Surgical History and Principles
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Questions and Answers

Which of the following organisms is NOT associated with the pathophysiology of septic shock?

  • Klebsiella
  • Proteus
  • Escherichia coli
  • Staphylococcus aureus (correct)
  • What is the initial stage of septic shock characterized by?

  • Loss of pyrogenic response and decompensated shock
  • Disseminated intravascular coagulation (DIC) and hypodynamic state
  • Severe circulatory failure and multiple organ dysfunction syndrome (MODS)
  • Fever, tachycardia, and tachypnea (correct)
  • Which of the following processes is NOT involved in the pathophysiology of septic shock?

  • Activation of macrophages, neutrophils, and monocytes
  • Release of cytokines and free radicals leading to endothelial injury
  • Upregulation of angiotensin-converting enzyme (ACE) activity (correct)
  • Inflammation and chemotaxis of cells
  • What is the primary cause of severe hypotension in the early stage of septic shock?

    <p>Sustained release of high levels of nitric oxide causing peripheral vasodilation</p> Signup and view all the answers

    Which stage of septic shock is considered reversible?

    <p>Hyperdynamic (warm) shock</p> Signup and view all the answers

    What is the primary cause of multiple organ dysfunction syndrome (MODS) in septic shock?

    <p>Severe circulatory failure due to hypotension</p> Signup and view all the answers

    What is the irreversible stage in shock characterized by anuria, respiratory failure, jaundice, and eventually coma and death?

    <p>Irreversible stage</p> Signup and view all the answers

    What can happen in unresuscitatable shock due to prolonged profound shock?

    <p>Loss of responsiveness to fluid or inotropic therapy</p> Signup and view all the answers

    What is the name of the syndrome where further injury occurs once normal circulation is restored to tissues following a period of systemic hypoperfusion?

    <p>Ischaemia–reperfusion syndrome</p> Signup and view all the answers

    In Ischaemia–reperfusion syndrome, what can lead to direct myocardial depression and vascular dilatation?

    <p>Flushed back cellular and humoral elements</p> Signup and view all the answers

    Which of the following is NOT a complication of poor shock management as discussed in the text?

    <p>Cardiac recovery</p> Signup and view all the answers

    What results from unresuscitatable shock as per the text?

    <p>Further hypotension due to loss of systemic vascular resistance ability</p> Signup and view all the answers

    Study Notes

    Classification of Hemorrhage

    • Based on the source of bleeding:
      • Arterial: bright red in color, spurting like a jet along with pulse of the patient
      • Venous: dark red, steady and continuous flow
      • Capillary: rapid and bright red, often torrential due to continuous ooze
    • Based on the time of onset of bleeding in relation to trauma:
      • Primary: occurs at the time of injury or operation
      • Reactionary: occurs within 24 hours after surgery or after injury
      • Secondary: occurs in 7-14 days after surgery

    Pathophysiology of Hemorrhage

    • Bleeding leading to:
      • Circulatory hypovolaemia
      • Cellular hypoxia
      • Coagulopathy
    • Circulatory hypovolaemia:
      • Low cardiac output
      • Tachycardia and shunting of blood from splanchnic vessels by vasoconstriction
    • Cellular hypoxia:
      • Anaerobic metabolism and altered cell membrane function
      • Influx of sodium and calcium inside the cell and potassium comes out of the cell
      • Hyponatraemic, hypocalcaemic, hyperkalaemic metabolic acidosis
    • Coagulopathy:
      • Consumption coagulopathy
      • Dilution coagulopathy
      • Acidosis induced coagulopathy
      • Hypothermia induced coagulopathy
      • Inflammatory factors induced coagulopathy
      • Genetic effect in induction of coagulopathy

    Measurement of Blood Loss

    • The adult human has approximately 5 liters of blood
    • Methods of measurement:
      • Collection in suction bottles inside theater
      • Clot size of a clenched fist is 500 ml
      • Blood loss in a closed spaced tibial fracture is 500-1500 ml
      • Weighing the swab before and after use
      • Hb% and PCV estimation
      • Blood volume estimation using radioiodine technique or micro-haematocrit method
      • Measurement of CVP or PCWP

    Treatment of Bleeding

    • Identify hemorrhage: external hemorrhage may be obvious, but the diagnosis of concealed hemorrhage may be more difficult
    • Any shock should be assumed to be hypovolaemic until proved otherwise

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    Description

    Test your knowledge of surgical history, principles, and procedures with this introductory quiz. Designed by Dr. Ali Jawad Al-Shammari from the College of Medicine at the University of Al-Qadissiyah, this quiz covers the basics of surgery and its role in diagnosing and managing injuries, defects, and deformities. Challenge yourself and expand your surgical knowledge today!

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