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43 Cards in this Set

  • Front
  • Back
What is a Thrombosis?
An organized clot caused by damage to endothelial lining of vessels
Factors in Thrombogenesis?
*Endothelial injury - Promotes platelet adhesion & activates clotting factors

*Change in blood flow - platelets in contact with endothelium for longer periods of time

*Hypercoagulative state (ie bed rest, cancer, estrogens)
Steps of Thrombogenesis:
What happens during Primary Hemostatis?
1) Platelet adhesion (due to exposed breaks in endothilium, stagnant blood, etc)
2) Platelets change shape
3) Granule release (ADP, TXA2) from platelets
4) Recruitment of platelets
5) Aggregation to form primary hemostatic plug - loose clot
Steps of Thrombogenesis: What happens during Secondary Hemostatis?
1) Tissue Factor (from exposed endothelium) triggering intrinsic coagulation cascade
2) Phospholipid complex expression induced by platelets triggers extrinic coag. cascade
3) Thrombin activation (from coag. cascade)
4) Fibrin polymerization to form secondary clot
What is Vichow’s triad in thrombosis?
Causes of thrombogenesis: Endothelial injury, hypercoagulability, and abnormal blood flow
What are the characteristics of arterial thrombi?
Composed primarily of platelets and fibrine with mixed layers of RBS's - "lines of Zahn" (BE ABLE TO RECOGNIZE SLIDE).
**White or Conglutination thrombi
What causes vasoconstriction in a endothelial injury and why is this important?
Endothelin is released by cells surrounding the damages endothelial cells. Important to reduced blood flow the the local area to diminish loss
What is an example of a drug (brand name) that prevents platelet clotting to prevent thrombogenesis?
What is the role of Nitrous Oxide (NO)?
Prevent coagulation
What is von Willebrand's factor?
A coagulation factor - without it, patients will have increased bleeding
Describe a venous thrombi?
Starts on endothelium & swells the vein
Appears gelatinous yet friable (easily crumbled)
"Statis or red coagulation thrombi"
Is Trosseu's sign - related to cancer
How do you tell difference between post-mortem and pre-mortem clots?
Post-mortem: rubbery, gelationous & forms "cast" of the vessel, looks like "currant jelly" or chicken fat if clear
What is a mural clot?
Thrombus on the wall that does not occule lumen of vessel, usually in heart(common in MI)
What is an occlusive clot?
Where found usually?
Clots that occludes lumen.
In order of frequency for each:
Arterial: Coronary, cerebral, iliac, femoral
Venous: deep calf, femoral, popliteal, iliac
Clots on the heart valves are called?
DIC stands for?
Disseminated Intravascular Coagulation - microcirulatory thromboses
Hypercoagulable states - that is meant by primary and secondar causes?
Primary causes of hypercoagulation are GENETIC causes.
Secondary are acquired (ie CA, MI, bed rest, tissue damage, Rx, etc)
What is an embolism?
Usually DETATCHED thrombus - an intravascular solid, liquid or gaseous mass carried from origin to a distant site.
Common causes of emboli?
Lack of moving - Plane trips, long periods of immobility - followed by movement that gets blood moving again to move clot
What is a pulmonary embolism?
Where do they originate?
-A clot that prevents or reduces blood to the lungs

-95% start in leg veins
-Large=sudden death by pulmonary A occlusion
-Small- infaction; insufficient circulation to bronchials
What is a systemic emboli? Origin? Result?
-A detached thrombus in arterial circulation
-Arices from from l. side of heart, aorta or Mj Aa.
-Infarction, most often in brain (CVA), lower extr., spleen & kidneys
What's a gas embolism?
A bubble in the circulatory system. Ex: Decompression sickness from dissolved N in blood forms bubble due to change in pressure.
Define "Bends" & "Chokes"
Bends: Nitrogen bubbles in joints, cause intense pain

Chokes: N bubbles form in lungs, causing respirtory distress
What is a fat emboli? Origin?
It's a loose piece of fat in circulatory system from trauma to fatty tissue (ie bone marrow from broken bone; liposuction) or by chylomicrons of fat formed in veins
What is an Amniotic Embolism?
Amniotic fluid that gets into blood stream of mother following delivery, causing DIC and shock. High chance of death. Tx: Heparin, even though bleeding to death, to stop DIC
What is Infarction?
Localized ischemic necrosis due to occlusion of arterial supply or venous drainage
What is an Anemic infarct?
Where does it occur?
Arterial & solid tissue occlusions leadind to ischemic necrosis.
"White" infarct
Occurs in heart, spleen, kidneys
What is a Hemorrhagic infarct?
Where does it occur?
Venous occlusion leading to necrosis - also in tissues where blood can collect or is congested to to blocked veins
"Red" infarct
Occurs in lung, intestine, brain & liver
What are septic and bland infarcts?
Infarcts where bacterial inflammation is present are called septic. If there's no bacteria, it's called bland.
What's the gross morphology of an infarct? Microscopic?
Gross appearance: wegde-shape, apex toward occlusion & exteral part of organ forms base

Microscopic: ischemic coagulative necrosis
What affects the degree of damage in an infarction?
1) General status of blood and CV system
2) Anatomic pattern of arterial supply in individual
3) Rate of dev. of occlusion (time for collateral circulation development)
4) Vulnerability of tissue to ischemia
What are the Gross and Microscopic damage done from MI during:
0-2 hrs?
None in first ~1/2 hr - reversal cell injury changes only
What are the Gross and Microscopic damage done from MI during:
4-12 hrs?
G: Occasionally dark mottling

M: begining coag. necrosis of fibers; edema; hemmorage
What are the Gross and Microscopic damage done from MI during:
12-48 hrs?
G: Dark mottling

M: Ongoing coag. necrosis of mucles; polyleukocyte infiltrate
What are the Gross and Microscopic damage done from MI during:
2-4 days?
G: Yellow-brown with dark border, tissue soft
M: Lysis of muscle fibers, granulation of tissue at periphery
What are the Gross and Microscopic damage done from MI during:
4-10 days?
G: Tan to bright yellow with hyperemic border. Tissue gets softer
M: Tissue replaces with granulation tissue
What are the Gross and Microscopic damage done from MI during:
4-6 WEEKS?
G: Pearly white or gray, firm

M: Fibrous scar tissue
Define Shock
A set of syndroms characterized by inadequate perfusion leading to imbalance between metabolic needs of vital organs and the available blood flow
Describe hypovolemic shock
Reduction in blood volume from external loss of blood plasma or water or from internal loss (e.g., massive exudation or internal hemorrhage)
Describe Cardiogenic shock
Decrease in cardiac output due to infarction, myocaridal disease, arrythmia or cardiac tamponade
Describe septic shock
Overwhelming bacterial infection causes peripheral vasodilation & pooling of blood and/or DIC due to endothelial cell injury.
Describe Neurogenic shock
Anesthesia or spinal cord injury causes pheripheral vasodilations with pooling of blood.
Result of shock?
Causes generalized celular damage, especially in brain, heart, lungs, kidneys. Also adrenals GI tract & liver

Chemical mediators are produced that result in complement activation, fever, and in high concentration can learn to DIC