Pathophysiology of thrombosis and embolism

Question 1

normal blood flow is described as

Answer 1

laminar

Question 2

process of thrombosis.

Answer 2

endothelial injury, stasis or turbulent blood flow, hyper coagulability of blood

Question 3

significance of Virchow’s triad.

Answer 3

change in blood vessel wall (eg atheromatous artery), blood constituents and pattern of blood flow. these are factors of thrombosis NOT clot

Question 4

relationship between atheroma and thrombosis.

Answer 4

arterial thrombosis most commonly superimposed on atheroma due to virchows triad. hypercholesterolaemia due to virchows triad

Question 5

factors causing thrombosis.

Answer 5

change in the heart eg vessel wall, hyper viscosity, post traumatic hyper-coagulability, stasis eg economy class syndrome, turbulence eg atheromatous plaque, aortic aneurysm

Question 6

factors causing embolism.

Question 7

defects in blood flow

Answer 7

atheroma, spasm, vasculitis, vascular steal syndrome, external compression, hyperviscosity, thromboembolism

Question 8

clinical consequences of thrombosis

Answer 8

deep vein thrombosis, ischaemic limb, myocardium infarction

Question 9

outcomes of thrombosis

Answer 9

resolution, organisation, recanalisation

Question 10

outcomes of thrombosis

Answer 10

resolution, organisation, recanalisation, death, propagation

Question 11

embolus

Answer 11

detached intravascular solid, liquid or gaseous mass. most are dislodged thrombi

Question 12

types of embolus

Answer 12

systemic thromboembolus, venous thromboembolus, fat embolus, gas embolus, tumour, trophoblast, septic material, amniotic fluid, bone marrow, foreign bodies

Question 13

mural thrombus

Answer 13

thrombus of the heart

Question 14

systemic thromboembolus

Answer 14

travel to other sites eg lower limbs or brain. consequences depend on vulnerability of affected tissues to ischaemia, calibre of occluded vessel, collateral circulation but usually infarction occurs

Question 15

consequences of pulmonary thromboembolism

Answer 15

depends on size of embolus but can be silent, pulmonary haemorrhage/infarction, right heart failure, sudden death. multiple PE over time leads to pulmonary hypertension and right ventricular failure

Question 16

risk factors for DVT and pulmonary thromboembolism

Answer 16

cardiac failure, severe trauma or burns, post op, nephrotic syndrome, disseminated malignancy, oral contraceptive pill, elderly, bed rest, obesity

Question 17

fat embolus

Answer 17

bits of fat get from the fractures thrown into the circulation after major fractures of bone. can affect the brain, kidneys or skin if get into systemic circulation

Question 18

gas embolus

Answer 18

decompression sickness (nitrogen as bubbles in capillaries), air embolus (head and neck wounds, surgery, CV lines)

Question 19

rheumatic fever

Answer 19

disease of disordered immunity, inflammatory changes in the heart and joints sometimes neurological symptoms

Question 20

presenting feature of rheumatic fever

Answer 20

presenting feature is painful polyarthritis of large joints plus skin rashes and fever. pancarditis in acute phase, heart murmurs common. recent sore throat

Question 21

valvular heart disease

Answer 21

valvular stenosis, valvular incompetence/ regurgitation, vegetations

Question 22

valvular stenosis,

Answer 22

valve thickened/ calcified and obstructs normal blood flow into chamber or vessel

Question 23

valvular incompetence/ regurgitation

Answer 23

valve loses normal function and fails to prevent reflux of blood after contraction of cardiac chamber

Question 24

vegetations

Answer 24

infective or thrombotic nodules develop on valve leaflets impairing normal valve mobility and may embolise

Question 25

rheumatic heart disease

Answer 25

pancarditis in acute rheumatic fever can progress into rheumatic heart disease manifesting as valvular abnormalities. characterised by fibrotic valvular disease involving the mitral valve- leaflet thickening, commissural fusion and shortening, thickening and fusion of chordae tendinae

Question 26

mitral stenosis cause

Answer 26

rheumatic heart disease