الرحمن بسم الله الرحيم
Shock & DICBy Dr. Ghada AhmedLecturer of pathologyBenha Faculty of Medicine
على ركزت اذا اكبر نجاح ستحققعلى أ تركيزك من أكثر هدافك
الماضية أ خطائك
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