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Week 2 - General Pathology > Thrombosis, Embolism, Ischaemia & Infarction > Flashcards

Thrombosis, Embolism, Ischaemia & Infarction Flashcards

1
Q

What is Virchow’s triad and describe its components [3]

A

Virchow’s Triad describes the 3 broad categories of risk factors for thrombosis:

  1. vascular wall injury
    • trauma or surgery
    • chemical irritation
    • atherosclerosis
    • heart valve disease or replacement
  2. blood flow stasis
    • ​​atrial fibrillation
    • left ventricular dysfunction
    • venous insufficiency or varicose veins
    • immobility or paralysis
  3. hypercoagulable state
    • ​​malignancy
    • sepsis
    • thrombophilia
    • nephrotic syndrome
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2
Q

The histopathology of thrombosis is determined by the flow rate of blood. Describe the histopathological differences between thrombosis in:

  1. arterial vessels? [4]
  2. venous vessels? [4]
A
  1. arterial:
    • white thrombus
    • many platelets
    • small amounts of fibrin
    • reflects high flow
  2. venous:
    • red thrombus
    • many fibrin
    • with trapped red cells
    • reflects indolent flow
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3
Q

List the differential diagnoses of a sore leg under the following headings:

  1. Trauma? [5]
  2. Non-traumatic? [9]
  3. Skin/soft tissue infections? [4]
  4. Vascular causes? [9]
  5. Causes of bilateral leg swelling? [6]
A
  1. Trauma
    • Fractures
    • Dislocations
    • Muscle strain/rupture or haematoma
  2. Non-traumatic
    • Musculoskeletal causes,
    • Osteoarthritis,
    • Rheumatoid arthritis,
    • Septic arthritis,
    • Gout and pseudogout,
    • Popliteal (Baker’s) cyst,
    • Tenosynovitis,
    • Bursitis,
    • Myopathies
  3. Skin/soft tissue infections
    • Cellulitis,
    • Erysipelas,
    • Abscesses,
    • Necrotising fasciitis
  4. Vascular causes
    • Venous occlusion:
      • DVT,
      • superficial vein thrombosis,
      • venous insufficiency (post-DVT, varicose veins)
    • Acute ischaemia:
      • cardiac thromboembolism,
      • peripheral arterial disease,
      • massive DVT,
    • Lymphoedema
  5. Causes of bilateral leg swelling
    • Systemic oedema:
      • heart failure,
      • cirrhosis,
      • nephrotic syndrome,
      • malnutrition,
      • immobility
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4
Q

What are the risk factors for DVT? [11]

A
  1. Vessel wall
    • increasing age,
    • varicose veins,
    • surgery
  2. Blood flow
    • obesity,
    • pregnancy,
    • immobilisation,
    • intravenous catheters,
    • external vein compression
  3. Composition of blood
    • thrombophilias (including family history),
    • inflammatory conditions,
    • oestrogen hormones
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5
Q

What investigations should you carry out on a patient with suspected DVT? [3]

A
  1. blood tests → fibrin D-dimer
    • a measure of dissolved thrombus
  2. imaging of venous system of leg
    • compression ultrasound
    • venography
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6
Q

What are the complications of DVT? [5]

A
  1. painful swollen leg
  2. pulmonary embolism
  3. recurrent venous thromboembolism (VTE)
  4. venous insufficency
  5. post-thrombotic syndrome
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7
Q

What are the complications of PE? [7]

A
  1. dyspnoea
  2. chest pain
  3. haemoptysis
  4. collapse (massive PE)
  5. death (fatal PE)
  6. recurrent venous thromboembolism (VTE)
  7. chronic thromboemboilc pulmonary hypertension
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8
Q

What are the treatments for DVT? [6]

A
  1. Prevent thrombus extending or embolising
    • Anticoagulation for 3-6 months:
      • low-molecular weight heparin [LMWH]
      • warfarin [target INR 2.5]
      • Direct Oral Anti-Coagulant [direct Xa or lla inhibitor]
  2. Remove risk factors
  3. Pain relief
  4. Graduated elastic compression stockings
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9
Q

Name the anticoagulant drugs which have the following actions:

  1. Xa inhibitors? [3]
  2. IIa inhibitors? [1]
  3. indirect Xa inhibitors (via antithrombin)? [4]
  4. indirect IIa inhibitors (via antithrombin)? [2]
A
  1. Xa inhibitors
    • rivaroxaban
    • apixaban
    • edoxaban
  2. IIa inhibitors
    • dabigatran
  3. indirect Xa inhibitors (via antithrombin)
    • fondaparinux
    • danaparoid
    • low molecular weight heparin (LMWH)
    • unfractioned heparin (UFH)
  4. indirect IIa inhibitors (via antithrombin)
    • low molecular weight heparin (LMWH)
    • unfractioned heparin (UFH)
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10
Q

What are the prevention methods of VTE? [6]

A
  1. avoid risk factors if possible
  2. risk assess at hospital admission or surgery
  3. provide thrombo-prophylaxis when appropriate
    • anti-embolism stockings
    • heparin [LMWH daily sub cut]
  4. education patients on risks and avoidance measures
    • early mobilisation
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11
Q

List the causes of chest pain under the following headings:

  1. musculoskeletal? [3]
  2. cardiac? [2]
  3. lung? [1]
  4. vascular? [2]
  5. oesophageal? [2]
A
  1. Musculoskeletal
    • rib fracture,
    • muscular,
    • chondritis
  2. Cardiac
    • angina,
    • myocardial Infarction
  3. Lung
    • pleuritic pain [infection, infarction, malignant]
  4. Vascular
    • pulmonary embolism
    • aortic dissection
  5. Oesophageal
    • acid reflux
    • hiatus hernia
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12
Q

Describe the pathophysiology of coronary artery disease [7]

A
  1. Atheromatous arterio-vascular disease
  2. Development of atheroma/plaques
  3. Progressive narrowing & stenosis of artery
    • PIaque rupture
    • Acute thrombus
      • VascuIar occlusion
      • Downstream ischaemia & infarction
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13
Q

What are the risk factors for arteriosclerotic cardiovascular disease? [6]

A
  1. Smoking
  2. Hypertension
  3. Hyperlipdiaemia
  4. Diabetes
  5. Obesity
  6. Family history
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14
Q

What are the treatments of ACS? [7]

A
  1. Prevent thrombus extension
    • anti-platelet agent [aspirin, clopidogrel]
    • anticoagulant [heparin]
  2. Remove the thrombus
    • thrombolysis [alteplase, tenecteplase]
    • remove clot via catheter [PCI]
  3. Widen the stenotic plaque
    • balloon angioplasty
    • insert coronary artery stent
  4. Prevent further thrombus
    • anti-platelet agent
    • statin
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15
Q

What are the complications following an MI? [7]

A
  1. Death
  2. Arrythmia
  3. Pericarditis
  4. Myocardial rupture
  5. Mitral valve prolapse
  6. Left ventricular aneurysm +/- thrombus
  7. Heart Failure
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16
Q

What are the causes of limb weakness? [5]

A
  1. Musculoskeletal
    • Myopathy
    • Arthropathy
  2. Neurological
    • Peripheral neuropathy
    • Spinal lesion
    • Cerebral lesion
    • [ischaemia, inflammation, malignancy]
17
Q

What are the treatments of stroke and AF? [7]

A
  1. Remove thrombus [rarely]
    • thrombolysis
    • carotid end-arterectomy
  2. Remove/correct source of thrombus
    • anticoagulation [warfarin or DOAC]
    • revert to sinus rhythm [cardioversion]
    • replace defective heart valve
  3. Address other CVD risk factors
    • high blood pressure
    • hyperlipidaemia

Week 2 - General Pathology (11 decks)

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