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Surgery M4 part 1 > hemostasis > Flashcards

hemostasis Flashcards

1
Q

What are the steps of hemostasis?

A

primary hemostasis
secondary hemostasis
fibrinolysis

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2
Q

What are the phases that occur during primary hemostasis?

A

PHASE I
- vasoconstriction: decrease in local blood flow

PHASE II
- platelet plug (Vin Willebrand factor): thromboplastin -> adherence of platelets to sub-endothelial tissue

PHASE III

  • tamponade: surrounding tissue tension acts as a tamponade for bleeding
  • interstitial hemorrhage is less profuse than external or internal hemorrhage
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3
Q

When is vasoconstriction less effective?

A
  • in partially injured vessels
  • in stiff atherosclerotic vessels
  • in large veins (poor muscle coat)
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4
Q

What occurs during secondary hemostasis?

A

ACTIVATION OF COAGULATION CASCADE

- includes the intrinsic & extrinsic pathways

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5
Q

What are the factors activated in the intrinsic pathways & what test is used to measure their function?

A

factor XII
factor XI
factor IX
factor VIII

PTT

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6
Q

Which factor is activated in the extrinsic pathway & what test is used to assess its function?

A

factor XII

PT

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7
Q

What factor is activated in the common pathway?

A

factor X

which activates the conversion of thrombin to fibrinogen

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8
Q

What initiates the extrinsic pathway?

A

tissue lipoprotein

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9
Q

How does fibrinolysis occur?

A

tissue plasminogen activator converts plasminogen to plasmin which breaks down fibrin

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10
Q

What test will be affected incase of deficiency of factors VIII & IX and what is the disease that causes this deficiency?

A

HEMOPHILIA A for factor VIII & B for factor IX

PTT is affected

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11
Q

What are the manifestations of hemophilia?

A
  • spontaneous bleeding in childhood (severe form)

- bleeding after mild trauma or surgery

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12
Q

How should hemophilia be treated?

A

infusion of factor concentrate 1 hour before surgery & 10 days after

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13
Q

What are the manifestations of Von Willebrand disease & how should it be treated?

A
  • purpuric eruptions, ecchymosis or bleeding per orfices

- infusion of Von Willebrand factor

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14
Q

What are the hemostatic disorders associated with liver disease?

A
  • decreased concentration of factors 1972 (effected by vitamin K)
  • thrombocytopenia due to hypersplenism
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15
Q

How should hemostatic disorders due to hepatic diseases be treated?

A
  • Vit K administration

- Fresh frozen plasma

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16
Q

Vitamin K is a co-factor in the synthesis of which clotting factors?

A

1972
X, IX, VII, II

increase in traumatic bleeding

17
Q

What are the causes of vit K deficiency?

A
  • inadequate diet or TPN
  • obstructive jaundice
  • prolonged broad antibiotic
  • malabsorption
18
Q

How should vit. K deficiency be treated?

A
  • daily vit. K injection (SLOW IV)

- FFP in emergencies

19
Q

What are the causes of DIC?

A
  • septicemia
  • severe shock, trauma, & burns (SIRS)
  • ABO incompatible transfusion
20
Q

What occurs during DIC?

A
  • widespread activation of coagulation within circulation leading to dilution of clotting factors
21
Q

How should DIC be treated?

A
  • treat underlying cause
  • FFP to replace coagulation factors
  • platelet transfusion
22
Q

What are the platelet disorders?

A

THROMBOCYTOPENIA

THROMBASTHENIA

23
Q

What is the normal platelet count?

A

150 000 to 400 000

24
Q

What are the causes of thrombocytopenia?

A

PRIMARY: ITP
SECONDARY: Bone marrow suppression OR increase destruction in hypersplenism

25
Q

What are the causes of thrombasthenia?

A

disorders of platelet function due to drugs like ASPRIN & NSAIDS

26
Q

How can we differentiate between the 2 secondary causes of thrombocytopenia?

A

Bone marrow aspiration to search for megakaryocites (platelet precursors)

  • decreases in megakaryocites -> bone suppression
  • increase megakaryocites -> hypersplenism
27
Q

What are the characters of bleeding if the defect is of primary hemostasis?

A
  • superficial bleeding (patichae, purpura, & easy bruisability)
  • early onset following trauma
  • controlled by local pressure
28
Q

What are the characters of bleeding if the defect is of secondary hemostasis?

A
  • bleeding is deep (hematoma inside muscle)
  • delayed onset following trauma
  • local pressure is ineffective
29
Q

What disorder has a decreased number of platelets < 100 000?

A

thrombocytopenia

30
Q

What is the normal bleeding time & what diseases increase it?

A

normal = < 8 minutes

  • thrombocytopenia
  • abnormal platelet function
  • deficiency of Von Willbrand disease
  • Vascular abnormality
31
Q

What is the normal PT time & what factors affect it?

A

normal = 12 - 15 seconds

  • deficiency in factor VII or X
32
Q

What is the normal PTT time & what factors affect it?

A

normal = 30 - 40 seconds

  • factor XII, XI, X, IX, VIII, V, II
33
Q

What is the normal INR and what effects it?

A

normal = 1

  • patients taking oral anticoagulants (2-3)
  • patients with prosthesis (2.5-3.5)
34
Q

an increase in FDPs (fibrinogen degradation products) is an indication of?

A

DVT

Surgery M4 part 1 (47 decks)

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