Shock

Question 1

Define shock

Answer 1

Systemic tissue hypoperfusion due to global circulatory failure.

Question 2

Categorize the causes of shock

Answer 2

Firstly shock is divided into 3 different types which all have different causes
1.Hypovolaemic- this is due to reduces blood volume
2. Cardiogenic- this is due to pump failure
3.Distributive- due to:
Septic Shock: Caused by severe infections.
Neurogenic Shock: Induced by nerve injury.
Anaphylactic Shock: Resulting from severe allergic responses.
4.Endocrine- Cused by hormones, i.e. hypoadrenalism, hypothyrpidism

Question 3

Discuss the stages of shock

Answer 3

1. Compensatory Phase:
   
   • During this initial stage, the body can still compensate for decreased tissue perfusion despite a loss of intravascular fluid volume or cardiac dysfunction.
   • Compensatory mechanisms, such as increased heart rate, heightened heart contractility, and vascular constriction, work to maintain cardiac output and blood pressure.
   • Vital organs like the brain and heart continue to receive adequate perfusion.
   • If addressed promptly, damage to tissues during this phase may be reversible.
2. Decompensated (Progressive) Phase:
   
   • As shock persists, compensatory mechanisms become overwhelmed.
   • Signs of organ dysfunction emerge, including decreased urination, confusion, cold and clammy skin, and irregular heart rhythms.
   • Tissue damage becomes irreversible during this stage.
   • If left unaddressed, decompensated shock can lead to multiple organ failure.
3. Irreversible Phase:
   
   • In this final stage, vital organs (such as the brain, heart, and kidneys) begin to shut down.
   • Damage is severe and often irreversible.
   • Immediate intervention is crucial to prevent progression to this stage.

Remember that shock can have various underlying causes, including hypovolemia (due to severe bleeding, fluid losses, etc.), cardiogenic issues (such as myocardial infarction), obstructive factors (like cardiac tamponade or pulmonary embolism), and distributive conditions (such as anaphylactic, septic, or neurogenic shock) ¹²³. Early recognition and appropriate management are essential to improve outcomes. 🌟

Question 4

Explain which sites would be vulnerable to shock

Answer 4

Sites that are vulnerable to shock include sites with;
.high metabolic needs
.Low flow sites i.e. watershed zones and second capillary beds
.Toxic sites
.Capillary rich sites

Question 5

Explain the effects of shock on the brain

Answer 5

Selective neuronal necrosis
Watershed infarct
Cortical(pseudo) laminar necrosis
Hypoxic ischaemic encephalopathy

Question 6

Explain the effects of shock on the kidney

Answer 6

Reduced blood flow to the kidneys can cause kidney problems like acute renal failure, Oliguria, anuria or even the death of kidney tissue. This can lead to issues like not producing urine properly or even kidney failure.

Question 7

Explain the effects of shock on the liver

Answer 7

The liver can become congested and lack oxygen if blood flow is reduced. This can lead to a buildup of fat and eventually the death of liver cells. i.e. Centrilobular haemorrhagic necrosis

Question 8

expain the effects of shock on the lungs

Answer 8

Reduced blood flow to the lungs can cause fluid buildup and damage to the lung tissue, which can lead to difficulty breathing and lung problems in the long term.

Question 9

explain the effects of shock on Gastrointestinal tract

Answer 9

The stomach and intestines can develop ulcers or bleed if they don’t get enough blood flow.

Question 10

explain the effects of shock on the Pancreas

Answer 10

the pancreas can become swollen and inflamed if it doesn’t get enough blood. This can lead to the release of harmful enzymes and even tissue death.

Question 11

Explain the effects of shock on the adrenal

Answer 11

The adrenal glands, which sit on top of the kidneys, can also be affected. They may not produce enough hormones, and in severe cases, parts of the adrenal gland can die.

Question 12

Explain the effects of shock on the placenta

Answer 12

During pregnancy, reduced blood flow to the placenta can cause problems like premature birth or growth problems for the baby.

Question 13

Explain the effects of shock on the Pituitary.

Answer 13

If the pituitary gland doesn’t get enough blood, it can lead to a condition called Sheehan syndrome/Simmond disease, especially after childbirth. This can cause a range of hormone-related problems because the pituitary gland isn’t working properly.

Question 14

Explain the effects of shock on the Heart.

Answer 14

In the heart, reduced blood flow can lead to abnormal heart rhythms or even sudden death. Certain changes like fatty deposits can occur, and in severe cases, parts of the heart muscle can die.

Question 15

Define DIC(Disseminated Intravascular Coagulopathy)

Answer 15

Widespread microthrombi in the microcirculation causing, consumptive coagulopathy and microangiopathic haemolytic anemia.

Question 16

Categorise the causes of DIC

Answer 16

1. Release of inappropriate tissue coagulation factors into the circulation- This can occur in situations such as obstetric emergencies (e.g., amniotic fluid embolism), fat embolism, certain cancers (especially those that produce mucin or in acute promyelocytic leukemia), and bacterial infections (particularly those caused by Gram-negative bacteria like meningococcal septicemia).

Endothelial injury- Damage to the lining of blood vessels can occur due to infections (bacterial, viral, or parasitic), shock, inflammation of blood vessels (vasculitis), acute hemolysis (as in burns or transfusion reactions), immune-mediated processes (such as in autoimmune diseases like systemic lupus erythematosus), or severe tissue injury (like trauma or major surgery).

Miscellanous- Liver disease can also contribute to the development of DIC.

Question 17

Outline the laboratory findings of DIC

Answer 17

Decreased levels of fibrinogen and platelets.
Increased levels of fibrin degradation products (FDP), partial thromboplastin time (PTT), and prothrombin time (PT). These changes reflect the activation of both the intrinsic and extrinsic pathways of the clotting cascade.
Clinical Features:

Skin manifestations can range from small pinpoint hemorrhages (petechiae) to larger bruises (purpura), and in severe cases, gangrene.
Adrenal involvement can lead to Waterhouse-Friderichsen syndrome, characterized by adrenal gland failure due to massive bilateral adrenal hemorrhage. This condition is often associated with DIC, skin hemorrhages (purpura), and septic shock, classically seen in meningococcal septic shock, but can also be caused by other highly virulent bacteria like Pseudomonas, pneumococci, Haemophilus influenzae, or Staphylococcus species.