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Pathology > Thrombosis > Flashcards

Thrombosis Flashcards

1
Q

Define a thrombus

A

A solid mass formed in the living circulation from components of the streaming blood

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2
Q

What distinguishes ‘thrombus’ from ‘clotting’

A

Clotting is solidification of the blood when it is:

  • Static
  • Outside a blood vessel
  • Outside the body
  • Within a vessel of a dead body
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3
Q

What is Virchow’s triad

A
  1. Changes in the vessel wall
  2. Changes in the blood flow
  3. Changes in the constituents of blood (hypercoagulable)
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4
Q

What is the most common cause of arterial thrombus

A

Atherosclerosis

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5
Q

What is the most common cause of venous thrombosis

A

Stasis of flow

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6
Q

What causes change to the normal laminar flow of blood

A
  • Prolonged inactivity following surgery/trauma/MI
  • Cardiac failure
  • Proximal occlusion of venous drainage
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7
Q

Outline the stages of thrombus formation

A
  1. Platelets stick to damaged epithelium
  2. Fibrin and leucocytes adhere to the surface fo the platelets
  3. Blood clot (fibrin and red cells) develop on this layer
  4. Second layer of platelets collects on the surface of the blood clot
  5. Organisation begins which adheres the clot to the vessel wall as a mural thrombus
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8
Q

What are the ridges on the surface of thrombi known as

A

Ridges of Zahn

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9
Q

What are the 4 possible fates of a thrombus

A
  1. Lysis (resolution)
  2. Recanalisation
  3. Propagation
  4. Embolisation
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10
Q

What is recanalisation

A

New vessels grow into the thrombus

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11
Q

Define an embolus

A

Abnormal mass of undissolved material which passes in the bloodstream from one part of the circulation to another, impacting in blood vessels too small for it to pass

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12
Q

What may emboli consist of

A
  • Thrombus
  • Gas
  • Fat
  • Tumour
  • Amniotic fluid
  • Foreign body
  • Therapeutic e.g. coils, gel
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13
Q

How may a venous embolism cause arterial infraction

A

Right-to-left shunt e.g. ASD

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14
Q

What are the two main causes of gas embolism

A
  1. Gas entering the bloodstream as air

2. Gas dissolved in blood coming out of solution

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15
Q

What is an example of gas coming out of solution to cause embolism

A

Nitrogen decompression sickness

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16
Q

How much air must be injected into the circulation to cause air embolus

A

100ml+

17
Q

What are the symptoms of fat embolism

A
  • Fever
  • Respiratory distress
  • Cerebral symptoms
  • Rash
18
Q

How does amniotic fluid embolism occur

A

During labour when the placenta is detached from the uterine wall and amniotic fluid enters the maternal circulation

19
Q

What causes death in amniotic fluid embolism

A

DIC

20
Q

Describe ‘Steal’ syndrome

A

Occurs when blood is redirected preferentially along one branch of a vessel to the detriment of the end territory of the branch

21
Q

Describe phlegmasia cerulea dolens

A

A severe form of DVT with venous engorgement such that venous gangrene may supervene

22
Q

What is the initial treatment of frostbite

A

Aspirin 300mg due to small vessel obstruction

23
Q

Define infarction

A

Death of a tissue following acute ischaemia when irreparable damage has occurred

24
Q

How are infarcts classified

A
  1. Red infarct

2. White infarct

25
Q

What causes Red infarcts

A

Due to venous infarcts and occurs in loose tissues e.g. lung

26
Q

What causes White infarcts

A

Due to arterial occlusion of ‘end arteries’ in solid tissues e.g. heart, spleen, kidneys

27
Q

Which part of the GI tract is most susceptible to low-flow infarction and why

A

Splenic flexure of the colon - watershed area situated between the territories of SMA and IMA

28
Q

What clotting factors are initially consumed in DIC

A
  • Factor 5

- Factor 8

29
Q

What is the mechanism of action of TXA

A

Inhibits plasmin

30
Q

How is DIC diagnosed

A
  • Thrombocytopenia
  • Raised fibrin degradation products
  • Prolonged PT, APTT and bleeding time
31
Q

What is the critical mediator of DIC

A

Tissue Factor (TF)

32
Q

Outline the common coagulation pathways

A
  • Activated Factor 10 causes the conversion of prothrombin to thrombin
  • Thrombin hydrolyses fibrinogen peptide bonds to form fibrin
  • Thrombin also activates factor 13 to form links between fibrin molecules
33
Q

What is required to activate the extrinsic coagulation pathway

A

Tissue Factor released by tissue damage

34
Q

Outline the extrinsic coagulation pathway

A
  1. Tissue damaged
  2. Factor 7 binds to tissue factor
  3. This activates factor 9
  4. Activated factor 9 works with factor 8 to activate factor 10
35
Q

Outline the intrinsic coagulation pathway

A
  1. Exposed collagen leads to Prekallikrein is conversion to kallikrein and Factor 12 becomes activated
  2. Factor 12 activates Factor 11
  3. Factor 11 activates Factor 9, which with its co-factor Factor 8a forms the tenase complex which activates Factor 10
36
Q

What is used as an anticoagulant in stored blood

A

Citrate

Pathology (7 decks)

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