SHOCK
PATHOLOGY
Faculty of Medicine
Competencies and course outcome
Competency No. Competency CO
PA6.3 CIH-CO1
Define and describe
shock,its
pathogenesis and
its stages.
Specific learning objectives
At the end of the student should be able to-
• Define and classify shock
• Describe etiopathogenesis of septic shock
• Describe stages and morphological changes of shock
• Enumerate the effects of shock on various organs
Alignment and integration
• Aligned with Medicine IM2.1 and Surgery SU2.1-1)
Case scenario
A 40 year old male met with an accident and lost considerable amount of blood. He has
hypotension and dyspnoea, Cool and Clammy Skin , Weak Pulse , Oliguria.
• Enumerate four types of the above clinical condition.
• Enumerate three stages of the above clinical condition
• Discuss in detail pathophysiology for the same.
Definition of shock
Shock is circulatory collapse, may develop following any serious assault on the
body’s homeostasis, such as-
•Profuse hemorrhage,
•Severe trauma or burns,
•Extensive myocardial infarction,
•Massive pulmonary embolism
•Uncontrolled bacterial sepsis.
Definition of shock
At the fundamental level shock constitutes widespread hypo perfusion of cells and tissue leading
to decrease in supply of nutrients, decrease supply of oxygen and excessive accumulation of
metabolic wastes.
Etiological Classification Of Shock
1. Cardiogenic shock
2. Hypovolumic shock
3. Septic shock
4. Neurogenic shock
Causes and mechanism of shock
Types of shock Clinical Examples Principal Mechanisms
1. Cardiogenic Myocardial infarction Failure of myocardial pump due
Rupture of heart to intrinsic myocardial damage
Arrhythmias or extrinsic pressure or
Cardiac tamponade obstruction to outflow
Pulmonary embolism
2. Hypovolumic Hemorrhage\ fluid loss – Inadequate blood or plasma
shock eg vomiting, diarrhoea, volume
burns
Causes and mechanism of shock
3. Septic shock Over whelming bacterial Peripheral vasodilatation
infections: Gram and pooling of blood; cell
negative septicemia membrane injury,
(endotoxic shock) or Endothelial cell injury
gram positive septicemia with disseminated
intravascular coagulation
4. Neurogenic shock Anesthesia, spinal cord Peripheral vasodilatation
injury with pooling of blood.
Stages Of Shock
Shock is a progressive disorder; the progression has been divided into three stages.
1. Early: Compensated stage
2. Progressive: Decompensated shock
3. Irreversible.
Stages Of Shock
1. Early: Minor deficiency in the circulating blood volume compensated by the
compensatory mechanism for eg. Constriction of arteriolar bed, increase in heart
rate, increase secretion of ADH and activation of renin angiotensin aldosterone
axis.
Stages Of Shock
2) Progressive stage: Despite of compensatory mechanism, there is decline in blood
pressure and cardiac output which leads to tachypnoea, A. R. D. S. oliguria,
metabolic acidosis. This stage can be overcomed by supportive therapy like I. V.
fluids and blood transfusion.
Stages Of Shock
3. Irreversible: This is applicable to the clinical situation in which even
correction of hemodynamic derangement does not hault download spiral.
This stage is marked by reduction in cardiac output, worsening of
metabolic acidosis, progressive renal failure, uraemia and coma.
Stages of shock
Morphological changes and effects of shock
Changes induced by shock take the form of hypoxic injury in all the organs
1. Brain – Hypoxic encephalopathy
2. Heart – A) Subepicardial and subendocardial hemorrhages and necrosis
B) Zonal lesions called as banding.
3. Lung- Adult respiratory distress syndrome or diffuse alveolar damage
4. Kidney - Acute tubular necrosis
5. GIT – Patchy mucosal hemorrhages & necrosis
6. Liver- Fatty change
Case Discussion
A 40 year old male met with an accident and lost considerable amount of blood. He has
hypotension and dyspnoea, Cool and Clammy Skin , Weak Pulse , Oliguria.
• Enumerate four types of the above clinical condition.
Answer: Cardiogenic shock , Hypovolumic shock , Septic shock , Neurogenic shock
• Enumerate three stages of the above clinical condition
Answer: Stages: Early: Compensated stage , Progressive: Decompensated shock , Irreversible.
• Discuss in detail pathophysiology for the same.
Summary
• Define and classify of shock
• Describe etiopathogenesis of septic shock
• Describe stages and morphological changes of shock
• Enumerate the effects of shock on various organs
Expected questions
SAQ
1) Define and Classify Shock and Write a note on etiopathogenesis of septic shock.
2) Describe stages and morphological changes of shock.
BAQ
2) Describe in brief effects of shock on various organs.
2)Write in brief about pathogenesis of septic shock.
3)Define shock .Give its classification .
References
• HARSH MOHAN,TEXTBOOK OF PATHOLOGY,9th EDITION
• ROBBINS AND COTRAN,PATHOLOGIC BASIS OF DISEASE,10th EDITION.
THANK YOU
