Abstract: . . .  mechanism : activation of intrinsic pathway Clinical findings: shock , respiratory distress, CNS depression, heart/renal failure Pathophysiology : rapid consumption of fibrinogen, platelets, prothombin, factors V, VIII, X, and at same time generation of fibrin split products D-DIMERS (important diagnostic entity produced by plasmin. slide w/ DIC : capillary with platelets and fibrin Enter Dr. Marcantonio: PART II SEPTIC SHOCK (often see DIC in this setting): characterized by normal cardiac output and a markedly decreased systemic vascular resistance (eventually cardiac output goes down, but initial response is increased CO) drop in blood pressure. Can measure with swan- ganz catheter. Clinical presentation: sudden drop of BP Page 5 Major initiatior: Gram-negative endotoxin (esp. Lipid A) Minor initiators: Exotoxins (staph aureus) / Gram-positive cell wall products / Yeast, viral and fungal antigens Septic Shock mechanism : endotoxin binds monocytes and macrophages cytokines turn on acute inflammatory response at high level with local or systemic effects (systemic effects in the case of DIC). Amplified signal causes systemic response: fever, . . .
. . .  acute myocardial infarct coagulative necrosis . Color looks like tiger skin pale and yellow (necrotic) areas juxtaposed to normal beefy red areas. Under high power: myocytes with absent nuclei and deep red color, surrounded by neutrophils. slide w/ splenic infarct : result of arterial thrombotic occlusion (e.g. thromboembolus from a mitral valve , or local thrombosis due to sickle cell disease ). Yellow portion typical of necrotic tissue. slide w/ pulmonary embolus: in pulmonary artery, total infarction of upper lobe evident compared to other lobes. DISSEMINATED INTRAVASCULAR COAGULATION (DIC): Widespread thrombosis in the microcirculation with platelets and fibrin (few RBC) in capillaries. Activation of intrinsic pathway of coagulation. (Think sepsis or cancer) DIC mechanism : activation of intrinsic pathway Clinical findings: shock , respiratory distress, CNS depression, heart/renal failure Pathophysiology : rapid consumption of fibrinogen, platelets, prothombin, factors V, VIII, X, and at same time generation of fibrin split products D-DIMERS (important diagnostic entity produced by plasmin. slide w/ DIC : capillary with platelets and fibrin Enter Dr. Marcantonio: PART II SEPTIC SHOCK (often see DIC in this . . .
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