Patho18(hemodynamics file17)

Question 1

Causes of thrombosis based on “Virchow triad”?

Answer 1

1) endothelial injuriy
2) abnormal blood flow
3) hypercoagulability
وهم مترابطين كما بالصورة ورح نشوف كيف خلال المحاضرة

Question 2

How endothelial injury cause thrombosis?

Answer 2

*Severe endothelial injury /may trigger thrombosis by exposing VWF and tissue factor.
*Inflammation and other noxious stimuli also promote thrombosis by
shifting the pattern of gene expression in endothelium to one that is “prothrombotic.”
* Endothelial activation or dysfunction: physical injury, infectious agents, abnormal blood flow, inflammatory mediators, melabolic abnormalities, such as hypercholesterolemia or homocystinemia, and toxins absorbed from cigarette smoke.

Question 3

how abnormal blood flow cause thrombosis ?

Answer 3

Turbulence (chaotic blood flow) contributes to arterial and cardiac thrombosis by causing endothelial injury or dysfunction, and stasis.

Question 4

In which conditions or diseases abnormal blood flow happens? And explain each

Answer 4

1. Ulcerated atherosclerotic plaques.
2. Abnormal aortic and arterial dilations called (aneurysms.)
3. Acute myocardial infarction.
4. Mitral valve stenosis.
5. Atrial Fibrillation.
6. Hyperviscosity syndromes.

Question 5

How hypercoagulability cause thrombosis?

Answer 5

Abnormally high tendency of the blood to clot. By Primary (genetic) /seconday (acquire) disorders

Question 6

Which disorders will cause this hypercoagulability ( primary,secondary)

Answer 6

Table Hypercoagulable States صورة

Question 7

What are the morphological characteristics of thrombi?

Answer 7

Thrombi can have grossly (and microscopically) apparent laminations called lines of Zahn; these represent pale platelet and fibrin layers alternating with darker red cell-rich layers. صورة

Question 8

The difference between arterial and venous thrombi (occlusive,color based on type of cell)

Answer 8

Arterial thrombi are frequently occlusive and rich in platelets. Venous thrombi are almost invariably occlusive and contain more enmeshed red cells. متشابك

Question 9

What is the term of venous thrombi/ and where we commonly found?

Answer 9

(phlebothrombosis)/ Lower extremities (90% of venous thromboses) , the upper extremities, periprostatic plexus, or ovarian and periuterine veins, and under special circumstances they may be found in the dural sinuses, portal vein, or hepatic vein. أماكن خطيرة وأماكن عادي

Question 10

What we call a thrombi on heart valves? And what’s the type of it ? And what is the disease in heart that cause it?

Answer 10

Vegetations/ Sterile vegetations and infectious vegetation/ nonbacterial thrombotic endocarditis, verrucous endocarditis (Libman Sacks endocarditis), infective endocarditis.

Question 11

What are the Fate of the Thrombus?

Answer 11

1. Propagation.
2. Embolization.
3. Dissolution.
4. Organization and recanalization.

Question 12

What are the 2 types of Venous Thrombosis (Phlebothrombosis) based on lower extremities?

Answer 12

• Superficial venous thrombosis (varicosities): occurs inside the saphenous system
• Deep venous thrombosis (DVTs): occurs in the larger leg veins at or above the knee joint
  (e.g., popliteal, femoral, and iliac veins)

Question 13

What are the consequences of superficial venous thrombosis?

Answer 13

these rarely embolize /// they can be painful and can cause local congestion and swelling from impaired venous outflow/// predisposing the overlying skin to the development of infections and varicose ulcers.

Question 14

What are the consequences of deep venous thrombosis?

Answer 14

more serious because they are prone
to embolize.///may cause local pain and edema, collateral
channels often circumvent the venous obstruction. Consequently, DVTs are
entirely asymptomatic in approximately 50% of patients and are recognized only
after they have embolized to the lungs. ////predisposing factors include congestive heart failure, bed rest, and
immobilization, Trauma, surgery, and burns, pregnancy, Tumors

Question 15

What is a major cause of arterial thromboses?

Answer 15

Atherosclerosis

Question 16

Which organs are prone to embolization in arterial thrombosis?

Answer 16

The brain, kidneys, and spleen.

Question 17

What is disseminated intravascular coagulation (DIC)?

Answer 17

Widespread thrombosis within the microcirculation that may be of sudden or insidious onset.

Question 18

What happens in disseminated intravascular coagulation (DIC)?

Answer 18

The Widespread microvascular thrombosis consumes platelets and coagulation proteins, and at the same time, fibrinolytic mechanisms are activated.

Question 19

What is the synonym of (DIC)?

Answer 19

consumptive coagulopathy بسبب طريقة عملها

Question 20

What are the consequences of disseminated intravascular coagulation (DIC)?

Answer 20

Excessive clotting and bleeding may co-exist in the same patient.

Question 21

What is an embolism? And often cause?

Answer 21

Detached intravascular solid, liquid, or gaseous mass carried by the blood/tissue dysfunction or infarction.

Question 22

Where the emboli lodged?

Answer 22

in vessels too small to permit further passage, resulting
in partial or complete vascular occlusion; depending on the site of origin, emboli can arrest anywhere in the vascular tree

Question 23

embolization in
the pulmonary circulation/ in systemic circulation leads to?

Answer 23

hypoxia, hypotension, and right-sided heart failure/// ischemic necrosis (infarction) of downstream tissues

Question 24

The pulmonary thromboembolism originates from ? And its responsible for which disease ?

Answer 24

originating from deep venous thromboses (95% of cases, from thrombi within
deep leg veins proximal to the popliteal fossa, from lower leg
uncommon) // The most common form of thromboembolic disease

Question 25

What is the incidence of pulmonary embolism (PE)?

Answer 25

2 to 4 per 1000 hospitalized patients

Question 26

How many deaths per year in the United States are caused by pulmonary embolism?

Answer 26

About 100,000 deaths

Question 27

Do multiple emboli commonly occur in pulmonary embolism cases?

Answer 27

Yes, either sequentially or as a shower of smaller emboli from a single large thrombus

Question 28

What is the risk for a patient who has had one pulmonary
embolus ?

Answer 28

increased risk for having more

Question 29

What is Paradoxical embolism?

Answer 29

embolus, typically a blood clot, travels from the right side of the heart to the left side without passing through the lungs. This can happen due to a right-to-left heart shunt, which is an abnormal opening between the two chambers of the heart.

Question 30

The Systemic Thromboembolism originated from?

Answer 30

• 80% arise from intracardiac mural thrombi ;
  1) Two-thirds of these are associated with left ventricular infarcts
  2) another 25% with dilated left atria (e.g., secondary to mitral valve disease).
  3) The remainder originate from aortic aneurysms, thrombi overlying ulcerated atherosclerotic plaques,fragmented valvular vegetations, or the venous system (paradoxical emboli).
• 10% to 15% are unknown origin

Question 31

What are the common targets of systemic emboli?

Answer 31

Lower extremities (75%)and central nervous system (10%), less commonly intestines, kidneys, and spleen

Question 32

Other types of embolism?

Answer 32

*Fat Embolism.
*Fluid Embolism
* Air Embolism.