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162 Cards in this Set

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What is a clot formed from?
Platelets and fibrin
What is a thrombus?
A clot in an inappropriate site--has pathologic consequences
What fluid compartment do red cells contribute to?
Intravascular volume
In an acute hemorrhage when we give blood, what are we replacing?
Replacing volume--hard to replace RBC's
What is edema?
Accumulation of increased fluid in the interstitial space
What is anasarka?
Severe generalized edema
As interstitial volume increases, waht happens to the excess volume?
Tissue lymphatics remove it and return it to the circulation via the thoracic duct
If the ability of the lymphatics is decreased, what happens?
Fluid accumulates in the tissues and edema occurs
What are the two basic causes of edema?
Increased hydrostatic pressure
Diminished plasma osmotic pressure
What kind of edema occurs with left sided heart failure?
Pulmonary edema
What kind of edema occurs with right sided heart failure?
Peripheal edema
Where does edema typically develop?
In dependent areas of the body--gravitational
What is pitting edema?
When pressing on the skin with a finger, it leaves an indentation which persists after the removal of the finger
What is a good place to identify edema in children?
Periorbital edema
What is pulmonary edema?
Accumulation of water in the lungs, particularly in the alveolar space
What is inflammatory edema?
Caused by soft tissue inflammation--acute or chronic--"swelling"
What is exudate?
Protein rich edema with a specific gravity of >1.020
What is transudate?
Protein poor edema with a specific gravity of <1.012
What does the prefix "hydro" refer to?
Fluid accumulation in a body cavity--hydrothorax, hydrocephalus, etc.
What is hyperemia?
An active process resulting from arteriolar dilation
What is an example of hyperemia?
Reddened face when embarrassed or flushed appearance from too much heat
What is congestion?
A passive process resulting from impaired outflow from a tissue
What happens to volume and pressure in hyperemia and congestion?
Both increase
What can congestion result in?
Cyanosis
What is hemorrhage?
Extravasation or presence of blood outside the intravascular space
What is bleeding diatheses?
Increased tendency for severe bleeding because of deficient clotting mechanisms
What is a hematoma?
Accumulation of blood within a tissue; usually a localized mass
What is petechiae?
1-2 mm pin point hemorrhage into skin or surfaces
What is petechiae frequently associated with?
Thrombocytopenia
What is purpura?
3 mm or greater areas of hemorrhage
What is ecchymoses?
Large (1-2 cm) sub-q hematoma seen after trauma--changes colors as hematoma clears
What type of people have blotchy areas of hemorrhage?
Usually people on coumadin
How much blood volume can be lost acutely before signs and symptoms present?
20% loss is usually tolerated ok
How much blood can be lost chronically before signs and symptoms present?
300-400 ml/day
What are the three major components involved in hemostasis?
Blood vessel-Endothelial cells
Platelets
Coagulation cascade
What is involved in primary hemostasis?
Vessel injury; clot initiation and formation
What is involved in secondary hemostasis?
Clot propagation and stabilization
What in involved in antithrombocytic activity?
Clot inhibition and cessation
What is fibrinolysis?
Clot dissolution
Normally, does the luminal surface of endothelium cells initiate a clot?
No--only when continuous disruption occurs
Who promotes/enhances the formation of a clot?
The intact endothelial cells of the vessel immediately adjacent to the injury
What is does fibrinolysis do?
Inhibits the enlargement of clot formation and stimulates the dissolution of the clot
What attaches to the ECM and serves as a link for platelet adherence?
von Willebrand factor
What is released from the endothelial cells when they are injured?
Tissue factor
What does tissue factor activate?
The "Extrinisic" portion of the clotting cascade and Factor IX in the "Intrinsic" portion of the cascade
What does prostacyclin do to platelet aggregation?
Inhibits platelet aggregation
What inactivates thrombin, Xa, and IXa?
Antithrombin III
What does Protein C inactivate?
Factors Va and VIIa
What is attached to von Willebrand factor to enhance adhesion of platelets?
Factor VIII
What is the intial plug at the site of injury dependent on?
Platelets
What do platelets form in order to adhere to one another?
Filiapodia
What do activated platelets release?
ADP and Thromboxane A2 for vasoconstriction and platelet aggregation
What do platelets expose that stimulates fibrin production?
Phospholipid surface
What is made on the phopholipid surface of platelets?
Fibrin
What is the "glue" that allows platelets to adhere to one another?
Firbin
Where does the coagulation pathway start?
The Extrinsic pathway--Factor VII
What factors are involved in the Common Coagulation pathway?
Factors X, V, II, and I
If you want to shut down the whole coagulation cascade, what do you want to inhibit?
The last step of the common pathway--Fibrinogen to Fibrin
What pathway is activated first?
The Extrinisic pathway and then the Intrinsic pathway is activated to amplify firbin production
What factor is Fibrinogen?
Factor I
What factor is fibrin?
Factor Ia
What factor is prothromin?
Factor II
What factor is thrombin?
Factor IIa
What stimulates prothrombin (Factor II)?
Factor Xa
Besides Factor X, what other factor makes thrombin?
Factor V
What are the circulating natural anticoagulants do we have to break down Thrombin?
Antithrombins I, II, and III
Proteins C and S
What does fibrinolysis activate?
Clot dissolution by activating plasminogen to form plasmin
What is plasmin?
The active enzyme that degrades fibrin
What is von Wildebrand's disease?
Deficiency if forming a platelet plug--lack of adhesion--can't even start a clot
What are Quantitative platelet disorders?
Normal platelets but there are not enough
What are examples of Quanitative platelet disorders?
Decreased production--Actue Leukemias
Increased destruction--ITP and DIC
What is idiopathic thrombocytopenic purpura?
Antibodies against platelets--producing a lot of platelets, but have increased destruction of them
What are Qualitative platelet disorders?
Have enough platelets but they don't work properly--can't form an effective plug
What are examples of Qualitative platelet disorders?
Uremia
Aspirin
Glanzmann Thrombasthenia
Bernard-Soulier Syndrome
What causes von Wildebrand's disease?
Autosomal dominant disorder--defective synthesis or function of the von Wildebrand factor
What is the most common congenital bleeding disorder in humans?
von Wildebrand's Disease
What are the symptoms of von Wildebrand disease?
Spontaneous hemorrhage from mucous membranes, prolonged and copious bleeding from cuts, menorrhagia
What are Type 1 and 3 von Wildebrand?
Decreased quantity of circulating vWF--associated with mild bleeding
Do Type 1 and 3 von Wildebrand patient's have deficient or normal factor VII?
They have deficient Factor VIII
What is Type 2 von Wildebrand?
Qualitative defect in vWF--mild to moderate bleeding
Do Type 2 von Wildebrand patients have deficient or normal Factor VIII?
They have normal Factor VIII
What is Uremic bleeding?
Decreased platelet function do to renal failure--organic acids poison platelets
What is Hemophilia A?
An X-linked recessive disorder caused by a deficiency in Factor VIII
What are the signs and symptoms of Hemophilia?
Joint and muscle bleeding
Traumatic operative bleeding
Easy bruising and hematoma formation
Minimal bleeding from small cuts
What is a thrombus?
A clot with pathologic sequellae
What things can cause thrombus formation?
MI
Arteriosclerosis
Trauma
Vasculitis
What is a major factor in developing thrombi?
Stasis
What is thrombophilia?
Failure to stop clot formation--NOT a defect in fibrinolysis
What is a thrombus?
A blood clot larger than a hemostatic plug that has pathological and clinical effects
What do the pathological/clinical effects of a thrombus depend on?
Obstruction or aletration of blood flow distal to the location
Fragmentation of the thrombus that results in a portion of the thrombus traveling to distant sites
What is a thrombus that travels to a distant site called?
Embolus
What is a thrombus called that forms in the cardiac chambers and aorta?
Mural thrombus
What is a thrombus called that forms in the cardiac valve leaflets and cusps?
Vegetations
What is a thrombus that forms in the arterioles and capillaries called?
Microthrombi
When thrombi form in the heart or aorta have a tendency to be quite large and form what?
Lines of Zahn
What abnormality is associated with a bacterial or fungal infection triggering the clotting mechanism forming a thrombus?
Infective endocarditis
What abnormality forms sterile thrombi on non-infected valves in patients with hypercoaguable disorders?
Non-bacterial thrombotic endocarditis
What type of endocarditis forms from thrombi that occur subadjacent to valves in patients with SLE?
Libman-Sachs endocarditis
What valve abnormality has the highest chance of forming "showers of emboli?"
Bacterial endocarditis
How do arterial thrombi grow or propogate?
Retrograde
What is the major complication with arterial thrombi?
Occulsion with cessation of blood flow past obsturction
Where are the most common sites for arterial thrombi to form?
Coronary
Cerebral
Femoral
What is the most important part of treatment for arterial thrombus?
Early intervention with agents that provide fibrinolysis
What is a thrombus?
A blood clot larger than a hemostatic plug that has pathological and clinical effects
What do the pathological/clinical effects of a thrombus depend on?
Obstruction or aletration of blood flow distal to the location
Fragmentation of the thrombus that results in a portion of the thrombus traveling to distant sites
What is a thrombus that travels to a distant site called?
Embolus
What is a thrombus called that forms in the cardiac chambers and aorta?
Mural thrombus
What is a thrombus called that forms in the cardiac valve leaflets and cusps?
Vegetations
What is a thrombus that forms in the arterioles and capillaries called?
Microthrombi
When thrombi form in the heart or aorta have a tendency to be quite large and form what?
Lines of Zahn
What abnormality is associated with a bacterial or fungal infection triggering the clotting mechanism forming a thrombus?
Infective endocarditis
What abnormality forms sterile thrombi on non-infected valves in patients with hypercoaguable disorders?
Non-bacterial thrombotic endocarditis
What type of endocarditis forms from thrombi that occur subadjacent to valves in patients with SLE?
Libman-Sachs endocarditis
What valve abnormality has the highest chance of forming "showers of emboli?"
Bacterial endocarditis
How do arterial thrombi grow or propogate?
Retrograde
What is the major complication with arterial thrombi?
Occulsion with cessation of blood flow past obsturction
Where are the most common sites for arterial thrombi to form?
Coronary
Cerebral
Femoral
What is the most important part of treatment for arterial thrombus?
Early intervention with agents that provide fibrinolysis
Which are bigger.....arterial or venous thrombi?
Venous thrombi are bigger (mm, cm)W
Where are venous thrombi typically located?
In zones of stasis or turbulence
Can venous thrombi form without exposure to endothelial injury and reaction to underlying matrix?
Yes
Do venous thrombi propogate anterograde or retrograde?
Anterograde
Where do 90% of venous thrombosis occur?
Deep veins of lower extremities and iliac system
What are the major complications of venous thrombi?
Edema and pulmonary embolism
Do arterial thrombi form with or against the flow?
Against the flow
Do venous thromi form with or against the flow?
With the flow
What are microthrombi?
Small micro (5-25 micron) clots that form in the circulating blood--may partially obstruct arterioles and capillaries
Where are microthrombi see?
DIC
TTP
What type of disorder is DIC?
Thrombotic disorder and a hemorrhagic disorder
What type of thrombi form from DIC?
Microthrombi
Where is DIC present?
In all vessels--arterial and venous
Is DIC amenable to thrombolytic treatment?
NO! It makes it worse
What will lab work of a patient in DIC most signifcantly show?
Low platelets--30,000
What are the most common causes of DIC?
Sepsis and massive tissue injury
What is the major clincal symptom of DIC?
Bleeding
Besides bleeding, what is another clinical characteristic of DIC?
Widespread deposition of small particles of fibrn in microcirculation--microangiopathic hemolytic anemia
Why is DIC sometimes referred to as comsumption coagulopathy?
Because there is decreased blood constituents--fibrinogen, platelets, coagulation factors, RBC's
What is the PT and PTT values in DIC?
Markedly prolonged
Are the fibrin split products elevated or decreased in DIC?
Elevated--breakdown products of fibrinogen and fibrin
What is the treatment for DIC?
Remove the source of coagulation activation--treat the inital condition--support with blood products
What is the mortality rate of DIC?
50-80%
What is an embolus?
Detached intravascular substance that is carried by the blood to a site distant from its origin
Where do 95% of of pulmonary thromboemboli come from?
Deep veins of the lower extremites
What are the types of pulmonary emboli?
Single large mass obstructing one or both pulmonary arteries--saddle emb.

Multiple sequential emboli

Multiple simultaneous emboli--emboli showers
What are the symptoms of a pulmonary embolus?
Acute shortness or breath
Tachypnea and dyspnea
What percentage of the pulmonary circlulation needs to be obstructed for a pulmonary embolus to be fatal?
60%
What does emobli obstruction of medium sized arteries result in?
Pulmonary hemorrhage but not usually MI
What does emboli obstruction of small arteries result in?
Infarction
What can multiple emboli over time with subsequent organization result in?
Pulmonary hypertension
Does a pulmonary embolus damage the vessel wall?
No--it's just a problem with plumbing
What is a fat embolism?
Occurs after fracture of long bones that have fatty marrow
When does a fat embolism develop?
1-3 days following injury
What are the symptoms of a fat embolism?
Pulmonary insufficiency, neurologic symptoms, anemia, and thrombocytopenia
What is an air embolism?
Air bubble behaving as a thrombus--takes more than 100mL of air to cause a problem
What is an amniotic fluid embolus?
Entry of amniotic fluid into the maternal circulation via a tear in placental membranes or rupture of uterine veins
What are the symptoms of an amniotic fluid embolus?
Sudden attack of severe dyspnea
Cyanosis
Profound shock
Death
If the patient survives an amniotic fluid embolus, what are they most likely to develop?
DIC
Where do we see red/hemorrhagic infarcts?
Where there is dual blood supply
Venous occlusion
Lungs
Reperfusion
What are white infarcts?
Arterial occlusion of solid organs with end-artery circulation
What type of infarct would be seen in the testis?
Red/hemorrhagic infarct
What type of infarct would be seen in the spleen?
White infarct
How do infarcts on the lungs typically appear?
Wedged shaped