Mesenteric Hemodynamics in Endotoxin Shock

  • G. F. Brobmann


In the last twenty years a widely accepted hypothesis on the pathophysiology of human septic shock has been postulated. Surveying the considerable literature one may conclude that we understand the events leading to lethal human shock. Related to the hypothesis of septic shock are the terms: adrenergic theory of shock and target organ theory. The essence of these theories is depicted in Fig. 1. Any kind of shock, whether it be hemorrhagic, septic, or due to myocardial infarction or massive trauma, leads to compensatory mechanisms to restore arterial pressure and cardiac output. One of the most important mechanisms is the stimulation of the sympathetic nervous system. Arteriolar constriction, particularly in the splanchnic region, results. Mesenteric vasoconstriction is leading to ischemic damage of critical abdominal organs, such as loss of intestinal barrier function against intraluminal contents, changes in the metabolic function of the liver, and the hepatic and splenic RES. Toxic materials enter the circulation and cannot be detoxified by the damaged RES. The subsequent endotoxemia, resulting in a vicious cycle, is responsible for what we call “irreversible” shock.


Portal Pressure Endotoxin Shock Intestinal Barrier Function Portal Venous Pressure Mesenteric Blood Flow 
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© Springer-Verlag/Wien 1975

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  • G. F. Brobmann

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