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Pathological Processes > Thrombosis and Embolism > Flashcards

Thrombosis and Embolism Flashcards

(38 cards)

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1
Q

thrombosis

A

Formation of a solid mass of blood within the
circulatory system.
That solid mass is then called a thrombus.

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2
Q

clot

A

mass of blood outside the vessel wall

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3
Q

when does a thrombus form

A

when there is an abnormality in the vessel wall, blood flow, and blood components

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4
Q

what causes damage to the wall of the vascular system

A

Atheroma
Inflammation
Direct injury
Damage to heart

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5
Q

arterial thrombus

A

Pale
Granular
Lower cell content
Lines of Zahn

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6
Q

venous thrombus

A

soft
gelatinous
deep red
higher cell content

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7
Q

intrinsic pathway

A

ETENTE

Factors 2 8 9 10 11

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8
Q

extrinsic pathway

A

TEFS

5 7 10

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9
Q

lysis

A
  • Most likely when thrombi are small
  • Complete dissolution of thrombus
  • Fibrinolytic system active
  • Blood flow re-established
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10
Q

propagation

A

Progressive spread of
thrombosis
Distally in arteries
Proximally in veins

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11
Q

organisation

A

• Reparative process
• Ingrowth of fibroblasts and capillaries (similar to
granulation tissue)
• Lumen remains obstructed

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12
Q

recanacalisation

A

• One or more channels form through
area of organising thrombus.
• Blood flow can be re-established but usually
incompletely.

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13
Q

thromboembolism

A
  • Part of thrombus breaks off
  • Travels through bloodstream
  • Lodges at distant site
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14
Q

effects of venous thrombosis

A

venous system-

  • congestion
  • oedema
  • ischaemia
  • infarction
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15
Q

effects of arterial thrombosis

A

arterial system

  • ischaemia
  • infarction
  • depends on site and collateral circulation
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16
Q

embolism

Study These Flashcards
A

Embolism is the blockage of a blood vessel
by solid, liquid or gas at a site distant from its
origin.
>90% of emboli are thrombo-emboli

17
Q

what does thrombosis in vein lead to

Study These Flashcards
A

pulmonary embolism

18
Q

thrombosis in heart

Study These Flashcards
A

Due to endocardial thrombus (myocardial infarction), vegetations, atrial fibrillation.

Fragments into aorta and then lodge in cerebral arteries, renal artery, mesenteric artery, iliac/femoral
arteries leading to ischaemic stroke, renal infarcts, bowel ischaemia, limb ischaemia.

19
Q

thrombosis in carotid artery

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A

Atherosclerotic plaque with development of thrombus causing emboli which causes cerebral
ischaemia (Ischaemic Stroke)

20
Q

abdominal aortic thrombosis

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A

Atherosclerotic plaque or aneurysm with development of thrombus causing emboli which causes
acute limb ischaemia.

21
Q

pre-disposing factors of DVT

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A
  • Immobility/bed rest
  • Post-operative
  • Pregnancy and post-partum
  • Oral contraceptives
  • Severe burns
  • Cardiac failure
  • Disseminated cancer
  • Superficial thrombophlebitis (inflammation of superficial veins of the legs)
22
Q

complications of pulmonary embolism

Study These Flashcards
A

massive coiled embolus in main pulmonary artery- death

small embolus lodged in peripheral pulmonary artery- pulmonary infarct

multiple repeated small emboli- pulmonary hypertension

23
Q

what does carotid artery thrombus lead to

Study These Flashcards
A

ischaemic stroke

24
Q

how do you treat a thrombus and thromboemboli

Study These Flashcards
A 
clot busters/ thrombolysis 
CT pulmonary angiogram 
low molecular weight heparin 
newer generation NOAC/DOAC antocoagulants 
oral warfarin 
embolectomy
25
what can form an embolism
-body fat -bone marrow -material from -atheromatous plaques -tumour fragments -parasites -bubbles of air or other gases -debris injected intravenously -amniotic fluid -medical equipment -bits of brain or liver after trauma.
26
where is embolisation more likely to occur and why
In veins blood flow is from smaller to larger vessels, hence embolization cannot occur in veins. Objects carried by the blood in veins will therefore go through the right heart and embolise in the pulmonary arteries
27
where do 80% of pulmonary emboli arise from
80% of pulmonary emboli arise from thrombi in the deep | veins of the thigh and the popliteal vein
28
what can multiple pulmonary emboli result in
pulmonary hypertension
29
what are paradoxical emboli
They are thromboemboli that form in the systemic veins but embolise to the systemic arteries. They manage to bypass the lungs in one of two ways.
30
what ways can a pulmonary emboli bypass the lungs
1. Small emboli are able to pass through the arterio-venous anastomoses in the pulmonary circulation (these anastomoses are 20-40 times the diameter of a capillary). Incidentally, this is also the way that fat droplets pass through the lungs in fat embolism. 2. Larger emboli can only enter the systemic circulation by passing through defects in the interventricular septum or a patent foramen ovale during coughing, lifting or straining (which increases the pressure in the right side of the heart to greater than that in the left, pushing the thrombus through the defect).
31
how can an emboli form from artherma
. It can be released into the blood when a plaque breaks open. This can happen spontaneously and also during surgery or catheterisation for coronary artery disease. Such emboli often affect the intestine and present with abdominal pain.
32
how can a fat and bone marrow emboli form
a complication of bone fractures but fat emboli can also occur after liposuction. When a bone is fractured the bone marrow fat cells that are injured break up and release oil droplets. These coalesce over a period of a few days and are then sucked into gaping venules that have been torn by the fracture
33
how does aspirin treat thromboembolism disease
Aspirin is antithrombogenic. It irreversibly acetylates an enzyme of prostaglandin synthesis (cyclooxygenase) and this means that platelets can’t produce thromboxane A2 which is a powerful platelet aggregator. the formation of a haemostatic plus is therefore inhibited so bleeding time is prolonged
34
when is aspirin used
to reduce the risk of MI and stroke also as a phophylactic agasint DVT in patients taking long haul flights
35
why is heparin used
Low molecular weight heparin is used as prophylaxis against thrombosis and also to treat thrombosis. It is given subcutaneously or intravenously. It forms irreversible complexes with antithrombin III resulting in its activation.
36
why is warfarin used
prophylaxis against thrombosis and also to treat thrombosis. It is an oral medication which interferes with vitamin K metabolism. The dosage required is titrated to the patients PT test results, specifically the INR results.
37
whta is INR
(INR stands for international normalised ratio which is the ratio of the patient’s PT to a normal control).
38
How are filters used to treat thromboembolism disease
putting an umbrella-shaped filter into the inferior vena cava

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