An assignment

on surgery
subject :-SHOCK
(definition, classification and
pathophysiology of shock)
Submitted to
Dr.p.v.parikh ass.
Professor dept.of vety
Surgery.AAU.ANAND
 Definition of shock
Shock is clinical condition characterized by
decrease blood flow to vital organ due to
imbalance between size of vascular bed
and effective circulating blood volume and
the inability of the body tissues to
metabolize nutrient normally
_ the decrease blood flow of vital organ (like
kidney, liver etc ) is caused by pooling and
stagnation of blood elsewhere in
circulation .
Classification of shock
• Modern classification of shock in to 4 type
based on etiology and approach to
treatments.
1. HYPOVOLEMIC SHOCK
due to 1.blood loss
2.plasma loss and
3.water loss
2.CARDIOGENIC SHOCK
due to 1.myocardial infarction
2.arrythmia
3.temponade
4.late hypovolemia
5.epidural and general anesthesia
6.pulmonary embolism
 Continued to….
3 . SHOCK CHARACTERIZED BY PERIPHERAL
POOLLING OF BLOOD DUE TO
1.loss of tone in resistants vessels
2.trapping of blood in capacitance vessels as may
happen in endotoxin shock
4. SEPTIC SHOCK
failure of cells of vital organs to perform normal
metabolic function despite availability of oxygen.
ANOTHER TYPE OF CLASSIFICATION

A. PRIMARY SHOCK –which develops

immediately after injury.
B. SECONDARY SHOCK –which develops
more time after injury.
 Pathophysiology of Shock
Flow diagram of pathophysiology of Shock
Hypovolaemic Cardiogenic Endotoxic
shock Shock Shock
↓se venous return ↓se cardiac output G –ve microbes
vasodilation
↓se effective circulating ↓se arterial pressure Endotoxin
volume
Neurological Vasoactive substance
shock
↑se mechanoreceptor activity
negetive feed back
↑se sympathetic activity mechanism
↑se aldosterone
↑se antidiuretic hormone
↑se h.rate
↑se water conservation
↑se B.P. ↓se capillary pressure

↑se effective circulating volume tissue fluid uptake

 Relaxation of precapilary sphincters
&
continue post capillary vasoconstriction

↑se Acid metabolites poolling of blood

capillary damage

Positive feed back fluid loss ↑se blood viscosity

mechanism
↓se effective circulating volume low flow state

↑se catacholamines

pathogenic shunt
Tissue hypoxia
Cellular death