organ are adequately perfused and oxygenated
-This is achievd by activation of various
neurohormanal mechanism causing widespread
vosoconstriction and by fluid conservation by the

11. 1 ) widespread vosoconstriction
2) F)luid conservation by the kidney
3) Stimulation of adrenal medulla.
2. Progressive decompensated shock
_ This is a stage when patient suffer from
some other stress or risk factors besides
persistence of the shock condition that
cause progressive determiration
_ the effect of resultant tissue hyperfustion in
progressive decompensated shock are as
under
1)Pulmonary hypoperfustion

12. 3 Irreversible decompensated shock
_ when the shock is so severe that is inspite of
compensated mechanism and etiologic agent
which caused the shock no recovery takes place ,
it is called decompensated or Irreversible shock
_ it’s effect
1)Progressive vosodilation
2)Increased vascular permeability
3)Myocardial depressant factor ( MDF)
4)Worsening pulmonary hypoperfustion
5)Anoxic damage to heart , kideny , and brain
6)Hypercoagulability of blood

13. Clinical
features
The clinical features of decompensated
shock are characterised by depression of
four vital factors
1)Very low blood pressure
2)2) subnormal temperature
3) Feeble and irregular pulse
4)Shallow and sighing respiration cold and
clammy skin

14. _
_ shock may lead to
1. Acute respiratory distress
syndrome ( ARDS)
2.Disseminated intravascular
coagulation (DIC)
3.Acute renal failure (ARF)
4.Multiple oragan dysfunction
syndrome (MODS)