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Titolo:
The mesenteric hemodynamic response to circulatory shock: An overview
Autore:
Reilly, PM; Wilkins, KB; Fuh, KC; Haglund, U; Bulkley, GB;
Indirizzi:
Univ Penn, Sch Med, Dept Surg, Philadelphia, PA 19104 USA Univ Penn Philadelphia PA USA 19104 Dept Surg, Philadelphia, PA 19104 USA Duke Univ, Sch Med, Durham, NC 27706 USA Duke Univ Durham NC USA 27706Duke Univ, Sch Med, Durham, NC 27706 USA Univ Uppsala Hosp, Uppsala, Sweden Univ Uppsala Hosp Uppsala SwedenUniv Uppsala Hosp, Uppsala, Sweden Johns Hopkins Univ, Sch Med, Baltimore, MD 21218 USA Johns Hopkins Univ Baltimore MD USA 21218 ch Med, Baltimore, MD 21218 USA
Titolo Testata:
SHOCK
fascicolo: 5, volume: 15, anno: 2001,
pagine: 329 - 343
SICI:
1073-2322(200105)15:5<329:TMHRTC>2.0.ZU;2-I
Fonte:
ISI
Lingua:
ENG
Soggetto:
PLATELET-ACTIVATING-FACTOR; INTESTINAL BLOOD-FLOW; NITRIC-OXIDE; CARDIOGENIC-SHOCK; HEMORRHAGIC-SHOCK; OXYGEN-CONSUMPTION; ISCHEMIC-INJURY; ORGAN FAILURE; PANCREATIC PROTEASES; INTRINSIC REGULATION;
Keywords:
splanchnic vasoconstriction; nonocclusive mesenteric ischemia; ischemic colitis; ischemic hepatitis; ischemic pancreatitis; acalculous cholecystitis; hemorrhage; sepsis; tamponade; renin-angiotensin axis; free radicals;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
112
Recensione:
Indirizzi per estratti:
Indirizzo: Bulkley, GB Johns Hopkins Hosp, 685 Blalock,600 N Wolfe St, Baltimore, MD 21287 USA Johns Hopkins Hosp 685 Blalock,600 N Wolfe St Baltimore MD USA 21287
Citazione:
P.M. Reilly et al., "The mesenteric hemodynamic response to circulatory shock: An overview", SHOCK, 15(5), 2001, pp. 329-343

Abstract

The mesenteric hemodynamic response to circulatory shock is characteristicand profound; this vasoconstrictive response disproportionately affects both the mesenteric organs and the organism as a whole. Vasoconstriction of post-capillary mesenteric venules and veins, mediated largely by the a-adrenergic receptors of the sympathetic nervous system, can effect an "autotransfusion" of up to 30% of the total circulating blood volume, supporting cardiac filling pressures ("preload"), and thereby sustaining cardiac output atvirtually no cost in nutrient flow to the mesenteric organs. Under conditions of decreased cardiac output caused by cardiogenic or hypovolemic shock,selective vasoconstriction of the afferent mesenteric arterioles serves tosustain total systemic vascular resistance ("afterload"), thereby maintaining systemic arterial pressure and sustaining the perfusion of non-mesenteric organs at the expense of mesenteric organ perfusion (Cannon's "flight orfight" response). This markedly disproportionate response of the mesenteric resistance vessels is largely independent of the sympathetic nervous system and variably related to vasopressin, but mediated primarily by the renin-angiotensin axis. The extreme of this response can lead to gastric stress erosions, nonocclusive mesenteric ischemia, ischemic colitis, ischemic hepatitis, ischemic cholecystitis, and/or ischemic pancreatitis. Septic shock can produce decreased or increased mesenteric perfusion, but is characterized by an increased oxygen consumption that exceeds the capacity of mesenteric oxygen delivery, resulting in net ischemia and consequent tissue injury. Mesenteric organ injury from ischemia/reperfusion due to any form of shock can lead to a triggering of systemic inflammatory response syndrome. and ultimately to multiple organ dysfunction syndrome. The mesenteric vasculatureis therefore a major target and a primary determinant of the systemic response to circulatory shock.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 18/01/20 alle ore 02:00:56