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5th yr- Finals- CSB revision > Abnormal bleeding > Flashcards

Abnormal bleeding Flashcards

1
Q

Give some effects of blood loss

A
  1. patient in distress
  2. Blood in tissues
  3. Blood in the stomach
  4. Blood in the airways
  5. Reduced oxygen flow
  6. Reduced portion and platelets
  7. Hypocolaemia
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2
Q

What is hypovolaemia

A

Reduced blood flow

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3
Q

What can hypovolaemia lead to

A

Shock

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4
Q

How do we manage bleeding

A
  1. Be prepared
  2. Inform the patient before hand that they may bleed
  3. Check bleeding and clotting history
  4. Be as conservative as possible
  5. Local measures
  6. Careful post op and follow up
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5
Q

What local measures do we need to take to manage bleeding

A
  1. Pressure
  2. Suture
  3. Surgical
  4. patience
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6
Q

What is virchows triad

A

Describes 3 factors that important in valour formation:

1) blood flow
2) activation of blood coagulation
3) vein damage

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7
Q

What haemostats

A

Prevention of blood loss

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8
Q

How is haemostats achieved

A
  1. Vascular spasm
  2. Platelet plug
  3. Blood coagulation
  4. Growth of fibrous tissue in the hole in the vessel permanently
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9
Q

What is vascular spasm

A

When smooth muscle in the blood vessel walls contract and reduce blood loss

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10
Q

What is the aim of the vascular spasm

A

Prevents excessive blood loss in the body

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11
Q

How is a platelet plug formed

A
  1. Platelet adhere to expoed tissue collagen
  2. Platelets release thromboxane A2 which increases stickiness
  3. Platelet aggregation
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12
Q

What does aspirin do

A

It irreversibly binds to platelets and inactivates platelet COX

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13
Q

What is platelet COX

A

Cyclooxygenase

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14
Q

What is the significance of cyclooxyrgenase

A

It is required for thromboxane A2 mediated aggregation

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15
Q

How does clopidogrel work

A

It binds to the P2Y12 receptor irreversibly and prevents Adenosine Di Phosphate (ADP) mediated aggregation

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16
Q

How long does it take for platelets to be renewed

A

About 10 days

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17
Q

How does ibuprofen work

A

Ibuprofen bind to platelets reversibly

18
Q

How does platelet plug formation activate the coagulation cascade

A
  1. Tissue damage
  2. Exposure of sub endothelial collagen
  3. platelet adhesion
  4. Enhances platelet adhesion and aggregation
  5. Enhanced activation of factor X and prothrombin
19
Q

Which patients are likely to be taking clopidogrel or aspirin?

A

Patients with:

  1. Vascular disease
  2. Ischaemic heart disease
  3. thromboembolic disease
  4. Stroke
  5. peripheral vascular disease
  6. In whom thrombi are more likely to form
20
Q

What is a thrombi

A

Platelet aggregation

21
Q

What effect does aspirin have on tooth socket bleeding time

A

Patients who take sprain have a longer tooth socket bleeding time

22
Q

Should we tell patients taking aspirin to stop taking it before their extraction? Why?

A

NO:
Takes weeks for effect to be reversed
Risk of stopping is greater than risk of continuing

23
Q

List some tests we can take to test bleeding function

A
  1. INR (International normalised ratio)
  2. Platelet count
  3. APTT (Activated Partial Thromboplastin Time)
24
Q

Name the 2 pathways of the clothing cascade

A
  1. Intrinsic pathway
  2. Extrinsic pathway
25
Q

What is the intrinsic pathway intuited by

A
  1. Exposed collage
  2. Platelet activation
26
Q

What is the extrinsic pathway initiated by

A

tissue damage

27
Q

What is the overall effect of the intrinsic and extrinsic pathway

A

They both Meet together at the end and activate prothrombin
this activated thrombin turns fibrinogen into fibrin

28
Q

Which bleeding test is the most commonly used

A

INR

29
Q

Which patients are likely to be taking warfarin?

A

Patients with:

  1. Atrial fibrillation
  2. Heart valve abnormalities or replacement
  3. Thromboembolic disease
  4. ischaemic heart disease
30
Q

How does warfarin work

A

It prevents the action of vitamin K which prevents carboxylation of clotting factor precursors

31
Q

Why is vitamin K important in blood clotting

A

It is require by the liver to produce factors II, VII, IX and X

32
Q

What is the half life for clotting factors

A

60 hours

33
Q

When is the full impact of warfarin seen in a patient

A

About 7 days

34
Q

What is the disadvantage of warfarin

A
  1. Multiple drug interaction
  2. Difficult to stabilise anti coagulation
  3. Some food interaction
  4. Needs to be monitored
35
Q

Which drugs can warfarin interact with

A

Metronidazole
Carbamazepine
Fluconazole
Miconazole
St Johns Wort

36
Q

What foods can warfarin interact with

A

Cranberry juice

37
Q

An INR below what is safe to do an extraction on

A

less than 4

38
Q

When should we check INR records of a patient

A

If stable, check INR 72hrs before extraction
if not check within 24 hours

39
Q

Give some advantages of new anti coagulants

A
  1. Single point of action
  2. Predictable effect
  3. No need for INR monitoring
  4. No interaction with food
40
Q

Give some disadvantages of new anticoagulants

A

No antidote
half life up to 17 hours

41
Q

How can we ask patients if they have any bleeding problems

A
  1. Do you have any problems with bleeding or bruising?
  2. Are you taking any medicines to thin the blood?
  3. Do you have any liver problems?

5th yr- Finals- CSB revision (17 decks)

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