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First Year med - dundee > 93. thrombosis, embolism and infarction > Flashcards

93. thrombosis, embolism and infarction Flashcards

1
Q

are blood clots and thrombosis the same thing

A

NO

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2
Q

where can you see blood clots

A

bruising etc

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3
Q

blood clot extravascular or intravascular

A

extravascular

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4
Q

what substances are involved in a blood clot

A

RBCs, fibrin, platelets etc

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5
Q

thrombus extravascular or intravascular

A

intravascular

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6
Q

Do thrombosis move around and circulate

A

NO - they are static

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7
Q

thrombosis - trigger of coagulation where?

A

WITHIN a blood vessel

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8
Q

what is thrombosis

A

excess intravascular coagulation

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9
Q

what is the end point of coagulation

A

aggregate of platelets, RBCs and fibrin etc

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10
Q

in coagulation what binds everything together

A

fibrin

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11
Q

what are the types of pathways in coagulation cascades

A

intrinsic
extrinsic
common

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12
Q

what is extrinsic pathway in coagulation cascade

A

produced through tissue factor
Factor 7 - factor 7a
which acts on
Factor 10- factor 10a
which acts on
prothrombin to thrombin
which acts on
fibrinogen to fibrin

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13
Q

which is more common in the coagulation cascade. The Intrinsic pathway or the extrinsic pathway

A

extrinsic

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14
Q

what is intrinsic pathway in coagulation cascade

A

produced through contact activation
Factor 12 - factor 12a
which acts on
Factor 11- factor 11a
which acts on
Factor 9 - factor 9a
which acts on
Factor 10 to 10a
prothrombin to thrombin
which acts on
fibrinogen to fibrin

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15
Q

explain the common cascade of coagulation

A

Factor 8 - factor 8a
which acts on
Factor 10 to 10a
prothrombin to thrombin
which acts on
fibrinogen to fibrin

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16
Q

what is the intrinsic coagulation cascade blood test

A

Prothrombin Time (PT)

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17
Q

what is the extrinsic coagulation cascade blood test

A

activated partial thromboplastin Time (APTT)

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18
Q

what does fibrin do?

A

binds everything together by forming the mesh of the net

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19
Q

thrombosis can occur anywhere but if favoured in locations with what 3 characteristics

A
  1. sites of endothelial injury
  2. turbulent blood flow
  3. hypercoagulative blood
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20
Q
  1. Sites of endothelial injury
  2. Turbulent blood flow
  3. Hypercoagulable blood
    these together are known as…..
A

Virchow’s Triad

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21
Q

why would hypertension be associated with endothelial injury

A

lots of banging on the side of the vessel walls

22
Q

what is primary vasculitis

A

autoimmune disease characterised by inflammation directed at vessel walls. specific antibodies.

23
Q

what are some things that contribute to endothelial injury

A
  • Hypertension
  • Increased exposure to tissue factor
  • Weak vessel walls
  • Atheroma
  • Aneurysms
  • Lots of surface thrombosis
  • Autoimmune disease
  • Primary vasculitis
  • Turbulence
  • Stasis
24
Q

describe laminar blood flow

A

most constituents are in center of vessel with slow flowing plasma peripherally

25
Q

what is stasis

A

slowing or stagnation of blood circulation in blood vessels

26
Q

what is hypercoagulability

A

increased tendency to develop blood clots

27
Q

what causes hyperrcoaguability

A

lots and lots of causes
- anything causing increased viscosity

28
Q

name some of the inherited disorders - primary causes

A
  • factor V Lieden
  • Protein C deficiency
  • Protein S deficiency
  • Antithrombin III deficiency
29
Q

name some of the inherited disorders - secondary causes

A
  • Prolonged immobility
  • Significant tissue injury – burns, RTA
  • Antiphospholipid syndrome –autoimmune
  • Myocardial infarction
  • Atrial fibrillation (irregular cardiac rhythm)
  • cancer
  • therapy
  • marantic endocarditus
30
Q

how is cancer a secondary cause of thrombosis

A

activate coagulation cascade through tumour produced TF, mucin, inflammatory cytokines

31
Q

how is therapy a secondary cause of thrombosis

A

many chemotherapeutic agents injure endothelium and increase risk of thrombosis

32
Q

what is an embolism

A

a thrombus that has been transported through the vasculature to a point where it gets stuck

33
Q

most thrombosis is … arterial or venous?

A

venous

34
Q

what is ischaemia

A

insufficient blood supply

35
Q

what is infarction

A

death of tissue as a result of ischaemia

36
Q

How does hypoxia cause cell injury and then acute inflammation?

A

No oxygen = no ATP

37
Q

what is ATP used for

A
  • ATP is the basic unit of currency for cellular energy
    • ATP is required for anything that is not passive
    • ATP required for most ion channel pumps
    • Na/K ATPase
    • Ca channels
38
Q

what if there is no ATP

A
  • Increased calcium stimulates
    1. ATPase (makes things worse)
    2. Phospholipase (membrane damage)
    3. Proteases (membrane and cytoskeleton damage)
    4. Endonuclease (DNA damage and breakdown)
      Mitochondrial permeability (release pro death factors
39
Q

are embolisms just blood constituents

A

no

40
Q

what are the different types of embolism

A

amniotic fluid
fat
tumour
blood
septic
air

41
Q

how much air is needed to get a air embolism

A

100ml

42
Q

breathing at high pressure (like diving in sea) results in what

A

more dissolved gas

43
Q

Breathing at high pressure results in more dissolved gas.
As pressure reduces ………….. comes out of solution

A

Nitrogen

44
Q
  • Breathing at high pressure results in more dissolved gas
    • As pressure reduces nitrogen comes out of solution
      Multiple bubbles which causes……? and what is this process called
A

decompression sickness
the bends

45
Q

explain amniotic fluid embolism

A

A rare complication of childbirth
Tear in placenta or uterine vessels with secondary infusion of amniotic fluid or fetal material
Identify fetal skin (squamous cells) and hair etc in pulmonary vessels

46
Q

what is a fat embolism made of

A

fat and marrow

47
Q

after what kind of injury does fat embolisms occur

A

skeletal muscle injuries

48
Q

large or small amounts of patients are symptomatic after injury (fat embolism)

A

small

49
Q

describe a tumour emboli

A
  • Usually associated with true thrombus
  • Tumours are thrombogenic
  • Some tumours have a propensity for vascular invasion
  • Tumours are often friable by their nature
    Failed metastases?
50
Q

describe septic emboli

A
  • Specific intravascular infections
  • Thrombus forms in association with an infectious agent
  • Abnormal cardiac valves
  • Mycotic aneurysm
  • In the heart – infective endocarditis
  • Symptoms from numerous septic emboli

First Year med - dundee (41 decks)

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