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Thrombosis
List the Classification of Thrombosis
- Venous Thrombosis
- Arterial Thrombosis
- Cardiac Thrombosis
Venous ThrombosisList the causes of Venous Thrombosis according to the Virchow's TriadVenous Thrombosis due to a change in the vessel wall is caused by: Inflammation
Mechanical damage: IV Lines, Long bone fractures
Chemical Damage: IV DrugVenous Thrombosis due to change in blood flow is caused by:Direct Pressure: POP and Occlusive damages
Lack of Muscle Pump: Bedbound patients
Poor General Circulation: Cardiac FailureWhat is the Typical Location of a Thrombus?Thrombus are often found in the deep vein of the CalfWhat are the results of a Deep Vein Thrombus ?
- Swelling of leg
- Erythema and Pain
- Positive Homans Sign
Arterial Thrombosis
List the causes of Arterial Thrombosis according to the Virchow's Triad
Arterial Thrombosis due to Changes in vessel wall are a result of:
Atherosclerosis
Inflammatory Agents: Infective vs Non-Infective
Mechanical: Intra-Arterial Catheters.
Arterial Thrombosis due to Changes in blood flow are a result of:
Atherosclerosis plaques
Aneurysms
Cardiac Thrombosis
List the causes of Cardiac Thrombosis according to the Virchow's Triad
Cardiac Thrombosis due to changes in vessel wall is caused by:
Post-Infarct
Inflammation
Mechanical
Cardiac Thrombosis due to changes in blood flow is caused by:
Conduction Defects
Vasvular Disease
What is Thrombosis ?
Thrombosis is the formation of a solid mass from blood constituents in circulating blood (platelets, RBC's and fibrin) - antemortem
What is a Clot ?
After death the heart stops beating, circulation stops and blood clots. -postmortem
List the factors that pre-dispose to Thrombosis
Changes to/Abnormality of:
Vessel Wall (Endothelial Injury)
Blood Flow (Venous Stasis)
Blood Constituents (Hypercoagulable State)
NOTE: Not all factors need to change at the same time, ONE is sufficient.
BUT the more there are, the faster the propagation of thrombus.
Describe the Microscopic and Macroscopic Features of a Thrombus
Microscopic:
Alternating lines of Zahn, due to alternating layers of Fibrin with Platelets and Red Blood Cells.
Fibrin and Platelets layers are lighter.
RBCs layers are darker.
The lines of the Zahn depend on the age of the thrombus
Macroscopic:
Firm and Dry in consistency
Alternating lines of Zahn
Adherent to vessel wall *
Describe the Macroscopic Appearance of The Thrombus Depending on The Type of Blood Vessel
Variation in Colour
Thrombus is Pale when it is:
mainly made up of platelets
seen in arteries where circulation is rapid.
Thrombus is Red when it is:
has a greater component of red blood cells
more commonly seen in veins, where circulation is slower
Describe the macroscopic Appearance of a Clot
A Clot has a:
Basal red layer, where as all red blood cells sink to the bottom
Upper yellow white layer of plasma with platelets
The Clot has a rubbery or gelatinous consistency which resembles chicken fat.
Describe the Evolution of a Thrombus The Evolution of a Thrombus:
- Primary Platelet Thrombus
- Coralline Thrombus
- Occlusive Thrombus
- Propagation of Thrombus
What are The Effects of Thrombi ?
Arterial Thrombi:
Results in Ischaemia/Infarction of distal tissue to occlusion
Venous Thrombi:
Results in Congestion and Oedema, Erythema
If Complete Occlusion occurs, increased pressure may impede arterial perfusion leading to Ischaemia
What are the Fates of Thrombus ?
Propagation
Lysis/Resolution
Embolisation
Re-Canalisation to create passage of blood circulation through Thrombus.
Organization and incorporation into vessel wall. (Non-Occlusive Thrombus)
Mention the causes of Changes in Blood Constituents
Primary Causes:
Protein C Deficiency
Protein S Deficiency
Factor V Leiden
Anti-Thrombin Deficiency
Secondary Causes:
Increased Viscosity due to Dehydration and Polycythaemia
Hypercoagulable State due to Malignancy and Oral Contraceptive Use.
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Aortic valve disease, with a valvular pathology
Ventricular Mural Thrombus
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