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Pathological Processes > Thrombosis and Embolism > Flashcards

Thrombosis and Embolism Flashcards

1
Q

What is thrombosis?

A

The formation of a solid mass of blood within the circulatory system

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2
Q

Why does thrombosis occur?

A

Abnormalities of the vessel wall

  • Atheroma
  • direct injury
  • inflammation

Abnormalities of flow

  • stagnation
  • turbulence

Abnormalities of blood components

  • smokers
  • post-partum
  • post-op
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3
Q

What is the appearance of an arterial thrombus?

A
  • Pale
  • Granular
  • lines of Zahn
    • platelets mixed with fibrin
  • lower cell content
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4
Q

What is the appearance of venous thrombus?

A
  • Soft
  • Gelatinous
  • Deep red
  • Higher cell content
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5
Q

What are the outcomes of thrombosis?

A
  • Lysis
  • Propagation
  • Organisation
  • Recanalisation
  • Embolism
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6
Q

What occurs in lysis of thrombosis?

A
  • complete dissolution of thrombus
  • fibrinolytic system active
  • blood flow is re-established
  • normally occurs when thrombi are small
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7
Q

What occurs in the propagation of a thrombus?

A
  • progressive spread of thrombosis
  • occurs distally in arteries
  • occurs proximally in veins
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8
Q

What occurs in the organisation of a thrombus?

A

The thrombus undergoes fibrous repair and forms a fibrous scar on the wall of the vessel.

  • ingrowth of fibroblasts and capillaries (similar to granulation tissue)
  • lumen remains obstructed
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9
Q

What occurs in the recanalisation of a thrombus?

A
  • blood flow is re-established through reforming channels through the organised thrombus/ occlusion)
  • new channels may have smaller capacity than the original vessel
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10
Q

What occurs in the embolism of a thrombus?

A
  • part of the thrombus breaks off
  • travels through the bloodstream
  • lodges at distant site
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11
Q

What are the effects of arterial thrombosis?

A

Dependant on the sire and collateral circulation

  • ischaemia
  • infarction
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12
Q

What are the effects of a venous thrombus?

A
  • congestion
  • oedema
  • ischaemia
  • infarction
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13
Q

What are the most clinical effects of a thrombus?

A
  • Coronary artery thrombosis/ myocardial infarction
  • Embolisation resulting in occlusion of an artery distant to the thrombus site
    • pulmonary embolism
    • cerebral vascular event
  • Congestion & oedema in capillary beds
    • pain
    • skin ulceration
  • Thrombosis of uteroplacental vasculature seen in inherited thrombophilias
    • repeated miscarriages
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14
Q

What is Virchow’s triad?

A

Rudolf Virchow was the first to call the process thrombosis and depended on these three things (Virchow’s triad):

  1. Endothelial damage
  2. Slow or turbulent flow
  3. Hypercoagulability
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15
Q

What is an embolism?

A

A blockage of a blood vessel by a solid, liquid or gas at a site distant from its origin.

  • >90% of emboli are thrombo-emboli
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16
Q

What are the types of embolism?

A
  • air
    • IV. 100ml of air required for a significant embolus
    • cutthroat - froth of air
  • amniotic fluid
    • common in improper termination of pregnancy
    • from rupture of veins in the uterus
  • nitrogen
    • in joints of divers (the Benz)
  • medical equipment
    • breakage into fragments
  • tumour cells
17
Q

Where do pulmonary emboli come from?

A

When a thrombus in the systemic veins passes to small capillaries in the lungs

18
Q

Where can thrombo-emboli from the left side of the heart travel to?

A

Through the aorta to renal, mesenteric and other arteries, effectively pass to any part of the body.

19
Q

Where do thrombo-emboli from the atheromatous carotid arteries travel to?

A

The brain. Can cause a stroke or a transient ischaemic attack.

20
Q

Where do atheromatous abdominal aorta thrombus travel to?

A

Arteries of the legs

21
Q

What are the predisposing factors to deep vein thrombosis?

A
  • immobility/bed rest
  • postoperative
  • pregnancy and postpartum
  • oral contraceptives
  • severe burns
    • from dehydration and immobility
  • cardiac failure
  • disseminated cancer
22
Q

How can DVT be prevented?

A

Cannot be ‘prevented’ risk just needs to be reduced

Compression stockings

Flowtron boots

23
Q

How is DVT treated?

A
  • IV heparin type drugs
  • To prevent more thrombus formation, oral warfarin
24
Q

What are the effects of a massive pulmonary embolism?

A
  • defined as over 60% reduction in blood flow
  • rapidly fatal
25
Q

What are the effects of a major pulmonary embolism?

A
  • medium-sized vessel are blocked.
  • pts are short of breath
  • may have cough with blood-stained sputum
26
Q

What are the effects of a minor pulmonary embolism?

A
  • small peripheral pulmonary arteries are blocked
  • asymptomatic or minor shortness of breath

Recurrence of minor PE can lead to pulmonary embolism

27
Q

When do fat embolisms occur?

A

Mainly associated with damage to long bones but is relatively uncommon.

28
Q
A

Pathological Processes (9 decks)

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