The Modern Concept of Etiopathogenesis and
Diagnosis of Shock

 

Uroš Ristić¹, Radmilo Janković^1,2, Marija Stošić^2,3, Milan Manić⁴, Jelena Živadinović^1,2,
Dalibor Stojanović³, Biljana Stošić^1,2

¹University Clinical Center Niš, Clinic of Anesthesia and Intensive Therapy, Niš, Serbia
²University of Niš, Faculty of Medicine, Niš, Serbia
³University Clinical Center Niš, Clinic of Cardiac Surgery, Niš, Serbia
⁴Department of Anesthesia and Intensive Care, General Hospital Pirot, Serbia

 

SUMMARY

 

Introduction/Aim. Shock is a life-threatening condition that occurs due to a mismatch in the supply and consumption of oxygen, which leads to cell and tissue hypoxia, resulting in cell death and dysfunction of vital organs. The effects of shock are reversible in the early stages, but delay in diagnosis and initiation of treatment can lead to irreversible changes. There are four main categories of shock: hypovolemic, distributive, cardiogenic, and obstructive. The aim of the paper is to present a new perception of viewing the etiopathogenesis and effectively establish the diagnosis of shock.
Etiology. Hypovolemic shock can occur due to hemorrhagic and non-hemorrhagic causes. Distributive shock is divided into septic, systemic inflammatory response syndrome (SIRS), anaphylactic, neurogenic, and endocrine. Cardiogenic shock occurs due to intracardiac causes, while obstructive shock occurs due to extracardiac causes.
Pathogenesis. The pathogenesis of each type of shock is different depending on the etiology. Generally speaking, shock has three phases: compensated, cellular distress phase, and decompensated. When the shock progresses into an irreversible phase, it usually ends with multiorgan failure (MODS) and death.
Clinical presentation. Symptoms may vary depending on the type and stage of shock. The most important changes during this syndrome are at the level of hemodynamics, so the most common clinical signs are hypotension, tachycardia, tachypnea, disturbed mental status, cold extremities, and oliguria.
Diagnosis. The diagnosis of shock is based on history, clinical presentation, physical examination, vital parameters and biochemical analyses, SOFA criteria (sequential organ failure assessment score), acid-base status, diuresis measurement, etc.
Conclusion. Understanding the etiopathogenesis of shock and recognizing its early signs are vital for timely interventions that lead to improved patient outcomes.

 Keywords: shock, hemodynamic disorder, sepsis, etiopathogenesis

 

Corresponding author:

Uroš Ristić