1.2.2 Inflammation, DIC and Shock

Question 1

Stage in which compensatory physiologic mechanisms may allow survival (reversible)

Answer 1

Non-progressive stage

Question 2

What causes bleeding associated with DIC?

Answer 2

Central event is the activation of the intrinsic or extrinsic clotting cascade within the vascular compartment by tissue injury. Platelets and clotting factors are consumed by massive intravascular coagulation, often in the capillary beds.

Question 3

What is this an image of?

Answer 3

Diffuse alveolar damage - so called shock lung

Question 4

What is significant about Waterhouse-Friderichson syndrome?

Answer 4

infarcted adrenal glands due to DIC. Need to used corticosteroids because fluid and pressors will not be enough

Question 5

What is the arrow pointing to?

Answer 5

Schistocytes which are caused by the fibrin meshwork fragmenting normal RBCs

Question 6

What is hypovolemic shock?

Answer 6

results from low cardiac output due to low blood volume; bleeding

Question 7

What is shock?

Answer 7

a state in which diminished cardiac output or reduced effective circulating blood volume impairs tissue perfusion and leads to cellular hypoxia

Question 8

Capillary bed perfused, sphincters controlled, AV shunts controlled, minimal hypoxia and drop of pH across capillary beds are characteristic of what stage?

Answer 8

Normal stage

Question 9

What is the importance of factor XII (Hageman’s Factor)

Answer 9

Microbial components can activate coagulation in affected tissues directly through factor XII

Question 10

What is the role of PDGF as a tissue mediator?

Answer 10

Secreted by activated platelets and macrophages. Induces vascular remodeling and smooth muscle cell migration. Stimulates fibroblast growth and collagen synthesis

Question 11

What is this?

Answer 11

Nutmeg liver - centri-lobular congestion

Question 12

What are some roles of inflammatory responses in septic shock?

Answer 12

TNF, IL-1, and other cytokines will trigger downstream events leading to a hyper inflammatory state

Question 13

What is this an image of?

Answer 13

Waterhouse-Friderichson syndrome (NEEDS CORTICOSTEROIDS!)

Question 14

Arteriolar vasodilation (pooling of blood), increased capillary hydrostatic pressure, decreased function of vital organ, and severe metabolic lactic acidosis are characteristics of what stage?

Answer 14

Irreversible stage

Question 15

What is the role of organ dysfunction in septic shock?

Answer 15

Systemic hypotension, interstitial edema, and small vessel thrombosis all decrease the delivery of oxygen and nutrients to tissues

Question 16

Stage in which increasing tissue hypoxia and beginning of lactic acidosis due to anaerobic metabolism in the tissues

Answer 16

Progressive

Question 17

Peripheral vasoconstriction, AV shunts open (redistributing blood to heart and brain), decreased pH across capillary beds, hemodilution (interstitial fluid moves into vascular spaces) are characteristics of what stage?

Answer 17

Reversible or non-progressive stage

Question 18

What is the role of EGF as a tissue mediator?

Answer 18

Stimulates cell growth via tyrosine kinases

Question 19

What is the role of induction of a pro-coagulative state in septic shock?

Answer 19

Sepsis alters the expression of many factors to favor coagulation by decrease of endothelial anti-coagulant factors. Can lead to DIC

Question 20

What is the role of FGF as a tissue mediator?

Answer 20

Stimulates angiogenesis

Question 21

What is the role of endothelial activation in septic shock?

Answer 21

activation leads to widespread leakage and tissue edema which has deleterious effects on nutrient delivery and waste removal

Question 22

What is this an image of?

Answer 22

Nutmeg Liver - from passive congestion, this was a result of right-sided heart failure

Question 23

What is the arrow pointing to?

Answer 23

Fibrin thrombi in the glomerulus caused by DIC

Question 24

Decreased blood volume, maximum peripheral vasoconstriction, lactic acidosis, decreased capillary perfusion, sludging and clotting begin are characteristics of what stage?

Answer 24

Progressive stage

Question 25

Stage that even if the hemodynamic defects are corrected tissue survival is not possible

Answer 25

Irreversible

Question 26

What is the arrow pointing to?

Answer 26

Microthrombi in the glomerulus caused by DIC.

Question 27

What percent of patients survive hypovolemic shock?

Answer 27

90% survival with appropriate management

Question 28

Anaerobic metabolism in tissues leads to what?

Answer 28

Lactic acidosis

Question 29

What is the role of TGF-beta as a tissue mediator?

Answer 29

Angiogenesis, fibrosis, and cell cycle arrest

Question 30

What is this an image of?

Answer 30

Shock liver, with cell dropout - prolonged hypoxia produces “cell dropout” (necrosis) of hepatocytes. Liver enzymes would be moderately increased

Question 31

What percent of patients survive septic or cadiogenic shock?

Answer 31

50-80% range

Question 32

How to manage septic shock?

Answer 32

pressors (dopamine) and IV fluid to manage until the underlying cause is discovered

Question 33

What is cardiogenic shock?

Answer 33

results from low cardiac output due to myocardial pump failure

Question 34

What is the role of VEGF as a tissue mediator?

Answer 34

Stimulates angiogenesis

Question 35

What is systemic inflammation shock?

Answer 35

inflammatory mediators lead to vascular leakage and blood pooling

Question 36

What is the presentation of DIC in the clinic?

Answer 36

Massive bleeding