Summary
Samenvatting - Shock en orgaanfalen
- Course
- Institution
Samenvatting van het vak 'Shock & Orgaanfalen' gegeven door prof. Jorens in de 2e Bachelor Geneeskunde aan de UA. Samenvatting van slides én lesnotities.
[Show more]
Seller
Follow
katovandenbroucke
Reviews received
Content preview
InhoudstafelZuurstofradicalen...........................................................................................................................................8
Reactive Oxygen Species (ROS)...............................................................................................................8
Stikstofoxide (NO)...................................................................................................................................... 9
Ischemie-reperfusie..................................................................................................................................10
Eliminatie van ROS.................................................................................................................................. 10
Necrose vs. apoptose.................................................................................................................................. 11
Necrose.................................................................................................................................................... 11
Apoptose.................................................................................................................................................. 12
Necrose vs. apoptose.............................................................................................................................. 12
Inflammatie................................................................................................................................................... 13
Acute inflammatie.....................................................................................................................................13
LPS / superantigen...................................................................................................................................13
Mediatoren van sepsis............................................................................................................................. 14
Acute fase respons.................................................................................................................................. 15
Werking van NO....................................................................................................................................... 16
Prostaglandines....................................................................................................................................... 17
Ischemie reperfusie..................................................................................................................................... 17
Stikstofmonoxide (NO)............................................................................................................................. 18
Endotheline.............................................................................................................................................. 18
Eicosanoïden........................................................................................................................................... 19
Cytokines – chemokines.......................................................................................................................... 19
Reperfusieschade.................................................................................................................................... 19
Biochemische aspecten.............................................................................................................................. 19
Celbeschadiging.......................................................................................................................................19
Lactaatvorming.........................................................................................................................................20
Metabole respons bij shock......................................................................................................................20
Zuur-base......................................................................................................................................................21
Bufferes.................................................................................................................................................... 21
Anion gap................................................................................................................................................. 22
H+ excretie............................................................................................................................................... 22
Beoordeling van zuur-base status............................................................................................................22
Bloedstolling................................................................................................................................................ 23
Bloedstolling.............................................................................................................................................23
Stollingscascade...................................................................................................................................... 23
Disseminated intravascular coagulation (DIC)......................................................................................... 24
Hemoglobine en zuurstoftransport............................................................................................................ 24
Gastransport............................................................................................................................................ 24
Zuurstofdissociatiecurve.......................................................................................................................... 25
Cellulaire hypoxie en weefselhypoxie........................................................................................................27
Celdood....................................................................................................................................................27
Hypoxie.................................................................................................................................................... 27
Zuurstoftransport......................................................................................................................................28
Zuurstofaanbod........................................................................................................................................ 28
Zuurstofverbruik....................................................................................................................................... 28
Zuurstofextractie...................................................................................................................................... 28
Weefselhypoxie........................................................................................................................................ 28
, Arteriële hypoxie...................................................................................................................................... 29
Anemische hypoxie.................................................................................................................................. 29
Hypokinetische hypoxie........................................................................................................................... 29
Oorzaken van weefselhypoxie................................................................................................................. 29
Gevolgen..................................................................................................................................................30
Autonoom zenuwstelsel.............................................................................................................................. 30
Neurotransmissie..................................................................................................................................... 30
Sympathisch zenuwstelsel....................................................................................................................... 30
Adrenerge receptoren.............................................................................................................................. 31
Parasympathisch zenuwstelsel................................................................................................................ 31
Neurotransmitters.....................................................................................................................................31
Circulatie.......................................................................................................................................................32
Nerveuze controle van de circulatie......................................................................................................... 32
Hartdebiet.................................................................................................................................................32
Shock............................................................................................................................................................ 33
Klinische vormen......................................................................................................................................... 33
Multiple Orgaan Falen (MOF) = Multiple Organ Disfunction Syndrome (MODS).....................................33
Stadia van shock......................................................................................................................................34
Algemene symptomatologie....................................................................................................................... 34
Cyanose................................................................................................................................................... 34
Diagnose, labo, hemodynamisch profiel................................................................................................... 35
Arteriële bloeddruk................................................................................................................................... 35
Afwijkende polsdrukken........................................................................................................................... 35
Centraal veneuze druk............................................................................................................................. 36
Capillaire refill...........................................................................................................................................36
Cardiac output..........................................................................................................................................36
Swan-Ganz katheterisatie........................................................................................................................ 37
Tekens van cellulaire schade................................................................................................................... 37
Labo......................................................................................................................................................... 37
Weefselhypoxie meten............................................................................................................................. 38
Lactaat..................................................................................................................................................... 38
Gemengd veneuze zuurstofsaturatie....................................................................................................... 38
Toekomst.................................................................................................................................................. 39
Conclusie................................................................................................................................................. 39
Cardiogene shock........................................................................................................................................ 39
Fysiopathologie........................................................................................................................................ 40
Risicofactoren.......................................................................................................................................... 40
Klinische presentatie................................................................................................................................ 40
Dyspnoe................................................................................................................................................... 41
Oedeem................................................................................................................................................... 41
Hemodynamische parameters................................................................................................................. 41
Hemodynamische subsets....................................................................................................................... 42
Hemodynamische profielen......................................................................................................................42
Hypovolemische shock............................................................................................................................... 43
Stadia van shock......................................................................................................................................43
Hemodynamische profielen......................................................................................................................43
Oorzaken..................................................................................................................................................43
Klinische presentatie................................................................................................................................ 44
1
,Septische shock...........................................................................................................................................44
Systemic inflammatory response syndrome (SIRS).................................................................................44
Sepsis...................................................................................................................................................... 44
Ernstige sepsis.........................................................................................................................................45
Septische shock....................................................................................................................................... 45
Definities.................................................................................................................................................. 45
Verband tussen zuurstofaanbod en zuurstofverbruik...............................................................................45
Lactaat..................................................................................................................................................... 46
Klinische presentatie................................................................................................................................ 46
Sequentie van pathogenetische stappen................................................................................................. 46
Verstoring van bloedstolling..................................................................................................................... 47
Hemodynamische veranderingen............................................................................................................ 47
Tekens ter hoogte van de huid................................................................................................................... 48
Darmen..........................................................................................................................................................48
Anatomie.................................................................................................................................................. 48
Fysiologie................................................................................................................................................. 49
Splanchnische circulatie...........................................................................................................................49
Oxygen countercurrent exchange............................................................................................................ 50
Pathofysiologie van ischemische enteritis................................................................................................50
Hypoperfusie van de darm....................................................................................................................... 51
Hypovolemische shock............................................................................................................................ 51
ischemie en infarct................................................................................................................................... 51
necrose en sepsis.................................................................................................................................... 52
Klinisch beeld - dikke darm...................................................................................................................... 52
Diagnose.................................................................................................................................................. 52
Klinisch beeld - dunne darm.....................................................................................................................53
Bacteriële translocatie..............................................................................................................................53
Behandeling............................................................................................................................................. 53
Bij acute intestinale ischemie................................................................................................................... 54
Lever..............................................................................................................................................................54
Anatomie.................................................................................................................................................. 54
Ischemische hepatitis (levershock).......................................................................................................... 54
Evolutie naar acuut leverfalen..................................................................................................................55
Behandeling............................................................................................................................................. 55
Onthouden.................................................................................................................................................... 55
Shock............................................................................................................................................................ 55
Regulatie van bloeddruk bij shock.............................................................................................................56
Acute regulatie van arteriële druk............................................................................................................ 56
Baroreceptorreflex....................................................................................................................................56
Chemoreceptorreflex................................................................................................................................57
CZS ischemische respons....................................................................................................................... 57
Verloop van reflexmechanismen.............................................................................................................. 57
Renine-angiotensine vasoconstrictor mechanisme..................................................................................58
Vloeistofshift doorheen de capillaire wand...............................................................................................58
Conclusie................................................................................................................................................. 59
Effecten van shock op het cardiovasculair systeem................................................................................59
Sepsis-geïnduceerde cardiomyopathie....................................................................................................59
Microcirculatoire disfunctie.......................................................................................................................59
2
, Cardiogene shock........................................................................................................................................ 60
Oorzaken..................................................................................................................................................60
Ruptuur van papillairspiertjes...................................................................................................................60
Ventriculair septum ruptuur...................................................................................................................... 61
Vrije wand ruptuur.................................................................................................................................... 61
Mechanische complicaties....................................................................................................................... 61
Behandeling............................................................................................................................................. 61
Intra-aortic balloon pump (IABP)..............................................................................................................62
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO).......................................................... 62
ARDS............................................................................................................................................................. 63
ARDS vs. acute longbeschadiging...........................................................................................................63
Risicofactoren.......................................................................................................................................... 63
De spelers................................................................................................................................................ 64
Verschillende stappen.............................................................................................................................. 64
3 stadia.....................................................................................................................................................64
Fysiopathogenese: 4 basisconcepten......................................................................................................64
Radiografie...............................................................................................................................................65
Verwikkelingen......................................................................................................................................... 65
Fysiologische principes.............................................................................................................................. 66
Cerebrale bloedflow (CBF).......................................................................................................................66
Cerebrale perfusiedruk (CPP)..................................................................................................................66
Cerebrale autoregulatie............................................................................................................................66
Monroe-Kelly principe.............................................................................................................................. 67
Cerebrale bloedvolume............................................................................................................................ 68
Effect van PCO2.......................................................................................................................................68
Bloed-hersenbarrière............................................................................................................................... 68
Encephalopathie.......................................................................................................................................... 68
Septische encephalopathie...................................................................................................................... 69
Rol van endotheel bij pathogenese
NIET......................................................................................................................................................... 70
Rol van astrocyten bij pathogenese
NIET......................................................................................................................................................... 70
Rol van neuronen bij pathogenese
NIET......................................................................................................................................................... 70
Cushing-respons...................................................................................................................................... 70
Neurogeen longoedeem...........................................................................................................................70
Invloed van hersenpatholgoie op de hemodynamiek...............................................................................71
Shock............................................................................................................................................................ 71
Acute Kidney Injury (AKI)............................................................................................................................71
Diagnose.................................................................................................................................................. 71
AKI + shock vs. AKI - shock..................................................................................................................... 72
Pathofysiologie: AKI etiologische diagnose............................................................................................ 72
Renale hypoperfusie................................................................................................................................ 73
Renale veneuze congestie.......................................................................................................................73
Microcirculatoire disfunctie.......................................................................................................................73
Endotheliale disfunctie............................................................................................................................. 74
Microvasculaire trombose........................................................................................................................ 74
Inflammatie...............................................................................................................................................74
3
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller katovandenbroucke. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $17.78. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
73243 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now