Lecture 29

Question 1

What are the 3 key elements of shock

Answer 1

1. life-threatening condition
2. circulatory failure
3. inadequate oxygenation

Question 2

Edema

Answer 2

accumulation of fluid in interstitial space of body tissues

Question 3

Distributive shock

Answer 3

arises from vasodilation that leads to hypotension and hypoperfusion of critical organs

altered mental state, clammy skin

causes of this: sepsis (#1), anaphylaxis, neurogenic

Question 4

Hypovolemic shock

Answer 4

arises from internal or external fluid loss, giving rise to hypotension and hypoperfusion it is associated with the triad of hypothermia, coagulopathy, and acidosis

causes: hemorrhage, severe burns, vomiting, diarrhea

Question 5

Cardiogenic shock

Answer 5

cardiac in origin, arising from low cardiac output and leading to tissue hypoperfusion

causes: heart attack, ventricular arrhythmia, cardiomyopathy, valvular disease

Question 6

Obstructive shock

Answer 6

results from a blockage of blood flow preventing normal organ perfusion

causes: cardiac tamponade, pulmonary embolism, pneumothorax

Question 7

Identify the component of gram-negative bacteria that mediates septic shock

Answer 7

endotoxin
LPS

Question 8

Describe the role of adrenomedullin in modulating vascular function

Answer 8

adrenomedullin in the intravascular space enhances the endothelial barrier, reducing the movement of solutes out of the vascular space by tightening the junctions (good)

when adrenomedullin enters the interstitial space, it mediates the relaxation in vascular smooth muscle, resulting in vasodilation (bad)

Question 9

State the primary drivers of the movement of fluid into and out of vascular space

Answer 9

hydrostatic pressure: drives fluid out of vascular space

colloid osmotic pressure: draws fluid back into the vascular space

An imbalance between the two can cause a net flow of fluid into the interstitial space which causes edema

Question 10

Describe the mechanisms and common clinical causes of edema

Answer 10

1. increased capillary permeability
2. increased hydrostatic pressure
3. decreased oncotic pressure
4. lymphatic obstruction

Question 11

Increased capillary permeability

Answer 11

local causes: cellulitis

systemic causes: sepsis, hypersensitivity reactions

Question 12

Increased hydrostatic pressure

Answer 12

local causes: compartment syndrome

systemic causes: heart failure, renal failure, pregnancy

Question 13

Decreased oncotic pressure

Answer 13

systemic causes: protein deficient states

Question 14

Lymphatic obstruction

Answer 14

local causes: tumor, trauma, infection

Question 15

Key difference for diagnosis

Answer 15

unilateral (local) bilateral (systemic)