Class 11.5 (Not On Test 1)

Question 1

Blood Vessel Conditions (What is Turbulence?)

Answer 1

• In body, blood flow is generally laminar.
• Laminar flow is characterized by concentric layers of blood moving in parallel down length of blood vessel. Highest velocity is found in center of vessel. Lowest velocity is found along vessel wall.
• Under conditions of high flow – such as from high blood pressure – laminar flow can be disrupted & become turbulent.
• When this occurs, blood does not flow linearly & smoothly in adjacent layers, but instead flow can be described as chaotic.
• Turbulent flow also occurs in large arteries at branch points, in diseased & narrowed (stenotic or partially
obstructed) arteries, & across stenotic
heart valves.
• Turbulence increases energy (heart action) required to drive blood flow.

Question 2

What is Thrombosis?

Answer 2

Formation of a blood clot in a blood vessel.

Question 3

What is a thrombus?

Answer 3

The clot itself is termed a thrombus.

Question 4

What is the process of Thrombosis?

Answer 4

• Injury, irritation, or surface irregularity in blood vessel wall can be due to variety of causes, e.g., direct trauma, turbulence from high blood pressure, inflammation, infection, smoking, atherosclerosis (fatty deposits called PLAQUES build up between tunica intima & tunica media walls of the arteries and project into the lumen)

• PLATLETS, are always circulating in blood in inactive state, are attracted to abnormal wall section. They “activate” meaning they puff up, leave laminar blood flow & adhere to each other & site. They release chemicals that start clotting cascade.

• As part of process, FIBRIN is formed, protein
that crosslinks with itself to form mesh that
entraps red blood cells to make up thrombus.

Question 5

_______________ can result in a partial or complete local occlusion of a blood vessel, or they can break off and circulate in the bloodstream.

Answer 5

Thrombi

Question 6

What is Infarction?

Answer 6

• Infarction is tissue death (necrosis) due loss of its blood supply. Resulting lesion is referred to as an infarct.
• Infarctions are either occlusive (blood vessel is blocked) or hemorrhagic (blood vessel has ruptured.)
• E.g., stroke (cerebrovascular infarction) can be caused by blockage/occlusion (e.g. thrombosis, embolism) or rupture/hemorrhage of cerebral artery.

Question 7

What is a embolus?

Answer 7

Piece of material traveling in blood vessel that should
not be there. When it reaches vessel whose lumen is too small to let it pass, it occludes vessel, causing an infarction. In this case infarction is referred to as an embolism.

Question 8

Pieces of thrombus are most common type of embolus. If thrombus breaks loose & travels through bloodstream, it’s often referred to as ________________________. When it blocks a vessel, the result is called ___________________________.

Answer 8

• thromboembolus
• thromboembolism

Question 9

Emboli can also be made up of a number of other materials, including?

Answer 9

fat globules (e.g. cholesterol from an atherosclerotic plaque, bone marrow from bone fracture); gas bubbles (e.g. air from syringe, or nitrogen bubbles caused by decompression sickness “the bends”); infected materials (e.g., from heart valve infections); cancer (e.g. part of a tumour), foreign substances (e.g. IV drug users injecting talc as a bulking agent with heroin, cocaine, etc.), bone chips from fracture, etc.

Question 10

What is ARTERITIS?

Answer 10

inflammation of an artery

Question 11

What is PHLEBITIS?

Answer 11

inflammation of a vein

Question 12

What is ANGIITIS?

Answer 12

inflammation of blood or lymph vessel (more general term)

Question 13

What is VASCULITIS?

Answer 13

• same meaning as angiitis

inflammation of blood or lymph vessel (more general term)

Question 14

Inflammatory Conditions causes?

Answer 14

1. Infection
   Local: infected wound, abscess, surgery, etc.
   Systemic: septicemia (infection circulating in bloodstream), septic embolism
2. Inflammatory Conditions
   Autoimmune diseases (e.g., rheumatoid arthritis, SLE)
3. Hypersensitivity Reactions
   Allergic & hypersensitive reactions to allergen; may be localized or systemic (e.g., Buerger’s Disease, sensitivity reactions to drugs, etc.)
4. Direct Trauma/Blow
   More common in veins because they are closer to
   body surface.
5. Some conditions are idiopathic.

Question 15

Phlebitis and phlebothrombosis are also fairly common in?

Answer 15

1. Post childbirth
2. In bedridden individuals or immobilized body parts

Question 16

What are Signs & Symptoms of Arteritis and Phlebitis?

Answer 16

• Significant local inflammation: With more superficial b.v.’s, there is usually distinct hot red streak apparent on skin surface above inflamed vessel; with deeper vessels, more generalized heat & redness are likely.)
• Edema: Local edema is always present to some extent; in phlebitis distal swelling is also typical since inflamed section of the vein acts as an impediment to venous return.
• Pain: Very tender locally; pain often emanates from site in a disseminated intense achiness; may also be ischemic pain in tissues serviced by b.v.

Question 17

Signs and symptoms of Phlebitis?

Answer 17

• Pain
• Tenderness
• Warmth
• Lump

Question 18

What are some Concerns for RMT regarding inflammatory conditions?

Answer 18

1. Platelet activation is inevitable when wall of a b.v. is inflamed, so there is high risk of thrombosis & its complications.

On-site massage could:
Intensify injury or irritation
Intensify thrombosis at site
Promote embolism
Disseminate infection if present
Weaken or rupture vessel wall

Massage therapy is therefore CI’d locally until medical clearance. When inflammation is in a large/core vessel, massage therapy may be completely CI’d.

2. Meds: Anti-inflammatory & anticoagulant use is common in treating these. Lytic substances may be injected locally to break up thrombi. Analgesics may
   also be used. There may be other meds involved in managing primary cause condition.
3. RMT should always be alert to the possibility of inflammatory conditions in blood vessels following an injury or surgery, & as risk factor in conditions where vasculitis is part of condition’s profile.
4. Possibility of residual thrombosis is always factor when patient has history of blood vessel injury of inflammation. RMT should weigh factors carefully & consult with MD if question about current risk.

Question 19

What is Temporal Arteritis?

Answer 19

• Idiopathic progressive low-grade arteritis of superficial temporal artery.
• Quite common in individuals over 50; no marked
gender preference.
• Can be bilateral, but is usually unilateral.

Question 20

Signs & Symptoms of Temporal Arteritis?

Answer 20

Very often none – silent process.
When present:
• unilateral headache, often confused with migraine
• ipsilateral facial pain/numbness/paraesthesia
• ipsilateral vision problem varying in severity from blurring to loss of sight in the eye in rare cases

Question 21

RMT Concerns for Temporal Arteritis?

Answer 21

1. Thrombosis will occur, although typically quite stable on its own since it develops from slow, progressive type of inflammatory process. Nonetheless, there is risk of embolism from direct manipulation of artery, which is very superficial. Local petrissage/friction types of manipulations are contraindicated.

Common condition that is often clinically silent, it’s good practice to palpate superficial temporal arteries of patients over 50 before massaging locally. Unaffected arteries are not palpable except for their pulse; affected arteries feel elevated, stiff, ‘lumpy’ & tortuous. On person with little hair, an affected superficial temporal artery is often clearly visible.

2. May be anti-inflammatory, anticoagulant meds involved, although frequently not.

Question 22

What is Buerger’s Disease (AKA Thromboangiitis Obliterans – TAO)?

Answer 22

Genetically conditioned hypersensitivity condition, i.e., person has an inherited susceptibility to develop this condition in reaction to exposure to allergen, which in Buerger’s is cigarette smoking.

Typical Sufferer (90+%)
• male
• aged 19-40 at diagnosis
• Jewish or Arabic descent
• heavy smoker