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Homeostatic responses to loss of blood volume

This flowchart shows the action of decreased blood pressure and volume in the neural and endocrine mechanisms.

Circulatory shock

The loss of too much blood may lead to circulatory shock    , a life-threatening condition in which the circulatory system is unable to maintain blood flow to adequately supply sufficient oxygen and other nutrients to the tissues to maintain cellular metabolism. It should not be confused with emotional or psychological shock. Typically, the patient in circulatory shock will demonstrate an increased heart rate but decreased blood pressure, but there are cases in which blood pressure will remain normal. Urine output will fall dramatically, and the patient may appear confused or lose consciousness. Urine output less than 1 mL/kg body weight/hour is cause for concern. Unfortunately, shock is an example of a positive-feedback loop that, if uncorrected, may lead to the death of the patient.

There are several recognized forms of shock:

  • Hypovolemic shock in adults is typically caused by hemorrhage, although in children it may be caused by fluid losses related to severe vomiting or diarrhea. Other causes for hypovolemic shock include extensive burns, exposure to some toxins, and excessive urine loss related to diabetes insipidus or ketoacidosis. Typically, patients present with a rapid, almost tachycardic heart rate; a weak pulse often described as “thread;” cool, clammy skin, particularly in the extremities, due to restricted peripheral blood flow; rapid, shallow breathing; hypothermia; thirst; and dry mouth. Treatments generally involve providing intravenous fluids to restore the patient to normal function and various drugs such as dopamine, epinephrine, and norepinephrine to raise blood pressure.
  • Cardiogenic shock results from the inability of the heart to maintain cardiac output. Most often, it results from a myocardial infarction (heart attack), but it may also be caused by arrhythmias, valve disorders, cardiomyopathies, cardiac failure, or simply insufficient flow of blood through the cardiac vessels. Treatment involves repairing the damage to the heart or its vessels to resolve the underlying cause, rather than treating cardiogenic shock directly.
  • Vascular shock occurs when arterioles lose their normal muscular tone and dilate dramatically. It may arise from a variety of causes, and treatments almost always involve fluid replacement and medications, called inotropic or pressor agents, which restore tone to the muscles of the vessels. In addition, eliminating or at least alleviating the underlying cause of the condition is required. This might include antibiotics and antihistamines, or select steroids, which may aid in the repair of nerve damage. A common cause is sepsis    (or septicemia), also called “blood poisoning,” which is a widespread bacterial infection that results in an organismal-level inflammatory response known as septic shock    . Neurogenic shock is a form of vascular shock that occurs with cranial or spinal injuries that damage the cardiovascular centers in the medulla oblongata or the nervous fibers originating from this region. Anaphylactic shock is a severe allergic response that causes the widespread release of histamines, triggering vasodilation throughout the body.
  • Obstructive shock , as the name would suggest, occurs when a significant portion of the vascular system is blocked. It is not always recognized as a distinct condition and may be grouped with cardiogenic shock, including pulmonary embolism and cardiac tamponade. Treatments depend upon the underlying cause and, in addition to administering fluids intravenously, often include the administration of anticoagulants, removal of fluid from the pericardial cavity, or air from the thoracic cavity, and surgery as required. The most common cause is a pulmonary embolism, a clot that lodges in the pulmonary vessels and interrupts blood flow. Other causes include stenosis of the aortic valve; cardiac tamponade, in which excess fluid in the pericardial cavity interferes with the ability of the heart to fully relax and fill with blood (resulting in decreased preload); and a pneumothorax, in which an excessive amount of air is present in the thoracic cavity, outside of the lungs, which interferes with venous return, pulmonary function, and delivery of oxygen to the tissues.

Chapter review

Neural, endocrine, and autoregulatory mechanisms affect blood flow, blood pressure, and eventually perfusion of blood to body tissues. Neural mechanisms include the cardiovascular centers in the medulla oblongata, baroreceptors in the aorta and carotid arteries and right atrium, and associated chemoreceptors that monitor blood levels of oxygen, carbon dioxide, and hydrogen ions. Endocrine controls include epinephrine and norepinephrine, as well as ADH, the renin-angiotensin-aldosterone mechanism, ANH, and EPO. Autoregulation is the local control of vasodilation and constriction by chemical signals and the myogenic response. Exercise greatly improves cardiovascular function and reduces the risk of cardiovascular diseases, including hypertension, a leading cause of heart attacks and strokes. Significant hemorrhage can lead to a form of circulatory shock known as hypovolemic shock. Sepsis, obstruction, and widespread inflammation can also cause circulatory shock.

Listen to this CDC podcast to learn about hypertension, often described as a “silent killer.” What steps can you take to reduce your risk of a heart attack or stroke?

Take medications as prescribed, eat a healthy diet, exercise, and don’t smoke.

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References

Centers for Disease Control and Prevention (US). Getting blood pressure under control: high blood pressure is out of control for too many Americans [Internet]. Atlanta (GA); [cited 2013 Apr 26]. Available from: (External Link)

Questions & Answers

type 2 is controled by diet
Chloe Reply
what is hypotension
regina Reply
hypotension is when the blood pressure is less than 60/50
Mursal
hypo means low so it implies low blood pressure
Isaac
ok
Mursal
what is mild DKA
Mursal
what is the difference between plasma and serum
Gloria Reply
Plasma contains fibrinogen while serum doesn't
Kateregga
plasma ----- fibrinogen = serum
Sneha
In what time stomach empty it's content in to doudemun? what is chyme?
Sneha Reply
write the chemical and mechanical digestion which occurs in stomach?
Sneha
Does absorption take place in stomach? what are absorption in the stomach by which cell?
Sneha
Chemical digestion---Mixtures of the food with the gastric acid Mechanical digestion--- churning of the food in the stomach making it become more involved into chyme
Mercy
absorption takes place in the small intestine because of the presence of the villi
Enada
name the muscles supplied redina nerve
Appu Reply
mechanism of hormone releasing by gland
said Reply
why is muscle tissue not considered to be a type of connective tissue?
Ezel Reply
A Skeletal muscles consist of numerous muscles cells called Muscle Fibers . Three layers of connective tissues surrounded these fibers to make the muscles tissues
Manisha
that's wny connective tissues is not considered as muscles fibers
Manisha
there are 4 types of tissues : epithelial, connective tissue, nervous tissue and muscle tissue, each one has its own properties. The main function of connective tissue is nutrition, it supplies nutrientes to epithelial tissues that are responsible for protection.
Ariete
Muscle tissue has properties that allow movement, the function here is movement and not nutrition like connective tissue.
Ariete
In what time stomach empty it's content in to doudemun?
Sneha
write the chemical and mechanical digestion which occurs in stomach?
Sneha
Does absorption take place in stomach? what are absorption in the stomach by which cell?
Sneha
Does absorption take place in stomach? what are the absorption in the stomach by which cell?
Sneha
mechanism of hormone controlling releasing by gland
said
please can someone explain renin angiotensin aldosteron system for me
okolie
name the joint present between epichysif and diachysif
JAYKISHAN Reply
what is arteries
JAYKISHAN
oxygenated blood carrying vessels
Karanpreet
I think oxygenated blood carrying pulmonary vein
Omaryare
ya this stetment is right 4 pulmonary vein carrying the oxygenated blood
Sneha
What is the relation between cold and clammy skin and disorders that cause poor perfusion?
Tyrone Reply
name the instruments used to measure the gas volume and flow in pulmonary function test
Preethi Reply
Spirometer
Ravi
In a spirometry test, While you are sitting, you breath into a mouthpiece that is connected to an instrument called a spirometer . The spirometer records the amount and the rate of air that you breath in and out over a period of time. When standing, Some numbers might be slightly different.
Ravi
tq soo much
Preethi
u most wlcm
Ravi
what is signal transduction?
Bahle
Signal Transduction (Also know as cell signaling) is the transmission of molecular signal from a cell exterior to its interior.Signals receive by cells must be transmitted effectively into the cell to ensure an appropriate response. This step is initiated by cell - surface receptors.
Ravi
i know now didn't know
Cypline
that's great respond
Feng
what is histological anatomy?
Thelma Reply
what is histological anatomy?
Thelma
the study of form of structure seen under the microscope
Metinah
is the branch of biology which studies the microscopic anatomy of biological tissues.
Jeffrey
it's the study of the microscopic anatomy of cells and tissues in the plants and it's carried out by examining a thin slice of tissues under a microscope light / or an electronic microscope
Manisha
is the study of anatomy in a microscopic level
simon
thank you
Thelma
what are the significance differrences can be donated between the female and male skeleton..
charles
What is Ions and Ionic bonds
Ravi Reply
2 less stable atoms
Hope
Ionic bonding is the complete transfer of valence electron(s) between atoms. It is a type of chemical bond that generates two oppositely charged ions. In ionic bonds, the metal loses electrons to become a positively charged cation, whereas the nonmetal accepts those electrons to become a negatively
Hope
what is osmosis
Brown Reply
it's out Body Fluid.
Sa
high pressure to low pressure flow
Sneha
Osmosis is the movement of solvent from a region of lower solute concentration to a region of higher solute concentration through a semi- permeable membrane.
Ravi
how many types of tissue
ABBAKARR Reply
4, that is muscle tissue, connective, nerve and epithelial tissue
Mapesho
We have four types of tissue these are ,epithelial tissue,nerve tissue,muscle tissue and connective tissue
Samboat
function of labia minora
temba
why is a graph of plasma [glucose] superimposed
Sefai Reply

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Source:  OpenStax, Anatomy & Physiology. OpenStax CNX. Feb 04, 2016 Download for free at http://legacy.cnx.org/content/col11496/1.8
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