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Chapter: Medical Physiology: Circulatory Shock and Physiology of Its Treatment

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Septic Shock

A condition that was formerly known by the popular name “blood poisoning” is now called septic shock by most clinicians.

Septic Shock

A condition that was formerly known by the popular name “blood poisoning” is now called septic shock by most clinicians. This refers to a bacterial infection widely disseminated to many areas of the body, with the infection being borne through the blood from one tissue to another and causing extensive damage. There are many varieties of septic shock because of the many types of bacterial infections that can cause it and because infection in different parts of the body produces different effects.

Septic shock is extremely important to the clinician, because other than cardiogenic shock, septic shock is the most frequent cause of shock-related death in the modern hospital.

Some of the typical causes of septic shock include the following:

1      Peritonitis caused by spread of infection from the uterus and fallopian tubes, sometimes resulting from instrumental abortion performed under unsterile conditions.

 

2.     Peritonitis resulting from rupture of the gastrointestinal system, sometimes caused by intestinal disease and sometimes by wounds.

 

3.     Generalized bodily infection resulting from spread of a skin infection such as streptococcal or staphylococcal infection.

 

4.     Generalized gangrenous infection resulting specifically from gas gangrene bacilli, spreading first through peripheral tissues and finally by way of the blood to the internal organs, especially the liver.

 

5.     Infection spreading into the blood from the kidney or urinary tract, often caused by colon bacilli.

Special Features of Septic Shock. Because of the multipletypes of septic shock, it is difficult to categorize this condition. Some features often observed are:

1.     High fever.

 

2.     Often marked vasodilation throughout the body, especially in the infected tissues.

 

3.     High cardiac output in perhaps half of patients, caused by arteriolar dilation in the infected tissues and by high metabolic rate and vasodilation elsewhere in the body, resulting from bacterial toxin stimulation of cellular metabolism and from high body temperature.

 

4.     Sludging of the blood, caused by red cell agglutination in response to degenerating tissues.

 

5.     Development of micro–blood clots in widespread areas of the body, a condition called disseminatedintravascular coagulation. Also, this causes the blood clotting factors to be used up, so that hemorrhaging occurs in many tissues, especially in the gut wall of the intestinal tract.

In early stages of septic shock, the patient usually does not have signs of circulatory collapse but only signs of the bacterial infection. As the infection becomes more severe, the circulatory system usually becomes involved either because of direct extension of the infection or secondarily as a result of toxins from the bacteria, with resultant loss of plasma into the infected tissues through deteriorating blood capillary walls. There finally comes a point at which deteriora-tion of the circulation becomes progressive in the same way that progression occurs in all other types of shock. The end stages of septic shock are not greatly differ-ent from the end stages of hemorrhagic shock, even though the initiating factors are markedly different in the two conditions.


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