12. thrombosis and embolism

Question 1

thrombosis etiology

Answer 1

virchows triad
hypercoagulability
stasis
endothelial injury

Question 2

endothelial injury

Answer 2

hypertension,
turbulent blood flow,
bacterial endotoxins,
radiation injury,
hypercholesterolemia,
homocysteineamia

Question 2

Abnormal blood flow

Question 2

turbulence

Answer 2

Turbulence
Commonly associated with hypertension, Ulcerated atherosclerotic plaques
Arterial and cardiac thrombosis

Question 2

stasis

Answer 2

Stasis
Typically seen in hyperviscosity syndromes (PV), Aneurysms, sickle cell anemia, mitral valve stenosis (left atrial dilation) and myocardial infarctions
Venous thrombi

Question 3

hypercoagubality type

Answer 3

genetic primary
acquired secondary

Question 3

genetic primary hypercoa factors

Answer 3

common
factor 5 leiden - arg to gln - resistant to protein c

prothrombin mutation

increased factors

rare
deficient protein c and s

Question 4

thrombi show lines of

Answer 4

zahn
red cells fibrin red cell fibrin

Question 5

Fate of a thrombus

Answer 5

Propagation
Embolization
Dissolution
Organization and recanalization
Inflammation and fibrosis (central liquefaction, bacterial seeding and influx of inflammatory cells)

Question 6

types of thrombi

Answer 6

Mural thrombi; Attached to one wall of an underlying structure (heart chambers and aorta)

Arterial thrombi; Usually occlusive in smaller vessels or mural in large vessels

Venous thrombi (= phlebothrombosis, red or stasis thrombi)
90% veins of lower extremity
always occlusive and always have a point of attachment to the underlying structure
Lines of Zahn are not well developed

Vegetative thrombi (NBTE); on heart valves

Question 6

Embolus

Answer 6

Embolus: intravascular solid, liquid, or gaseous mass that is traveled through the circulation until becoming lodged in a small vessel

Question 7

Classification based on physical state

Answer 7

Solid: Atheromatous, thromboemboli, tumor emboli, Fat and bone marrow
Liquid: Amniotic fluid emboli
Gaseous: Air emboli

Question 8

based on site of origin

Answer 8

Cardiac emboli (left side of heart), Arterial emboli (atheromas and aneurysms), Venous emboli (deep vein thrombosis) and Lymphatic emboli (tumor emboli)

Question 9

based on presenece of infection

Answer 9

Sterile/bland emboli and Septic emboli

Question 10

based on flow

Answer 10

Paradoxical emboli/crossed emboli- artery to vein

Retrograde emboli; Increased pressure in the body cavities during coughing or straining carries emboli from large thoracic ducts and abdominal veins.

Question 11

Pulmonary embolism(PE) origin common

Answer 11

bed ridden patients
DVT

Question 12

symptoms of pulm emboli

Answer 12

cough,
severe pleuritic pain,
shortness of breath,
occasionally haemoptysis and haemorrhagic pleural effusion

Question 12

types of pulm emboli

Answer 12

central
intermediate
peripheral

Question 13

cental emboli

Answer 13

Sudden death due to right-sided heart failure or cvs collapse

Saddle embolus; Straddle the pulmonary artery bifurcation

Question 14

Intermediate emboli

Answer 14

Occurs at branches of the pulmonary artery in the lungs
has a collateral circulation from the bronchial artery
so the area would not be necrotic

Question 15

peripheral emboli

Answer 15

Obstruction of end-arteriolar pulmonary branches where the bronchial artery don’t reach - red (hemorrhagic) infraction

Question 16

Chronic Thromboembolic Pulmonary Hypertension (CTEPH)

Answer 16

Multiple emboli clogging pulmonary capillary circulation

Question 17

Systemic thromboembolism origin

Answer 17

2/3 from left ventricular wall infarcts
1/4 from left atrial dilatation and fibrillation
The remaining from aortic aneurysms, atheromas, valvular vegetations and paradoxical emboli

Question 17

Fat embolism cause

Answer 17

Trauma to long bones or soft tissue (fracture with embolization of fatty marrow)
Extensive burns
Pancreatitis
Vigorous cardiopulmonary resuscitation

Question 17

Pathogenesis of fat emboli

Answer 17

mechanical
biochemical

Question 17

biochemical

Answer 17

free fatty acids are toxic to endothelium