Virchow's Triad
Common elements associated with thrombosis:
- endothelial injury
- stasis/turbulent blood flow
- hypercoagulability (more proagulants vs anticoagulants).
*endothelial integrity is the most important factor.
Primary - Promoters of Thrombus Formation (3)
Primary = congenital/something you're born with.
Factors:
1. Factor V Leiden,
2. Prothrombin 20210 mutation (Increased prothrombin transcription)
3. Deficiency of antithrombin (protein C or S)
Secondary - Promoters of Thrombus Formation (8)
Secondary = acquired condition
Factors:
OCs, pregnancy, disseminated cancer, heparin induced thrombocytopenia (HIT), antiphospholipid antibody syndrome (APS), old age, obesity, smoking.
Thrombus Types and Their Associated Locations
Mural Thrombi: Thrombus type found in the heart and aorta. Atherosclerotic plaques form first in in places with highest pressure (aorta).
Arterial Thrombi: Embolism that may cause infarct in any organs or LE that follows arterial pathway (less common than
Features of Disseminated Intravascular Coagulation
1. Decreased organ perfusion - widespread thrombosis in microcirculation leads to poor perfusion throughout the body.
2. Uncontrollable bleeding - depletion of platelets and clotting factors leads to continuous bleeding.
3. Not a primary disorder - usuall
Thrombus vs. Embolus
Thrombus: Solid mass of platelets and clotting factors that form when the clotting mechanism is activated. These may occur at atherosclerotic plaques, endothelial damage, and places with slow blood flow and can cause blockage.
Embolus: Most often a piece
List Sources of Emboli
cancer, pulmonary, saddle, paradoxical, thromboembolism, fat, amniotic fluid, and air.
Saddle emb. - emb at birfucation of palm aa.
Paradoxical - emb. passes through septal defect to aa.
Fat - associated with crushing injury
amniotic - cells from baby ent
Morphology of Infarct (Gross and Microscopic)
Gross:
1. Red - "hemorrhagic", dual circulation or reperfusion AFTER OCCLUSION. Hemosiderin turns brown grossly.
2. White - "anemic", tissue density limits blood accumulation.
3. Wedge-shaped - infarct shows vessel occlusion at apex.
Microscopic:
1. Coagu
Categories of Shock (5)
1. Cardiac - Failure of myocardial pump (some causes include MI, ventricular rupture, arrhythmia, cardiac tamponade, pulmonary e.)
2. Hypovolemic - inadequate blood/plasma volume (causes include hemorrhage, vomiting, diarrhea, burns, trauma).
3. Neurogeni
Waterhouse-Friderichson Syndrome
DIC condition that affects adrenal glands. This can lead to septic shock.
ARDS
Acute Respiratory Distress Syndrome. Can't get adequate gas exchange due to edema in the lungs from bacterial infection. May lead to septic shock.
Physiologic Stages of Shock (3)
Non-progressive:
- Reflex mechanisms maintain organ perfusion through compensation. Maintains adequate BP (baroreceptors, catacholeamines, ADH, renin-aldosterone, SNS stimulated) and induces tachycardia, vascular constriction, and renal fluid retention.
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