lecture 13 Flashcards

1
Q

Causes of Vascular injury to blood vessels

A

-trauma, surgical manipulation, prior thrombosis, atherosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Stasis (flow of blood) (mainly cause venous thrombosis)

A

immobility - post op, plane
Pressure - (blockages) catheter, tumour obstruction
Increased viscosity - polycthaemia, dehydration, EPO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Blood Hypercoagulability

mainly venous thrombosis

A

increased procoagulants
decrease in inhibitors
impaired fibrinolysis (rare)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Deep vien thrombosis

  • what is it caused by?
  • what are the symptoms/signs of DVT, PE ?
A

Vessel itself is intact, but due to other disruptions, a clot forms with platelets blocking the vien (normally a leg vein)

  • get swelling
  • some can break off and travel up to the pulmonary arteries of the lung (when they get thinner)
  • can be fatal

DVT - leg swelling, leg pain, oedema

PE - shortness of breath, chest pain, tachycardia, Tachypnoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

D dimer blood test

A

D dimer - is the breakdown products of fibrin

  • use if in low prob for DVT
  • if D dimer negative - then discharge
  • if D dimer positive - then ultrasound
  • Also get ultrasound if they are high probability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cancer linked to DVT

A

cancer can disrupt balance and cause thrombosis

  • need to think of this as being a cause
  • if anaemia is present - could be cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Diagnosis of PE

A

classic symptom triad - pleuritic pain, shortness of breath, haemoptysis (blood in cough)

Signs - tachycardia, tacypnoea, hypoxia

Can do a CT scan
V/Q scan

  • can die, or can get hypotension - need thormbolysis to break down the clot
  • also can get see severe right heart strain due to back pressure from pulmonary arteries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Thrombophilia

-KEY LEARNING POINT - she said it was a hint

A
  • Tendency to develop thrombosis
  • Can be acquired or inherited
  • manifested as venous thromboembolism
  • some spontaneous -have genetic increased risk
  • some are provoked events - surgery or trauma, immobility, hospitalisation, malignancy, pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Inherited Thrombophilia

A

-abnormal inhibitor function - resistance to activated protein C (factor 5 leiden)
-Deficiencey of inhibitors - antithrombin , protein C, protein S
Increased factor levels - prothrombin gene mutation, elevated factor VIII

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Factor V leiden

A

Factor 5a enhances factor 10 activation

  • activated protein C cleaves normal factor Va
  • slows Xa production
  • so if have bad protein C then cannot get inactive factor 5 and keep getting the clot
  • may have helped survival in oldern days e.g not bleeding to death with pregnancy

APCr
-if have both carriers - then get a huge increase in risk of thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Treatment PE and DVT

A

Initially - heparin
Immediate effect
-heparine prolongs the APPT, antitrobin deificencey does not.??!

low molecular weight heparin

  • similar to heparin, comes in injection, shorter chains of thormbin
  • inhibits 10a
  • subcutaneous better bioavailability
  • come in prepackaged vials
  • Enoxaparin 1mg/kg twice daily
  • dont use appt to measure low molecular weight heparin

-basically are changing the bodys mechanisms around so can get clotting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Wafarin

A
  • interacts with a lot of things e.g antibiotics,

- higher INR increases bleeding risk further

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Direct acting oral anticoagulants

A
  • same as warfarin for treatment of VTE
  • superior for anticoagulation in atrial fibrillation - better stroke prevention with similar rates of bleeding
  • people with kidney failure can accumulate high levels of this
How well did you know this?
1
Not at all
2
3
4
5
Perfectly