Neoplasia 5 Flashcards
in the non progressive stage of shock, what are some of the compensatory mechanisms
cutaneous and peripheral vasoconstriction –> cool, pale skin; to maintain BP and supply to vital organs
- sympathetic stimulation
- ADH, RAA, etc
if the patient is warm then it is more indicative of what kind of shock?
septic
what is the underlying situation in the progressive stage of shock?
impaired tissue perfusion but there it is still sufficient to prevent cell injury and death
will see low pH due to anaerobic glycolysis
↓ Cardiac output leading to anoxic endothelial cell injury and leads to DIC
what is the effect of low pH in the progressive stage
blunts vasomotor response leading to dilation of arterioles
at the irreversible stage of shock, it is characterized by ________
multi organ failure
how can hypovolemic shock lead to septic shock?
at the stage of decompensation (irreversible), the ischemic bowel can leak bacteria and lead to septic shock
gram ________ bacterial are the most common cause of septic shock
positive
with endothelial activation more ___________ thrombotic factors are produced
pro-thrombotic (↑ clot formation) specifically procoagulants and anti-fibrinolytics
septic shock patients have ↑ gluconeogenesis due to TNF and IL-1 and stress hormones and leads to _______
insulin resistance, ↓ insulin release and hyperglycemia
what are the two effect of hyperglycemia on the inflammatory cells?
- suppresses the phagocytic activity of PMN’s
- ↑ the expression of adhesion molecules on endothelial cells
DIC occludes the ________ vessel leading to _________ syndrome
adrenal;
Waterhouse friedrichsen
what are metabolic abnormalities seen in septic shock?
- hyperglycemia
- insulin resistance
- initial surge in glucocorticoid release and later depression (waterhouse friedrichsen syndrome)
__________ is more resistant to hypoxic injury in shock because they have dual blood supply
lungs
most sensitive neurons to hypoxia
pyramidal cells of hippocampus and purkinje cells of the cerebellum
watershed infarcts of the brain
region where the ACA meets w/ MCA and it is the first region to die
what are some morphological changes seen in ischemic encephalopathy
- edema, mottled discoloration in grey matter
- grey/white junction blurred
- neuronal necrosis
- hemorrhages
_______ necrosis is a morphological feature seen in an ischemic heart
contraction band necrosis
define thrombosis
inappropriate activation of the formation of a thrombus in an injured vessel or thrombotic occlusion of a vessel after a relatively minor injury
what are the three components of Virchow’s Triad
- endothelial injury
- hypercoagulable state
- abnormal blood flow
all three lead to thrombosis
endothelial cell injury in the main cause of ________ thrombi
arterial
hereditary causes of hypercoagulability of blood and it is due to a lack of _______
lack of: anticoagulants
- Factor V (Leiden) mutation (most common)
- anti thrombin III deficiency
- Protein C deficiency
- Protein S deficiency
