الرحمن بسم الله الرحيم

Shock & DICBy Dr. Ghada AhmedLecturer of pathologyBenha Faculty of Medicine

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الماضية أ خطائك

SHOCK

Shock •Generalized hypoperfusion due to

Inadequate Effective circulating blood volume

Pathophysiology

Hypoperfusion

COP

Effective circ

blood volume

Types of shock

•Hypovolemic shock•Cardiogenic shock•Septic shock•Others (Neurogenic shock, Anaphylactic

shock)

Hypovolemic Shock

Venous return

Cardiac out put

Blood flow O2 supply

(Anoxia)

Cardiogenic shock

MIArrhythmias

Coronary occlusionOutflow obstruction

Failure of cardiac pump

COP

Septic shock

( BP )

Systemic VD

Cardiac contractility

Endothelial injury &

activation

Coagulation

system ++

& DICEndotoxin

STAGES OF SHOCK

•Initial non-progressive

•Progressive

•Irreversible

Morphology Effect on:•Kidney •Adrenal•GIT•Lung•Brain

Clinical course

•In hypovolemic shock

•In septic shock

DICDisseminated Intravascular

Coagulopathy

DIC

•Thrombo-hemorrhagic disorder •chch by depletion of the elements required for hemostasis

Pathogenesis (A)

Widespread endothelial

damageRelease of

thrombogenic substance

Obst complic

Neoplasm

Severe burn/ trauma

Infection

Pathogenesis (B)

++coagulation PW

Thrombi in microcirc

Consumption of platelets & coag factors

++fibrinolysis

Effects of DIC

•Widespread fibrin deposition in microcirc.

Ischemia & hemolysis

•Depletion of platelets & coag factorsBleeding diathesis

•Microinfarctions Multiple organ failure

Morphology

No organ is spared:•Kidney•Brain•Heart•Pituitary

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