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R-Cradio-illness > Pathophysiology of Thrombosis and Embolism > Flashcards

Pathophysiology of Thrombosis and Embolism Flashcards

1
Q

What defects in blood flow can result in thrombosis and embolism?

A 
Atheroma
Hyperviscosity
Spasm
External compression
Vasculitis 
Vascular steal syndrome
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2
Q

What is normal blood flow?

A

Laminar - smooth and ordered

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3
Q

What is the vascular system affected by?

A

Pressure gradient
Resistance
Blood viscosity
Compliance of the vessel

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4
Q

What features of blood flow are abnormal?

A

Stasis

Turbulence

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5
Q

What is stasis of blood flow?

A

Stagnation of blood flow e.g. in cardiac failure where there is not enough force to push the blood

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6
Q

What is turbulence of blood flow?

A

Forceful, unpredictable flow e.g. due to something protruding into the lumen such as an atheromatous plaque
Noisy on auscultation

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7
Q

What are the components of Virchow’s triad?

A

Changes in blood vessel wall
Changes in blood constituents
Changes in pattern of blood flow

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8
Q

What is the most important risk factor for thrombus formation?

A

Hypercholesterolaemia

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9
Q

What is thrombosis?

A

Formation of a solid mass from the constituents of blood within the vascular system during life

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10
Q

What steps are involved in the pathogenesis of thrombosis?

A

Endothelial injury
Stasis or turbulent flow
Hypercoagulability of the blood

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11
Q

What effect does an atheromatous plaque have on blood flow when it starts to protrude from the lumen?

A

Starts to cause turbulent flow

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12
Q

What does turbulent blood flow cause?

A

Damage to the endothelial surface - loss of intimal cells and denuded plaque

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13
Q

What happens when the endothelial surface is lost due to turbulent flow?

A

Collagen in the fatty core of the plaque is exposed to the blood, platelets in the blood then stick to the collagen and form a fibrin meshwork which traps the RBCs

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14
Q

What do alternating bands of fibrin and RBCs form?

A

Lines of Zahn

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15
Q

What do the consequences of thrombosis depend on?

A

Site
Extent
Collateral circulation

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16
Q

What are common consequences of thrombosis?

A

DVT
Ischaemic limb
MI

17
Q

What are possible outcomes of thrombosis?

A

Resolution
Organisation/recanalisation
May relieve itself but often medical intervention is needed to break down the platelets and restore blood flow

18
Q

What will organisation/recanalisation cause?

A

Restoration of blood flow, but tissue damage may still occur as thrombus is stabilised, endothelial surface grows and fibrosis and granulation can occur along with the formation of new blood vessels

19
Q

What is embolism?

A

Movement of abnormal material in the blood stream and its impaction in a vessel, blocking its lumen

20
Q

What substances can form an embolus?

A

Detached intravascular solid, liquid or gaseous mass

21
Q

What are most emboli formed from?

A

Detached thrombi

22
Q

What are some causes of thromboembolism?

A 
Systemic/arterial thromboembolism 
Mural thrombus 
Aortic aneurysm
Atheromatous plaque
Valvular vegetations
23
Q

What are the features of a systemic thromboembolism?

A

Travels to a wide variety of sites - lower limbs most common but brain and other organs also affected
Usually infarction occurs

24
Q

What do the consequences of a systemic thromboembolism depend on?

A

Vulnerability of the affected tissues to ischaemia
Calibre of occluded vessel
Collateral circulation

25
Q

Where do most venous thromboembolisms originate from?

A

Deep venous thromboses in the lower limbs

26
Q

What is the most common form of thromboembolic disease?

A

Venous thromboembolism

27
Q

Where do venous thromboembolisms travel to? What can this cause?

A

Pulmonary arterial circulation

May occlude the main pulmonary artery, bifurcation or small arteries

28
Q

What do the consequences of a venous thromboembolism depend on?

A

Size of the embolus

29
Q

What are the potential consequences of venous thromboembolism?

A 
May be silent
Pulmonary haemorrhage
Pulmonary infarction
Right heart failure 
Sudden death
30
Q

What do multiple pulmonary emboli cause over time?

A

Pulmonary hypertension and right ventricular failure

31
Q

What are the possible types of embolus?

A 
Fat
Gas
Air
Tumour
Trophoblast
Septic material 
Amniotic fluid
Bone marrow
Foreign bodies
32
Q

What are the risk factors for DVT and pulmonary thromboembolism?

A 
Cardiac failure
Severe trauma/burns
Post-operative or post-partum state
Nephrotic syndrome
Disseminated malignancy 
OCP 
Increasing age
Bed rest/immobilisation
Obesity 
PMH of DVT
33
Q

What does prophylaxis for surgical patients at risk of DVT and pulmonary embolism include?

A

TEDS and subcutaneous heparin

R-Cradio-illness (27 decks)

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