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162 Cards in this Set
- Front
- Back
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What is a clot formed from?
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Platelets and fibrin
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What is a thrombus?
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A clot in an inappropriate site--has pathologic consequences
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What fluid compartment do red cells contribute to?
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Intravascular volume
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In an acute hemorrhage when we give blood, what are we replacing?
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Replacing volume--hard to replace RBC's
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What is edema?
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Accumulation of increased fluid in the interstitial space
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What is anasarka?
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Severe generalized edema
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As interstitial volume increases, waht happens to the excess volume?
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Tissue lymphatics remove it and return it to the circulation via the thoracic duct
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If the ability of the lymphatics is decreased, what happens?
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Fluid accumulates in the tissues and edema occurs
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What are the two basic causes of edema?
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Increased hydrostatic pressure
Diminished plasma osmotic pressure |
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What kind of edema occurs with left sided heart failure?
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Pulmonary edema
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What kind of edema occurs with right sided heart failure?
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Peripheal edema
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Where does edema typically develop?
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In dependent areas of the body--gravitational
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What is pitting edema?
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When pressing on the skin with a finger, it leaves an indentation which persists after the removal of the finger
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What is a good place to identify edema in children?
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Periorbital edema
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What is pulmonary edema?
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Accumulation of water in the lungs, particularly in the alveolar space
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What is inflammatory edema?
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Caused by soft tissue inflammation--acute or chronic--"swelling"
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What is exudate?
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Protein rich edema with a specific gravity of >1.020
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What is transudate?
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Protein poor edema with a specific gravity of <1.012
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What does the prefix "hydro" refer to?
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Fluid accumulation in a body cavity--hydrothorax, hydrocephalus, etc.
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What is hyperemia?
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An active process resulting from arteriolar dilation
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What is an example of hyperemia?
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Reddened face when embarrassed or flushed appearance from too much heat
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What is congestion?
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A passive process resulting from impaired outflow from a tissue
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What happens to volume and pressure in hyperemia and congestion?
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Both increase
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What can congestion result in?
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Cyanosis
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What is hemorrhage?
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Extravasation or presence of blood outside the intravascular space
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What is bleeding diatheses?
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Increased tendency for severe bleeding because of deficient clotting mechanisms
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What is a hematoma?
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Accumulation of blood within a tissue; usually a localized mass
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What is petechiae?
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1-2 mm pin point hemorrhage into skin or surfaces
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What is petechiae frequently associated with?
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Thrombocytopenia
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What is purpura?
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3 mm or greater areas of hemorrhage
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What is ecchymoses?
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Large (1-2 cm) sub-q hematoma seen after trauma--changes colors as hematoma clears
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What type of people have blotchy areas of hemorrhage?
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Usually people on coumadin
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How much blood volume can be lost acutely before signs and symptoms present?
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20% loss is usually tolerated ok
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How much blood can be lost chronically before signs and symptoms present?
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300-400 ml/day
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What are the three major components involved in hemostasis?
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Blood vessel-Endothelial cells
Platelets Coagulation cascade |
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What is involved in primary hemostasis?
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Vessel injury; clot initiation and formation
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What is involved in secondary hemostasis?
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Clot propagation and stabilization
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What in involved in antithrombocytic activity?
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Clot inhibition and cessation
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What is fibrinolysis?
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Clot dissolution
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Normally, does the luminal surface of endothelium cells initiate a clot?
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No--only when continuous disruption occurs
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Who promotes/enhances the formation of a clot?
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The intact endothelial cells of the vessel immediately adjacent to the injury
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What is does fibrinolysis do?
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Inhibits the enlargement of clot formation and stimulates the dissolution of the clot
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What attaches to the ECM and serves as a link for platelet adherence?
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von Willebrand factor
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What is released from the endothelial cells when they are injured?
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Tissue factor
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What does tissue factor activate?
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The "Extrinisic" portion of the clotting cascade and Factor IX in the "Intrinsic" portion of the cascade
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What does prostacyclin do to platelet aggregation?
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Inhibits platelet aggregation
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What inactivates thrombin, Xa, and IXa?
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Antithrombin III
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What does Protein C inactivate?
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Factors Va and VIIa
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What is attached to von Willebrand factor to enhance adhesion of platelets?
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Factor VIII
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What is the intial plug at the site of injury dependent on?
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Platelets
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What do platelets form in order to adhere to one another?
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Filiapodia
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What do activated platelets release?
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ADP and Thromboxane A2 for vasoconstriction and platelet aggregation
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What do platelets expose that stimulates fibrin production?
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Phospholipid surface
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What is made on the phopholipid surface of platelets?
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Fibrin
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What is the "glue" that allows platelets to adhere to one another?
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Firbin
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Where does the coagulation pathway start?
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The Extrinsic pathway--Factor VII
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What factors are involved in the Common Coagulation pathway?
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Factors X, V, II, and I
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If you want to shut down the whole coagulation cascade, what do you want to inhibit?
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The last step of the common pathway--Fibrinogen to Fibrin
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What pathway is activated first?
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The Extrinisic pathway and then the Intrinsic pathway is activated to amplify firbin production
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What factor is Fibrinogen?
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Factor I
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What factor is fibrin?
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Factor Ia
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What factor is prothromin?
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Factor II
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What factor is thrombin?
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Factor IIa
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What stimulates prothrombin (Factor II)?
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Factor Xa
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Besides Factor X, what other factor makes thrombin?
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Factor V
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What are the circulating natural anticoagulants do we have to break down Thrombin?
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Antithrombins I, II, and III
Proteins C and S |
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What does fibrinolysis activate?
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Clot dissolution by activating plasminogen to form plasmin
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What is plasmin?
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The active enzyme that degrades fibrin
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What is von Wildebrand's disease?
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Deficiency if forming a platelet plug--lack of adhesion--can't even start a clot
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What are Quantitative platelet disorders?
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Normal platelets but there are not enough
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What are examples of Quanitative platelet disorders?
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Decreased production--Actue Leukemias
Increased destruction--ITP and DIC |
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What is idiopathic thrombocytopenic purpura?
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Antibodies against platelets--producing a lot of platelets, but have increased destruction of them
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What are Qualitative platelet disorders?
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Have enough platelets but they don't work properly--can't form an effective plug
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What are examples of Qualitative platelet disorders?
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Uremia
Aspirin Glanzmann Thrombasthenia Bernard-Soulier Syndrome |
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What causes von Wildebrand's disease?
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Autosomal dominant disorder--defective synthesis or function of the von Wildebrand factor
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What is the most common congenital bleeding disorder in humans?
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von Wildebrand's Disease
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What are the symptoms of von Wildebrand disease?
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Spontaneous hemorrhage from mucous membranes, prolonged and copious bleeding from cuts, menorrhagia
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What are Type 1 and 3 von Wildebrand?
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Decreased quantity of circulating vWF--associated with mild bleeding
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Do Type 1 and 3 von Wildebrand patient's have deficient or normal factor VII?
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They have deficient Factor VIII
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What is Type 2 von Wildebrand?
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Qualitative defect in vWF--mild to moderate bleeding
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Do Type 2 von Wildebrand patients have deficient or normal Factor VIII?
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They have normal Factor VIII
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What is Uremic bleeding?
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Decreased platelet function do to renal failure--organic acids poison platelets
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What is Hemophilia A?
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An X-linked recessive disorder caused by a deficiency in Factor VIII
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What are the signs and symptoms of Hemophilia?
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Joint and muscle bleeding
Traumatic operative bleeding Easy bruising and hematoma formation Minimal bleeding from small cuts |
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What is a thrombus?
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A clot with pathologic sequellae
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What things can cause thrombus formation?
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MI
Arteriosclerosis Trauma Vasculitis |
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What is a major factor in developing thrombi?
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Stasis
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What is thrombophilia?
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Failure to stop clot formation--NOT a defect in fibrinolysis
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What is a thrombus?
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A blood clot larger than a hemostatic plug that has pathological and clinical effects
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What do the pathological/clinical effects of a thrombus depend on?
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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 |
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What is a thrombus that travels to a distant site called?
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Embolus
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What is a thrombus called that forms in the cardiac chambers and aorta?
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Mural thrombus
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What is a thrombus called that forms in the cardiac valve leaflets and cusps?
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Vegetations
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What is a thrombus that forms in the arterioles and capillaries called?
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Microthrombi
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When thrombi form in the heart or aorta have a tendency to be quite large and form what?
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Lines of Zahn
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What abnormality is associated with a bacterial or fungal infection triggering the clotting mechanism forming a thrombus?
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Infective endocarditis
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What abnormality forms sterile thrombi on non-infected valves in patients with hypercoaguable disorders?
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Non-bacterial thrombotic endocarditis
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What type of endocarditis forms from thrombi that occur subadjacent to valves in patients with SLE?
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Libman-Sachs endocarditis
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What valve abnormality has the highest chance of forming "showers of emboli?"
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Bacterial endocarditis
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How do arterial thrombi grow or propogate?
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Retrograde
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What is the major complication with arterial thrombi?
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Occulsion with cessation of blood flow past obsturction
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Where are the most common sites for arterial thrombi to form?
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Coronary
Cerebral Femoral |
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What is the most important part of treatment for arterial thrombus?
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Early intervention with agents that provide fibrinolysis
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What is a thrombus?
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A blood clot larger than a hemostatic plug that has pathological and clinical effects
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What do the pathological/clinical effects of a thrombus depend on?
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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 |
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What is a thrombus that travels to a distant site called?
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Embolus
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What is a thrombus called that forms in the cardiac chambers and aorta?
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Mural thrombus
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What is a thrombus called that forms in the cardiac valve leaflets and cusps?
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Vegetations
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What is a thrombus that forms in the arterioles and capillaries called?
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Microthrombi
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When thrombi form in the heart or aorta have a tendency to be quite large and form what?
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Lines of Zahn
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What abnormality is associated with a bacterial or fungal infection triggering the clotting mechanism forming a thrombus?
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Infective endocarditis
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What abnormality forms sterile thrombi on non-infected valves in patients with hypercoaguable disorders?
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Non-bacterial thrombotic endocarditis
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What type of endocarditis forms from thrombi that occur subadjacent to valves in patients with SLE?
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Libman-Sachs endocarditis
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What valve abnormality has the highest chance of forming "showers of emboli?"
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Bacterial endocarditis
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How do arterial thrombi grow or propogate?
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Retrograde
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What is the major complication with arterial thrombi?
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Occulsion with cessation of blood flow past obsturction
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Where are the most common sites for arterial thrombi to form?
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Coronary
Cerebral Femoral |
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What is the most important part of treatment for arterial thrombus?
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Early intervention with agents that provide fibrinolysis
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Which are bigger.....arterial or venous thrombi?
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Venous thrombi are bigger (mm, cm)W
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Where are venous thrombi typically located?
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In zones of stasis or turbulence
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Can venous thrombi form without exposure to endothelial injury and reaction to underlying matrix?
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Yes
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Do venous thrombi propogate anterograde or retrograde?
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Anterograde
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Where do 90% of venous thrombosis occur?
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Deep veins of lower extremities and iliac system
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What are the major complications of venous thrombi?
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Edema and pulmonary embolism
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Do arterial thrombi form with or against the flow?
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Against the flow
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Do venous thromi form with or against the flow?
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With the flow
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What are microthrombi?
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Small micro (5-25 micron) clots that form in the circulating blood--may partially obstruct arterioles and capillaries
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Where are microthrombi see?
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DIC
TTP |
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What type of disorder is DIC?
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Thrombotic disorder and a hemorrhagic disorder
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What type of thrombi form from DIC?
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Microthrombi
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Where is DIC present?
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In all vessels--arterial and venous
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Is DIC amenable to thrombolytic treatment?
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NO! It makes it worse
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What will lab work of a patient in DIC most signifcantly show?
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Low platelets--30,000
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What are the most common causes of DIC?
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Sepsis and massive tissue injury
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What is the major clincal symptom of DIC?
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Bleeding
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Besides bleeding, what is another clinical characteristic of DIC?
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Widespread deposition of small particles of fibrn in microcirculation--microangiopathic hemolytic anemia
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Why is DIC sometimes referred to as comsumption coagulopathy?
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Because there is decreased blood constituents--fibrinogen, platelets, coagulation factors, RBC's
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What is the PT and PTT values in DIC?
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Markedly prolonged
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Are the fibrin split products elevated or decreased in DIC?
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Elevated--breakdown products of fibrinogen and fibrin
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What is the treatment for DIC?
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Remove the source of coagulation activation--treat the inital condition--support with blood products
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What is the mortality rate of DIC?
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50-80%
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What is an embolus?
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Detached intravascular substance that is carried by the blood to a site distant from its origin
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Where do 95% of of pulmonary thromboemboli come from?
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Deep veins of the lower extremites
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What are the types of pulmonary emboli?
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Single large mass obstructing one or both pulmonary arteries--saddle emb.
Multiple sequential emboli Multiple simultaneous emboli--emboli showers |
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What are the symptoms of a pulmonary embolus?
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Acute shortness or breath
Tachypnea and dyspnea |
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What percentage of the pulmonary circlulation needs to be obstructed for a pulmonary embolus to be fatal?
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60%
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What does emobli obstruction of medium sized arteries result in?
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Pulmonary hemorrhage but not usually MI
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What does emboli obstruction of small arteries result in?
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Infarction
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What can multiple emboli over time with subsequent organization result in?
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Pulmonary hypertension
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Does a pulmonary embolus damage the vessel wall?
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No--it's just a problem with plumbing
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What is a fat embolism?
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Occurs after fracture of long bones that have fatty marrow
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When does a fat embolism develop?
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1-3 days following injury
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What are the symptoms of a fat embolism?
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Pulmonary insufficiency, neurologic symptoms, anemia, and thrombocytopenia
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What is an air embolism?
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Air bubble behaving as a thrombus--takes more than 100mL of air to cause a problem
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What is an amniotic fluid embolus?
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Entry of amniotic fluid into the maternal circulation via a tear in placental membranes or rupture of uterine veins
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What are the symptoms of an amniotic fluid embolus?
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Sudden attack of severe dyspnea
Cyanosis Profound shock Death |
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If the patient survives an amniotic fluid embolus, what are they most likely to develop?
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DIC
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Where do we see red/hemorrhagic infarcts?
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Where there is dual blood supply
Venous occlusion Lungs Reperfusion |
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What are white infarcts?
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Arterial occlusion of solid organs with end-artery circulation
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What type of infarct would be seen in the testis?
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Red/hemorrhagic infarct
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What type of infarct would be seen in the spleen?
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White infarct
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How do infarcts on the lungs typically appear?
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Wedged shaped
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