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SA pathological processes > S5) Thrombosis and Embolism > Flashcards

S5) Thrombosis and Embolism Flashcards

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1
Q

What is a thrombosis?

A

A thrombosis is the formation of a solid mass from the constituents of the blood, within the circulatory system

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2
Q

There are three fundamental predisposing factors to thrombosis.

What is this called?

A

Virchow’s triad

  1. Changes in the vascuar wall
  2. changes in blood flow
  3. Changes in Blood
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3
Q

Identify the three predisposing factors to thrombosis as outlined in Virchow’s triad

A
  • Abnormalities of the flow of blood
  • Abnormalities of the blood vessel wall
  • Abnormalities of the constituents of the blood

2/3 are enough to create a thrombus

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4
Q

State two possible abnormalities in the flow of blood

A
  • Stagnation
  • Turbulence
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5
Q

State three causes for abnormalities in the blood vessel wall

A
  • Atheroma
  • Direct injury
  • Inflammation
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6
Q

State three causes for abnormalities in the constituents of the blood

A
  • Smoking
  • Post-partum
  • Post-operation
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7
Q

Describe the appearance of arterial thrombi

A
  • Pale
  • Granular
  • Lines of Zahn
  • Lower cell content
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8
Q

Describe the appearance of venous thrombi

A

(normally found where there is stasis - slowinf/stopping of blood flow)

  • Soft
  • Gelatinous
  • Deep red
  • Higher cell content
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9
Q

What are the 5 possible outcomes of a thrombosis?

A
  • Lysis - thromus dissolves
  • Propagation - thrombus grows
  • Organisation - undergoes fibrous repair and forms a scar
  • Re-canalisation - new channels grow and restore blood flow
  • Embolism - part breaks off and embolises
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10
Q

In three steps, describe the following outcome of a thrombosis: lysis

A

⇒ Complete dissolution of thrombus (small)

⇒ Fibrinolytic system active

⇒ Blood flow re-established

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11
Q

In three steps, describe the following outcome of a thrombosis: propagation

A

⇒ Progressive spread of thrombosis

⇒ Spreads distally in arteries

⇒ Spreads proximally in veins

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12
Q

In two steps, describe the following outcome of a thrombosis: organisation

A

⇒ Ingrowth of fibroblasts and capillaries (similar to granulation tissue)

⇒ Lumen remains obstructed

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13
Q

In two steps, describe the following outcome of a thrombosis: re-canalisation

A

⇒ Blood flow re-established but usually incompletely

⇒ 1/more channels formed through organising thrombus

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14
Q

In three steps, describe the following outcome of a thrombosis: embolism

A

⇒ Part of thrombus breaks off

⇒ Travels through bloodstream

⇒ Lodges at distant site

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15
Q

What are the arterial effects of thrombosis?

A

Depends on site and collateral circulation:

  • Ischaemia
  • Infarction
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16
Q

What are the venous effects of thrombosis?

A
  • Congestion
  • Oedema
  • Ischaemia
  • Infarction
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17
Q

What is an embolism?

A

An embolism is the sudden blockage of a blood vessel by thrombus or foreign material which has been brough back to its site of lodgement by blood current

(part of a thrombus thats come off)

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18
Q

What is the most common type of embolism?

A

Over 90% of emboli are thrombo-emboli

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19
Q

What are other types of embolism?

A
  • Air
  • Amniotic fluid
  • Nitrogen
  • Medical equipment
  • Tumour cells
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20
Q

Outline the four different pathways for thromboemboli

A
  • From systemic veins → lungs (pulmonary emboli)
  • From the heart (via aorta) → renal, mesenteric and other arteries
  • From atheromatous carotid arteries → brain
  • From atheromatous abdominal aorta → leg arteries
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21
Q

Identify common areas where emboli can occur

Study These Flashcards
A
  • Pulmonary embolism
  • Coronary embolism
  • Cerebral embolism
22
Q

What is a deep vein thrombosis?

Study These Flashcards
A
  • A deep vein thrombosis is the formation of a thrombus within a deep vein, most commonly the deep calf veins
  • It produces an inflammatory response (calor, dolor, rubor, tumor, functio laesa)
23
Q

Identify 5 predisposing factors to deep vein thrombosis

Study These Flashcards
A
  • Immobility
  • Post-operative
  • Pregnancy and postpartum
  • Oral contraceptives
  • Severe burns
24
Q

How does one prevent DVT?

Study These Flashcards
A
  • Prophylaxis for high-risk patients
  • Heparin sub-cutaneously
  • Leg compression during surgery

I. TED stockings

II. ‘Flowtron’ boots

25
What is the treatment for DVT?
- **aspirin** - Intravenous **heparin** - Oral **warfarin**
26
What is a pulmonary embolism?
- A **pulmonary embolism** is a sudden blockage of a pulmonary artery in the lung, usually due to a deep vein thrombosis - It presents with chest pain, shortness of breath, coughing and blood stained sputum
27
Identify and describe the three forms of pulmonary embolism
- **Massive PE** – \>60% reduction in blood flow (rapidly fatal) - **Major PE** – medium-sized pulmonary vessels blocked (SOB ± cough, blood stained sputum) - **Minor PE** – small peripheral pulmonary arteries blocked (asymptomatic/SOB)
28
What is the effect of recurrent minor pulmonary emboli?
Recurrent minor PEs lead to **pulmonary hypertension**
29
arterial and cardiac thrombi
occur at site of endothelial injury or turbulence
30
endothelial damage
- after MI secondary to haemodynamic stress of hypertension, scarred heart valves, after trauma or surgery - stasis thrombus will form (as platelets, clotting factors and chemical mediators) arent being washed away
31
Slow/Turbulent flow
**abnormal flow** increases chance of **clot** forming ==\> **Veins** have higher chance as their flow is slow ==\> Patients on **bed rest** are at risk ==\> occurs in **ulcerated atheroscletoric plaques**, with aneurysms **turbulent flow** can also additionally cause **damage** to endothelial wall turbulent flow (calcification/plaque)
32
formation of a thrombus
* platlets concentrated in th endothelium * catch onto a valve * form and aggrevate into a clump * more platelets join **haemostasis fibrinogen** * Platelets combine * fibrin gows out * fibrin traps red blood cells * then a second layer of white platelets join (lines of zahn)
33
hypercoagulability
pregnancy/after surgery = increased levels of fibrinogen and factor VIII = blood is hypercoagulability =-\>the pill causes this ==\> DIC
34
difference btetween post/pre mortem
post = more rubbery and shiny
35
thrombophlebitis
painful/superficial thrombi where the vein is inflammed
36
parietal
thrombi attached to the vessel wall and restrict the the lumen eg. arterial thrombi
37
clinical effects of thrombosis
==\> occulusion of an artery at site of thrombus ==\> embolisation thrombus = occlusion of artery ==\> congestion and odema in venous bed ==\> repeated miscarriages due to thrombosis of uteroplacental vasculature
38
thromboemboli
emboli that arise from thrombi
39
why cant embolization occur in veins
vein blood flows from small -\> Large vessels objects carried by blood in veins goes through right side of heart and embolise in pulmonary arteries
40
embolization in arteries
blood flows from large - small objects in the large arteries impact small ones - arise in the left heart, aneurysms and thrombi and embolise to lower extremities, brain, intestines
41
paradoxial emboli
RARE! form in systemic veins but embolise to systemic arteries and bypass lungs
42
thrombi seen in left heart as
1) infarcts 2) Atrial fibrillation =\> decreased atrial contraction =\> dialation of left atrium 3) vegetations
43
Emboli from Atheroma
- build up of materials that adhere to arteries occurs spontaneously / surgery / catherisation
44
TIAs
Transient ischameic attacks - episodes of neurological dysfunction - result of microscopic emboli
45
fat and bone marrow
- complication of bone fractures - damaged bone marrow fat cells release oil droplets - sucked up into venules **RESPIRATORY SYMPTOMS** - emboli lodge into lungs - some droplets pass through into brain, kidney, skin ===\> coma, agitation, rash
46
Gas emboli
negative pressure in veins air transports into right heart bubbles gather = frothy mass that stops circulation fatal = 100mls of air
47
The bends
- diver resurfaces too quickly then sudden depressurisation =\> dissolved gases being released as bubbles bubbles distort tissue and acts as an emboli - Nitrogen is very bad =\> fat soluble and creates problems in lipid - rich tissues **treatment** slow decompression
48
amniotic fluid embolism
complication of labour and C section amniotic fkuid enters maternal circulation respiratory distress/hypotension/seizures
49
Talcum Emboli
microscopic foreign bodies
50

SA pathological processes (15 decks)

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