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PATHO I > Embolism > Flashcards

Embolism Flashcards

1
Q

What are the (4) steps of thrombus activity?

A
  • Propagation as it enlarges and occludes or embolizes
  • Embolization as it is dislodged and transported elsewhere
  • Recanalization as original lumen is reformed (smooth muscle cells, fibroblasts, etc.)
  • infection if bacterial seeding occurs which may lead to mycotic aneurysm
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1
Q

What does recanalization of a thrombus look like?

A
  • End-stage of thrombus
  • Blood clot is replaced by connective tissue w/ many new channels
  • Channels can re-establish blood supply and acquire/maintain perfusion
  • Multiple lumens form to facilitate this function
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2
Q

C&C venous thrombi versus arterial thrombi

A

Venous Thrombi
* Gradual onset of pain, swelling, congestion, edema due to obstruction
* Potential embolization of lungs (PE) from (DVT of around knee joint (e.g., femoral, popliteal, iliac veins))

Arterial Thrombi
* Sudden onset of ischemia and obstruction
* May embolize

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3
Q

What is an embolus?

A

Detached intravascular solid, liquid, or gaseous mass that is carried by blood to a distant site to occlude a vessel leading to tissue dysfunction or infarction

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4
Q

What type of embolism would you see from a patient with a fracture of a long bone?

A

Fat droplet emboli

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5
Q

What type of fluid can lead to embolism during parturition?

A

Amniotic fluid

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6
Q

What type of HF will you note from a patient with a PE?

A

Right sided HF

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7
Q

What is the pathogenesis of PE?

A
  • Virchow’s Triad leads to a DVT
  • Ends up within the pulmonary arteries from IVC where it will obstruct pulmonary artery
  • Leads to surfactant dysfunction
  • Triggers hyperventilation
  • Multiple occurring at one time can lead to PHTN & RV failure (cor pulmonale)

Triad: hypercoagulability, hydrostasis, endothelial dysfunction

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8
Q

What vein most commonly leads to PE?

A

Iliac vein

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9
Q

S/Sx of cholesterol embolization syndrome.

A
  • Acute renal failure (cholesterol crystal embolization of kidneys)
  • Skin involvement (purura, necroses, livedo reticularis)
  • Blue toe syndrome
  • Gastrointestinal involvement
  • CNS symptoms (TIA, Stroke)
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10
Q

What type of shock is noted in fat embolism?

A

Obstructive shock

Due to fat emobli lodged in pulmonary vessels

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11
Q

What is the classic triad of fat embolism?

A

RAN
* Rash: petechial rash – capillary obstruction
* ARDS (acute respiratory distress)
* Neurological symptoms: confusion, lethargy, seizures

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12
Q

What is Caisson disease?

A
  • Gas emboli in bones leads to multifocal ischemic necrosis
  • Heads of long bones
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13
Q

How to Tx decompression sickness?

A

High-pressure air chamber

Forces gas back into solution

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14
Q

Which gas is most responsible for decompression sickness?

A

Nitrogen

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15
Q

Explain decompression sickness.

A
  • Rapid formation of gas bubbles within skeletal muscle and joints leads to pain
  • Gas bubbles in pulmonary vasculature leads to edema, hemorrhages, and respiratory distress
  • Bubbles in CNS lead to mental impairment, and possible coma

Due to increased amounts of gas (nitrogen)

16
Q

What is the mortality rate of amniotic fluid embolism?

A

80%

17
Q

How does amniotic fluid embolism take place? (basic)

A
  • Mechanical obstruction of pulmonary vessels
  • Biochemical activation of coagulation pathway and innate immune system due to substances in amniotic fluid
18
Q

How does amniotic fluid embolism take place? (detailed)

A
  • Tears of placental membrane or uterine vein lead to entry of amniotic fluid into maternal circulation
  • Amniotic fluid embolize into pulmonary arterioles increasing pulmonary arterial pressure causing right HF and pulmonary edema
  • Procoagulants (e.g., thromboplastin enter maternal circulation activating the coagulation cascade leading to DIC and systemic fibrin thrombi
  • Entry of leukotrienes from amniotic fluid into maternal circulation trigger an anaphylactic-like response leading to pulmonary edema and hypotension
19
Q

What type of necrosis is noted by ischemic events of the CNS?

A

Liquefactive necrosis

20
Q

In most tissues (except for the brain), the main histologic finding (type of necrosis), is?

A

Coagulative necrosis

21
Q

Give (2) organs as an example of dual supply that helps minimize the effects of vascular occlusion.

A
  • Liver: hepatic artery & portal vein
  • Pulmonary system: pulmonary arterioles and bronchioles supply
22
Q

How long does the CNS have regarding hypoxic events to minimize irreversible damage?

A

3-4 mins

23
Q

How long can myocardial cells survive an ischemic event?

A

20-30 mins

PATHO I (8 decks)

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