3 SEQUELAE OF THROMBOSIS Flashcards
What are the 6 types of Sequelae of Thrombosis?
1) Resolution
2) Organization
3) Racanalization
4) Propagation
5) Infarction
6) Embolism
What is Resolution?
Dissolving of a clot disappears on its own due to natural blood anticoagulation factor overcoming the thrombus formation factors
What is the LEAST dangerous sequela of thrombosis?
Resolution
What are 2 types of Resolution Thromboses?
In atherosclerosis and Transient Ischemic Attack TIA
What happens during Atherosclerosis in Resolution?
Thrombus disappears due to high fibrinolytic function
Resolution of Atherosclerosis thrombus leads to _____
A high chance of developing another thrombus
What happens in Transient Ischemic Attack (TIA) in Resolution of thrombus?
Decreased or blocked blood flow to the brain (ischemia) due to embolus - often clot that occludes a cerebral artery
After a short time in TIA, what happens?
Symptoms go away, TIA is a “mini stroke”
What is TIA a warning sign for?
A future stroke (neurological malfunction)
Define an Organization (sequelae of Thrombosis):
Thrombus doesn’t disappear, but it undergoes reorganization
What happens after Organization?
Replacement w/scar tissue (CT)
What happens during Organization?
Phagocytic digestion of the thrombus within 2-3 days after it forms
What does the replacement of CT mean in Organization?
Replacement with CT makes it non-contractile, this causes decreased blood flow, this causes recanalization
What is recanalization a result of?
Organization
What happens during Recanaliztion?
Endothelium is reformed, over the organized thrombus, fibrous tissue
What are Recanalizations?
Formations of canals w/in the thrombus (vessels within vessels)
What is Propagation?
Enlargement of thrombus size over time
Where does Propagation usually occur?
In veins
In areas of slow blood flow, what happens during Propagation?
In areas of slow blood flow, the thrombus serves as a site for further adherence and aggregation of platelets, propagating the thrombus
In arteries, what happens during Propagation?
Propagation is likely to happen in turbulent blood flow areas like bifurcations
Where else does propagation happen?
Valves, cardiac and venous
What is Infarction?
Process where an infarct is formed
What is the #1 cause of death in the US?
Infarction
What is an infarct?
Region of necrosis caused by O2 deficiency due to decrease in blood flow to that area
What are the 2 types of infarct?
white and red
What is White Infarct?
In tissues with only 1 blood vessels supply, artery, or vein
What is an example of White infarct?
Heart infarct: 1 blood supply (coronary artery)
What is a Red Infarct?
Red color in tissues with 2+ blood supplies
What is an example of Red infarct?
Lung Infarct: 2 blood supplies (pulmonary and bronchial art)
What is the most common form of Infarction?
Myocardial Infarction (infarct in the heart muscle)
What type of necrosis is associated with myocardial infarction?
Coagulative
What is Ischemic stroke associated with?
Infarction
What is ischemic stroke?
Brain infarct
What is the most common area for a stroke?
Brain
What type of necrosis is associated with Brain infarct?
Liquefactive Necrosis
What repairs lost brain tissue in Ischemic stroke?
Neuroglia repair lost brain tissue, no change in length (if CT repaired, it would decrease/shorten space)
What is Gliosis?
Replacement of damaged neurons without shrinking
What are the Factors leading to Infarction?
Thrombosis and Vasculitis (Aterial and Venous)
What is Thrombosis?
Obstruction of vessel lumen
What is the MC factor resulting in infarctions?
Thrombosis
If thrombosis occurs in Basilar Artery what happens?
Stroke
If thrombosis occurs in Coronary artery what happens?
Myocardial Infarction
What is the MC factor resulting in infarction?
Atherosclerosis (thrombosis)
What is Vasculitis?
Inflammation of vessel wall with decreased lumen
Where does Vasculitis predominantly occur?
In autoimmune diseases
In Vasculitis, how many components of inflammation are present?
5 (ALL of them)
What are the aka’s of Arterial Vasculitis?
Superficial Temporary artery/Temporal Arteritis/Giant Cell Arteritis/Actute Chronic Granulomatous Vasculitis/Horton’s Disease
What is the most common autoimmune disease?
Giant Cell Arteritis
What is Giant Cell Arteritis?
Inflammatory disease of the vessels to the head, especially the branches of the external carotid artery
How is granuloma formed in Giant Cell Arteritis?
Dendritic cells recruit T cells and macrophages to form granuloma
What age group is Giant Cell Arteritis?
> 50 year old and more in women 2:1
What is the main symptom of Giant Cell Arteritis?
Headache
What is visibly seen in Giant Cell Arteritis?
Inflamed arteries and tender upon palpation
What are the symptoms of Giant Cell Arteritis?
Fever, Muscle Weakness, and Headache
If ophthalmic artery is affected in Giant Cell Arteritis, what can happen?
Temporary loss of vision that may result in permanent loss if not treated
What is the ONLY treatment for Giant Cell Arteritis?
Corticosteroids therapy because they inhibit the granuloma pathway (prednisone) 1 month
What condition is Giant Cell Arteritis often accompanied by?
Polymyalgia Rheumatic
What is Polymyalgia Rheumatic?
Seen in 50% of patients with Temporal Arteritis, it causes pain and stiffness in hip and shoulder muscles
Para esophageal hernia is associated with what?
Venous Vasculitis
Para esophageal hernia aka
Hiatal Hernia
What happens during Para esophageal hernia?
Stomach protrudes from the abdomen through the hiatus into the thoracic cavity
What happens with flexion/compression of the diaphragm? (para esophageal hernia)
VEINS of the stomach are occluded preventing outflow of venous blood
What happens with Arteries during flexion/compression of the diaphragm?
The arteries are NOT occluded because the pressure in the arteries is higher than the pressure exerted by diaphragmatic compression
What does Para Esophageal Hernia lead to?
Increased Hydrostatic pressure in the veins. As the pressure increases, it eventually becomes so high that it equals the pressure in the arteries, this causes stasis = no new blood tissue = infarction = gangrene
What are the 2 syndromes associated with Venous Vasculitis?
Para esophageal hernia aka Hiatal Hernia and Sheehan’s Syndrome (aka postpartum syndrome)
What is Sheehan’s Syndrome associated with?
Anterior Pituitary (adenohypophysis) doesn’t have an arterial blood supply and instead receives blood via a venous plexus only
During normal pregnancy what happens?
The ant. pit. hypertrophies due to an increased demand in hormones
What happens normally after delivery of pregnancy?
The ant pituitary undergoes physiological shrinkage due to a decreased need for hormones (normal)
What happens during complications of Sheehan’s Syndrome?
Hemorrhaging from the uterus, the body responds with vasoconstriction as well as constriction of the venous plexus supplying the anterior pituitary
What can Sheehan’s syndrome lead to?
Total Venous constriction and damage to the hypophysis = necrosis and loss of function of anterior pituitary
What are the factors affecting infarction?
1) Tissues innate vulnerability to hypoxia
2) Pattern of Vascular supply
3) Oxygen delivering capacity of the blood
4) Rate of occlusion development
What tissues have the highest vulnerability to Hypoxia from MOST to least?
1) BRAIN
2) Heart
3) Lungs
4) Kidney
5) Liver (least)
What is under “Pattern of Vascular Supply?”
Anastomosis
What is an Anastamosis?
The union of branches of 2+ arteries supplying the same region
What is the purpose of Anastomosis?
Allows you to overcome infarction, and exercise increases anastomoses of the heart
Who is likely to die from Infarction?
Young people die from infarction more than older b/c younger ppl haven’t developed Anastomoses yet
What is under “Oxygen Delivering capacity of the bloods?”
Amount of RBC, hemoglobin in RBCs (Hb binds O2 in RBCs)
What disease is associated with “Oxygen delivering capacity of the bloods?”
Anemia: Decreased amount of RBC, and/or Hb in RBC’s.
With anemia the probability ______
Of infarction is increased
If you have a slow rate of occlusion, what does this cause?
Possible development of anastomosis
Fast rate of occlusion causes -
No anastomosis - infarction is very probable, death may occur
What is involved with the coronary artery in “Rate of Occlusion”?
% of blockage determines if symptoms are experienced
What normally happens in the coronary artery?
Usually develops slowly, patient doesn’t experience symptoms until blockage is > 75% (3/4 lumen blocked) = Atherosclerosis
What is an Embolism?
Sudden occlusion of a blood vessel by an Embolus
What is an Embolus?
Abnormal mass moving through bloodstream, liquid, solid, or gas. (anything other than serum, RBCs, WBCs, and platelets (blood clot, fat, foreign particle)
What is a thromboembolism?
**MOST COMMON TYPE OF EMBOLISM; piece of thrombus BREAKS off
What are the 2 types of Thromboembolism?
Venous and Arterial
Where are the 2 places Venous Thromboembolism can occur?
LEGS and GI
Where is the most common location of thrombi?
LEGS**
What is significant about a thrombi in legs?
It can easily flow to the heart because vein lumen size increases as it approaches the heart
When the thrombi coming from the legs reaches the lungs, what happens?
It STOPS and obstructs blood flow there - Infarction in lungs is (not dangerous, but painful)
A venous thromboembolism will always end _____
In the LUNGS, and therefore, embolisms always end in the lungs (one exception)
What is one exception to embolisms always ending in the lungs?
It reaches GI
Any embolism that occurs in the GI will be seen in _____
The liver
What is the route of embolism in the Liver?
It travels to the liver via hepatic portal vein (vena porta)
Where will embolism stop in the liver?
Stops in the capillaries, liver infarction, PAINLESS and you will have detoxing problems
Where does thrombus form in Arterial Thromboembolism?
Forms in the left atrium or Left ventricle
What is the sequence in an arterial thromboembolism?
Left ventricle/atrium, then through aorta, then well supplied organs (heart, brain 20%, spleen, and kidneys), then likely to stop thrombus
What is a thrombus in the heart?
Myocardial ischemia
What is a thrombus in the brain?
Ischemic stroke
What are the sources of thrombus in the heart?
- mitral stenosis
- subacute bacterial endocarditis
- artificial valve
What is subacute bacterial endocarditis?
Bacterial infection in the heart - valves full of bacterial colonies - colonies can travel throughout the body and to the brain
What is most common cause of ischemic stroke?
Subacute bacterial endocarditis
What is a fat embolism?
From long bone fracture
What is the source of fat embolism?
Yellow Marrow, develops 1-2 days after fracture
Where does fat embolism enter?
Enters venous circulation and goes to the lungs
What happens when a fat embolism crosses the capillaries?
Travels in reverse direction to the brain, and this is called a purpuric brain hemorrhage
Air Embolism aka
Air lock, Bends/Caisson disease, Diver’s disease/compression sickness
What happens during an Air embolism?
Gas in vessels block fluid flow = air lock
Air embolism blocks blood flow
What happens during Bend’s Disease?
Nitrogen bubbles in blood from coming up to the surface too quickly.
How do you help Bend’s Disease?
Put pts right side up because this puts gas in pulmonary vein so you can breathe it out
