Thrombosis, Embolism and Shock

Question 1

What is a thrombosis?

Answer 1

formation of a solid or semi-solid mass from the constitutes of the blood.

Question 2

What are examples of where thrombi may form?

Answer 2

• lumen of the heart
• arteries
• veins
• capillaries

Question 3

When might a thrombi form in the lumen of the heart?

Answer 3

after MI

Question 4

What is disseminated intravascular coagulation?

Answer 4

• formation of a clot in small blood vessels
• involves both thrombus formation and haemorrhage
• minute thrombi may cause scattered ischaemic lesions

Question 5

What are the triggers for disseminated intravascular coagulation?

Answer 5

• infection
• septicaemia
• malaria
• neoplasm
• liver disease

Question 6

What are factors that promote thrombosis? (Virchow’s triad)

Answer 6

1. abnormalities of vessel wall
2. abnormalities of blood flow
3. abnormalities of the bloods constituents

Question 7

What is atherosclerosis?

Answer 7

a disease were plaque builds up inside your arteries

Question 8

What can cause abnormalities in the artery walls?

Answer 8

inflammation
heart attack
rheumatic endocarditis

Question 9

What can cause abnormalities in the vein and capillary walls?

Answer 9

trauma 
inflammation 
chemical such as :-
- sclerosants (irritant substances injected to obliterate varicose veins)
- glucose (artheroma in diabetes )

Question 10

What can cause abnormalities in blood flow in arteries?

Answer 10

turbulence 
aneurysms (bludge in blood vessel caused by weakness in wall)
plaques
spasms 
atrial fibrillation

Question 11

What can cause abnormalities in blood flow in veins?

Answer 11

compression
inactivity
heart failure
circulatory shock

Question 12

What can cause abnormalities of the blood constituents?

Answer 12

• increased viscosity
• hyperproteinaemia
• multiple myeloma (tumour in bone marrow)
• abnormalities of clotting

Question 13

What may cause abnormalities of clotting?

Answer 13

• pregnancy
• contraceptive pill
• following trauma liver may produce more clotting factors
• tumours
• thrombocythaemia (blood disorder, over production of platelets )
• inherited

Question 14

What may cause increased viscosity?

Answer 14

• polycythaemia (increased haemoglobin)
• dehydration
• chronic hypoxia
• polycythaemia rubra vera (bone marrow makes to many red blood cells )

Question 15

If a thrombi detaches it becomes a …

Answer 15

thromboembolism

Question 16

What is an embolism ?

Answer 16

transport of abnormal material (solid, liquid, gas) by the blood stream and its impacting in a blood vessel

Question 17

Fat emboli is normal caused by what?

Answer 17

physical trauma such as fracture of a long bone, soft tissue trauma or a burn

Question 18

When might a gas emboli occur?

Answer 18

infusion
vascular surgery
caisson disease

Question 19

What is caisson disease ?

Answer 19

happens when ascending from depth too rapidly
bubbles of nitrate form in blood stream
on enter bones and joints cause pain known as the bends

Question 20

When might a emboli involving tumour material occur?

Answer 20

when tumour penetrates blood vessel

parts may break away to form metastases

Question 21

Give an example of infective agent emboli.

Answer 21

fragments of vegetation growing on heart valves in infective endocarditis

Question 22

atheroma

Answer 22

fragments of artheromatous plaque may break off

Question 23

Explain how amniotic fluid may become an emboli

Answer 23

uterus may force amniotic fluid and squames from infant into uterine veins of mother.

Question 24

When may foreign bodies cause emboli ?

Answer 24

iv drug abuse

iatrogenic (caused by medical examination or treatment)

Question 25

What is shock ?

Answer 25

• physiological state characterised by
• reduction in tissue perfusion
• resulting in decreased tissue oxygen delivery
• insufficient removal of cellular metabolic products
• resulting in tissue injury

Question 26

What are the clinical features of shock ?

Answer 26

• low BP
• tachycardia
• abnormal respiratory rate
• low urine output
• metabolic acidosis
• hypoxia
• cutaneous vasoconstriction or vasodilation
• anxiety, agitation, indifference, lethargy, obtunded ( not alert )

Question 27

A clinical sign of shock is low BP.. what in particular are you looking for?

Answer 27

systolic under 110

Question 28

A clinical sign of shock is tachycardia.. above how many beats a minute is this..

Answer 28

90

Question 29

A clinical sign to watch in shock is urine output…. What would we be looking for?

Answer 29

low urine output

Question 30

A clinical sign of shock is metabolic acidosis, what is this?

Answer 30

• excessive amount of acid produced when kidneys are not removing enough from the body

Question 31

A clinical sign of shock is cutaneous vasoconstriction or vasodilation what is cutaneous?

Answer 31

affecting the skin

Question 32

Why may hypovolaemic shock occur?

Answer 32

• haemorrhage (internal or external )

- severe nurns

Question 33

When might cardiogenic shock happen?

Answer 33

• large acute myocardial infarction

- other acute cardiac disease

Question 34

When might septic shock occur?

Answer 34

• from endotoxins from gram negative bacteria
• exotoxins from gram positive bacteria
• both these leads to dilation of blood vessels

Question 35

When might anaphylactic shock occur?

Answer 35

• severe form of allergic reaction (food, antibiotics, insect sting)

Question 36

When might neurogenic shock occur?

Answer 36

• spinal cord trauma

- regional anaesthesia

Question 37

When might obstructive shock occur?

Answer 37

• cardiac tamponade (compression of heart by an accumulation of fluid in pericardial sac)
• tension pneumothorax (build up of air in pleural space)
• massive pulmonary embolism (blockage in pulmonary arteries)