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Patho Exam 4 > svensson- shock and edema > Flashcards

svensson- shock and edema Flashcards

1
Q

Shock

A

a life threatening condition of circulatory failure that results in inadequate oxygenation of body tissue

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2
Q

What are the four types of shock

A

-distributive shock
-hypovolemic shock
-cardiogenic shock
-obstructive shock

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3
Q

Distributive shock

A

occurs as a result of vasodilation, the blood vessels are unable to maintain normal pressure (not profusing properly)

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4
Q

What are signs that are indicative of circulatory shock, (something that is apart of all the shock pathways)?

A

-arterial hypotension (increased blood pressure)
-tachycardia (increased heart rate)
-and signs of tissue hypoperfusion are present

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5
Q

What are signs of tissue hypoperfusion

A

-altered mental state
-mottle, clammy skin
-oliguria
-elevated blood lactate

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6
Q

Following circulatory shock in distributive shock, what happens that leads to distributive circulatory shock?

A

-normal or high cardiac output or SvO2

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7
Q

what are the main causes of distributive shock?

A

-sepsis (#1)
-anaphylaxis
-neurogenic

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8
Q

what are symptoms of distributive shock?

A

-hypovolemia and hypotension
-result if vasodilation and release of inflammatory mediators

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9
Q

Sepsis

A
  • a life threatening organ dysfunction caused by a dysregulated host response to infection
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10
Q

septic shock

A

-a subset of sepsis in which underlying circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than sepsis alone
-a mortality rate of 25-50%
-ranks fist among causes of death in hospital ICUs
-accounts for an estimated 200,000 deaths in the US annually

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11
Q

What is the primary cause of septic shock?

A

-infection by endotoxin-producing gram-negative bacillus accounts for 70% of septic shock cases

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12
Q

Endotoxin

A

-gram negative bacteria have an outer membrane that is composed of endotoxin
-endotoxin is comprised of O-antigen, core oligosaccharide, and lipid-A

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13
Q

how does endotoxin cause infection?

A

the endotoxin triggers a cascade of chemokines which trigger effects

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14
Q

Does the amount of endotoxin affect the infection?

A

Yes, the quantity of endotoxin directly impacts the effects seen

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15
Q

What does a low quantity of endotoxin do

A

causes local inflammation

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16
Q

What does a moderate quantity of endotoxin do

A

causes systemic effects

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17
Q

What does a high quantity of endotoxin do

A

causes septic shock

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18
Q

What role does adrenomedullin play in septic shock?

A

-ADM in the intravascular compartment enhances endothelial barrier function when it binds to a receptor by causing contraction and closing the gaps it can also induce endothelial NO release which indirectly causes vascular smooth muscle cell relaxation
-if ADM passes into the interstitial compartment by passing through the endothelial barrier it can bind to vascular smooth muscle cells and trigger relaxation

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19
Q

What role does dipeptidy dipeptidase 3 play in septic shock?

A

-impaired tissue perfusion (dead endothelial cells) changes cellular necrosis which releases cytosolic DPP3 into the circulation
-cDPP3 rapidly breaks down circulating peptides (angiotensin metabolites)
-the break down angiotensin metabolites induces a blunted response which causes further deterioration of tissue perfusion through reduced VSMC contraction, sympathetic tone, vasopressin release, and catecholamine release

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20
Q

What are the mechanisms of anaphylaxis?

A

-immunologic (IgG)
-immunologic other
-non-immunologic

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21
Q

What are causes of hypovolemic shock

A

-hemorrhage
-severe burns
-severe vomiting, diarrhea

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22
Q

hypovolemic shock

A

the loss of plasma or blood volume

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23
Q

What happens after circulatory shock that leads to hypovolemic shock?

A

-low estimated cardiac output or SvO2
-low central venous pressure

24
Q

what are symptoms of hypovolemic shock?

A

-internal or external fluid loss leading to organ failure

25
Q

What is the trinity in hypovolemic shock?

A

-hypothermia
-acidosis
-coagulopathy

26
Q

What are the causes of cardiogenic shock?

A

-myocardial infraction
-ventricular arrhythmia
-cardiac myopathy
-valvular disease

27
Q

cardiogenic shock

A

ventricular failure

28
Q

what occurs after circulatory shock in cardiogenic shock?

A

-low estimated cardiac output or SvO2
-high central venous pressure

29
Q

what are symptoms of cardiogenic shock?

A

low cardiac output and inadequate oxygen transport

30
Q

what occurs after circulatory shock in obstructive shock?

A

-low estimated cardiac output or SvO2
-high central venous pressure

31
Q

obstructive shock

A

an obstruction of the veins or heart preventing adequate pumping

32
Q

what are causes of obstructive shock?

A

-cardiac tamponade
-pulmonary embolism
-pneumothorax

33
Q

what are symptoms of obstructive shock?

A

-a blockage in blood flow

34
Q

edema

A

an accumulation of fluid in interstitial space of body tissue

35
Q

where ca edema occur?

A

-subcutaneous
-pulmonary
-cerebral

36
Q

How does fluid move from capillaries to lymphatic vessels?

A

Through the capillaries fluid is filtered out where it can either move into the lymph or is reabsorbed, with a large majority being reabsorbed

37
Q

What filtration equivalent to?

A

the reabsorption rate and lymph flow rate

38
Q

What occurs that leads to the clinical states of edema?

A

the filtration is greater than the ability to be reabsorbed and/or the ability to remove fluid via lymph leading to the accumulation in the interstitial which results in the clinical state of edema

39
Q

what are the primary drivers for fluid movement in and out of vascular space?

A

-hydrostatic pressure
-colloid osmotic pressure

40
Q

what pressure pushes fluid out?

A

-hydrostatic

41
Q

what pressure pulls (reabsorbs) fluid back in?

A

-colloid osmotic

42
Q

What are mechanisms of edema?

A

-increased capillary permeability
-increased capillary hydrostatic pressure
-decreased oncotic pressure
-lymphatic obstruction (lymphedema)

43
Q

What are local causes of increased capillary permeability?

A

cellulitis

44
Q

What are systemic causes of increased capillary permeability?

A

-sepsis
-hypersensitivity reactions

45
Q

What are local causes of increased capillary hydrostatic pressure?

A

-compartment syndrome
-chronic venus insufficiency

46
Q

What are systemic causes of increased hydrostatic pressure?

A

-heart failure
-renal failure
-pregnancy

47
Q

What are systemic causes of decreased capillary oncotic pressure?

A

-protein deficient states (nephrotic syndrome, cirrhosis)

48
Q

what are local causes of lymphatic obstruction?

A

-tumor
-trauma
-infection (filariasis)

49
Q

transudate

A

protein poor

50
Q

exudate

A

protein rich

51
Q

What does a unilateral diagnosis of edema suggest?

A

it is local

52
Q

What does a bilateral diagnosis of edema suggest?

A

it is systemic

53
Q

What are mechanisms of drug induced edema?

A

-lymphatic drainage disruption (lymphedema)
-increase capillary permeability (permeability oedema)
-increased capillary hydrostatic pressure (renal oedema or vasodilatory oedema)

54
Q

Septic shock is mediated by which component of gram-negative bacteria?
A. adrenomedullin
B. DPP3
C. Endotoxin
D. PAF
E. all of the above

A

C. endotoxin

55
Q

Which form of shock is commonly associated with the triad of hypothermia, coagulopathy, and acidosis?
A. distributive shock
B. hypovolemic shock
C. cardiogenic shock
D. obstructive shock

A

B. hypovolemic shock

56
Q

An increase in capillary hydrostatic pressure will drive fluid
A. out of vascular space and into interstitial space
B. out of interstitial space and into vascular space
C. Neither of the above

A

A. out of vascular space and into interstitial space

57
Q

The nephrotic syndrome and other protein deficiency states will cause
A. an increase in capillary permeability
B. A decrease in capillary permeability
C. an increase in capillary oncotic pressure
D. A decrease in capillary oncotic pressure
E. lymphatic obsrtuction

A

D. a decrease in capillary oncotic pressure

Patho Exam 4 (7 decks)

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