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Flashcards in Surgery 2.2a-.csv - Name - Question - Answer.csv Deck (63):
1

Blood coming out from area of injury

Cessation of bleeding due to several factors

2

If there is cut either a complete or partial transaction

There is constriction

3

What do lumen and plasma (blood vessels) consist of?

RBC, WBC, Platelets, Lymphocytes, Neutrophils

4

What cells are present in the intimal lining of blood vessels?

endothelial cells

5

Outer layer

medial and externa

6

What is goal of hemostasis?

Goal is to prevent further blood loss function of disrupted vessel that has been incised or transected

Limit blood loss from an injured vessel

7

What major physiological events happen (independent of each other)?

Vascular constriction, platelet plug, fibrin formation, fibrinolysis

8

What is the half life of platelets?

7 days/1 week

9

What is the normal amount of platelets?

150,000 to 400,000/uL

10

What are platelets?

Anuclear fragments of megakaryotes

11

What role do platelets play in hemostasis?

They form a hemostatic plug and contribute to thrombin formation

12

How do platelets adhere?

via Von Willebrand factor

13

What causes secretion of substances in hemostasis?

Activation of platelet in the sub endothelial cell

14

What might be the result of excess adhesion (platelet adhesion and fibrinogen)?

Might cause obstruction of blood vessel, causing compromise in the blood supply

15

What are the phases of Hemostasis?

Vascular phase (Vasoconstriction), Platelet phase (Platelets aggregate), Coagulation phase (Clot formation), and Fibrinolysis (Clot retraction, clot destruction)

16

What is the name of Factor I?

Fibrinogen

17

What is the name of Factor II?

Prothrombin

18

What is the name of Factor III?

Tissue Factor

19

What is the name of Factor IV?

Calcium

20

What is the name of Factor V?

Labile, Proaccelerin, Accelerator Globulin

21

What is the name of Factor VII?

Proconvertin, Stable Factor, Serum Prothrombin Conversion Accelerator

22

What is the name of Factor VIII?

Antihemophilic Factor, Antihemophilic Globulin

23

What is the name of Factor IX?

Christmas Factor, Plasma Thromboplastin Component

24

What is the name of Factor X?

Stuart -- Power Factor

25

What is the name of Factor XI?

Plasma Thromboplastin Antecedent

26

What is the name of Factor XII?

Hageman Factor

27

What is the name of Factor XIII?

Fibrin Stabilizing Factor, Fibrinase

28

What are the steps of the common pathway?

Prothrombin --> Thrombin --> Fibrin

29

What clotting factors are involved in the intrinsic pathway?

VIII, IX, X, XI, XII

30

What clotting factor is involved in the extrinsic pathway?

VII

31

Vascular endothelial injury leads to what?

Platelet hemostatic function and vasoconstriction

32

Subendothelial collagen causes what functions in platelets?

Platelet adhesion secretion (reversible), Platelet aggregation secretion (irreversible), and Platelet aggregation

33

Platelet adhesion secretion involves what neurotransmitters?

ADP, serotonin, Ca2+, fibrinogen

34

Coagulation activation via tissue factor involves which clotting factor?

Factor VIIa

35

Coagulation activation via tissue factor leads to what?

Complexes on activated platelets

36

Complexes on activated platelets involve which clotting factors?

IXa, Xa

37

Complexes on activated platelets cause what? 

Thrombin + Fibrinogen

38

Thrombin + Fibrinogen cause what?

Platelet-fibrin thrombus

39

What is vascular constriction?

Initial response to vessel injury

40

When does vascular constriction occur?

Before any platelet adherence at the site of injury

41

What is Thrombosane A2?

A potent constrictor of smooth muscles, it is produced locally at the site of injury via the release of arachidonic acid from the platelet membranes

42

What is Endothelin

A potent vasoconstrictor synthesized by injured epithelium

43

What is serotonin?

A potent vasoconstrictor released during platelet aggregation

44

What are Bradykinin and Fibrinopeptides?

Vasoconstrictors

45

What is the lifespan of a platelet?

7 to 10 days

46

What are the steps of platelet plug formation?

1. Injury to intimal layer, 2. Exposes subendothelial collagen, 3. Platelets adhere, 4. Platelet adhesion, 5. Recruits other platelets from the circulating blood to seal disrupted vessel, 6. Primary Hemostasis

47

Activated partial thromboplastin time (aPTT)

Intrinsic pathway, common pathway...Factors: II, V, VII, IX, X, XI, XII, and Fibrinogen; High Molecular Weight (HMW) Kininogen and Prekallikrein

48

Prothrombin time (PT)

Extrinsic pathway, common pathway; Factors: II, V, VII, X, and Fibrinogen

49

Fibrin clot breakdown (lysis) allows what?

Restoration of blood flow during the healing process following injury. It begins at the same time clot formation is initiated.

50

If no lysis, continuous clot leads to...

occluded blood vessel --> tissue will die (e.g. heart attack, gangrene and necrosis)

51

Describe formation of the fibrin degradation products (FDPs), tPA (tissue plasminogen activator

Platelet --> Thrombin --> Fibrin -->FDP; Endothelium -->tPA --> Plasminogen to Plasmin to FDP

52

Describe the extrinsic pathway

Vascular injury --> Tissue factor + factor VII --> Tissue factor-Factor VIIa; (Tissue factor-Factor VIIa) Ca2+ can lead to Factor IX (and then IXa) to Factor X (and then Xa) [or directly to Factor X and then Xa] and then Factor Va, Ca2+, Phospholipid --> Prothrombin (factor II) and Thrombin (factor IIa) --> Fibrinogen to Fibrin, Factor XIIIa, and X-linked fibrin (or Factof XIII, Ca2+, and Fibrin)

53

Describe the intrinsic pathway

Surface - Factor XII to Factor XIIa (inflammation, complement activation, fibrinolysis) to Physiologic to Factor XI and XIa (where it can link up to the extrinsic pathway in the Factof IX stage) or Factor VIII and VIIIa (or V) (where it can link up with the extrinsic pathway at the Factor Va and phospholipid stage) or Thrombin (factor IIa)

54

What is the purpose of digital pressure?

To prevent further bleeding

55

What is the purpose of an extremity tourniquet?

To oclude a major vessel proximal to bleeding site

56

What is the pringle maneuver for, and how is it performed?

For liver bleeding. It is performed with a vascular clamp, and it occludes the hepatic pedicle containing the portal vein, hepatic artery, and common bile duct (the liver is supplied by hepatic artery and portal vein)

57

What is a simple ligature used for?

Small vessels

58

How is direct pressure applied?

By "packing" a wound with gauze

59

How does heat achieve hemostasis?

By denaturation of protein that results in coagulation of large areas of tissue

60

What does electrocautery do?

Helps control the bleeding

61

How should the amplitude of electrocautery be set?

High enough to produce prompt coagulation, but not so high as to set up an arc between the tissue and cautery tip

62

How are hemostatic agents classified, and what do they do?

Classified based on their mechanism of action, and many act at specific stages in the coagulation cascade and take advantage of natural physiologic responses to bleeding

63

What are the qualities of an ideal topical hemostatic agent?

Significant hemostatic action, minimal tissue reactivity, non-antigenicity, in vivo biodegradability, ease of sterilization, low cost, can be tailored to specific needs