Fluid and Hemodynamic Alterations II

Question 1

What is a thrombus?

Answer 1

Ante-mortem blood clot formation on vascular wall within the CV system

Question 2

What are thrombi made of?

Answer 2

Platelets, Fibrin, and Entrapped Cellular elements

Question 3

What circumstances do you see clots in?

Answer 3

Extravascular (hematoma) and intravascular (postmortem space)

Question 4

What are the components of a postmortem clot?

Answer 4

Coagulation factors and erythrocytes only

Question 5

Gross appearance of a postmortem clot?

Answer 5

Currant-jelly clot

Chicken Fat Clot

Question 6

Describe a currant jelly clot

Answer 6

Dark to red-black, smooth and shiney, rubbery, uniform, molded to the shape of the vessel, not attached, increased RBC levels

Question 7

Describe a chicken fat clot

Answer 7

Like currant jelly, but yellow

Result of settling and separation of RBC and plasma

Question 8

Gross appearance of thrombus

Answer 8

Heterogenous
More organized than clots, attached to wall
Laminated

Question 9

Appearance of an arterial thrombi?

Answer 9

Pale. grey-tan, dry, friable, concentric layers, attached to vessel wall

Question 10

Appearance of venous thrombi?

Answer 10

Red, friable, attached to vessel wall, confused with clot, often occlusive

Question 11

Contents of a thrombus?

Answer 11

Fibrin, Platelets, WBCs, RBCs, +/- bacteria

Question 12

What are the laminated lines of Zahn?

Answer 12

arterial thrombi, alternating layers of platelets/fibrin (pale) and RBCs (dark)

Question 13

Thrombus vs. PM Clot. Formation?

Answer 13

T – Ante-mortem

C – Post-mortem

Question 14

Thrombus vs. PM Clot. Cause

Answer 14

T – Endothelial Injury

C – Stagnant blood of dead animal

Question 15

Thrombus vs. PM Clot. Attachment

Answer 15

T – Vessel Wall

C – None

Question 16

Thrombus vs. PM Clot. Consistency.

Answer 16

T – Dry

C – Moist

Question 17

Thrombus vs. PM Clot. Surface

Answer 17

T – Granular, Rough

C – Smooth, Glistening

Question 18

Thrombus vs. PM Clot. Vascular endothelium?

Answer 18

T – Damaged, Rough

C – Smooth, Intact

Question 19

Thrombus vs. PM Clot. Organization.

Answer 19

T – Partial

C – None

Question 20

Thrombus vs. PM Clot. Structure.

Answer 20

T – Laminated.

C – Homogenous

Question 21

Three primary causes of thrombosis.

Answer 21

Endothelial Injury (Most Common)
Alterations in Blood Flow
Hypercoagulability

Question 22

Causes of endothelial injury leading to thrombosis?

Answer 22

Endocardium: Infar./myocarditis, Immune Rxn, valve prbs
Arteries: Atherosclerosis, Vasculitis
Radiation, Bacterial agents, catheter

Question 23

Two types of blood flow alterations that can lead to thrombosis?

Answer 23

Turbulence (Arterial/Cardiac)

Stasis (Venous Thrombi)

Question 24

Mechanism of blood flow alterations leading to thrombosis?

Answer 24

Stasis/Turbulence fuck up laminar flow. Platelets hit the endothelium. Coagulation factors aren’t diluted by fresh blood. Retard inflow of coag. inhibitor. Promote endothelial cell activiation

Question 25

Four examples of alterations in normal blood flow

Answer 25

Aneurysms -- Abnormal dilation of vessels MI -- Necrotic myofibers do not contract Ulcerated atherosclerotic plaques -- local turbulence Hyperviscosity syndromes (polycythemia) -- slow BF

Question 26

Causes of primary hypercoagulability?

Answer 26

``` Factor V Leiden Prothrombin mutation Elevated homocysteine levels antithrombin III deficiency protein C deficiency, protein S deficiency Defects in fibrinolysis ```

Question 27

Causes of secondary hypercoagulability?

Answer 27

``` Oral contraceptives -- increased synth of coag. factors Cancer -- tumor products Tissue damage -- stasis of injury site Aging -- increased platelet aggregation Heparin-induced thrombocytopenia antiphospholipid antibody (lupus) ```

Question 28

What happens after a thrombus has formed

Answer 28

Propagation (grows larger -- tail) Detachment (embolization) Stays attached

Question 29

What do you do with a thrombus that stays attached?

Answer 29

Lysis Retraction (incorporate into vessel walls) Organization (endothelial growth over surface, hyalinization, Calcification) Recanalization

Question 30

Where do you typically see artherial thrombi?

Answer 30

Coronary, Cerebral, and Femoral Arteries

Question 31

Significance of thrombi?

Answer 31

Obstruction -- Infarction, Congestion | Embolization

Question 32

What is an embolism?

Answer 32

Detached IV solid, liquid, or gasseous masses carrid by the blood stream to distant sites

Question 33

Almost all emboli are...

Answer 33

Fibrinous thromboembolus

Question 34

Sequale of Pulmonary emboli (not including silent ones)

Answer 34

Sudden Death -- R Heart failure, CV collapse (big ones) Pulmonary Hemorrhage (obs. of medium vessels) Infarction - Obs. of small vessels Pulmonary HTN -- from multiple. leads to R sides HF

Question 35

Almost all systemic emboli come from.... | Others from...

Answer 35

Intracardiac mural thrombi (LV wall infarct, dilated atria, fib) Aneurysms, Atherosclerotic plaques, Septal Defect

Question 36

Whats it called when an emboli hits systemic circulation by goign through a septal defect?

Answer 36

Paradoxical emboli

Question 37

List some causes of infarction

Answer 37

``` Thrombus/Thromboemboli Local vasospasm Tumor Torsion Edema causing vascular compromise ```

Question 38

What is a white (anemic) infarcts

Answer 38

Arterial occlusion in solid tissue

Question 39

What is a red (hemorrhagic) infarct

Answer 39

Venous occlusion Tissues with dual blood supplies Previously congested tissues, sluggish venous outflow

Question 40

Microscopic features of infarcts

Answer 40

Coagulative necrosis (except brain), sharply demarcated +/- occluded vessels, +/- congestion Congestion and leukocyte influx in tissues Fibrosis

Question 41

Which type of thrombus is most prone to be occlusive

Answer 41

Venous

Question 42

Name for the triad of endothelial injury, abnormal blood flow, and hypercoagulability

Answer 42

Virchow's Triad

Question 43

Common symptom of L sided embolism

Answer 43

Gangrene

Question 44

Fat emboli are typically surrounded by cells from

Answer 44

Marrow