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2. thrombosis, embolism, infarction dr. sinhasan- mdzah


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thrombosis, embolism, infarction

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2. thrombosis, embolism, infarction dr. sinhasan- mdzah

  1. 1. Virchow’s Triad::: Endothelial Injury Stasis or Blood turbulence Hypercoagulability
  2. 2.  Loss of endothelium exposes Subendothelial collagen Etiology: Hypertension Endotoxins Scarred valves Hyperhomocystinemia Hypercholesterolemia Smoking Radiation 1. ENDOTHELIAL INJURY
  3. 3.  Turbulence Arterial thrombus  Stasis Venous thrombus  Alteration in Flow causes….  Disrupt the laminar blood flow  Cause concentration of Clotting factors  Permit build of thrombi  Promote endothelial cell activation
  4. 4.  PRIMARY/ GENETIC:  Factor V Leiden mutation  Prothrombin mutation  Antithrombin III deficiency  Protein C & Protein S deficiency  ACQUIRED CAUSES:  Prolonged bed rest- Immobilization  Myocardial Infarction  Surgery, Fracture, Burns  Cancer, Cardiac valves,  DIC, SLE  Hyperestrogen states, Smoking, Sickle cell anemia, Nephrotic syndrome.
  5. 5. Previous extensive transmural myocardial infarction. The stasis of blood in the aneurysm predisposes to mural thrombosis.
  6. 6.  Deep thrombi occur in large veins of leg  DVT are asymptomatic in 50 % of patients  Trousseau Syndrome: Tumor associated procoagulant release Increased risk of Thromboembolic phenomenon in disseminated cancers.  Also known as migratory thrombophlebitis  Ca Pancreas, Prostate, Stomach, Breast, Lung, Osteosarcoma, AML- M3.
  7. 7. Propagation Embolization Dissolution Recanalization Organization
  8. 8.  “Detached Intravascular Solid, Liquid or gas mass carried by blood to a distant site.”  99% are Thrombo-embolus  Consequences of embolus is ischemic necrosis of affected tissue.
  9. 9.  Venous Embolism/ Pulmonary (DVT)  Arterial Embolism (Post MI)  Paradoxical Embolism (Venous will become arterial: due to ASD/ VSD)  Fat embolism  Amniotic fluid embolism  Air embolism  Septic embolism  Foreign body embolism. Types of Embolism:
  10. 10.  Most commonly from venous emboli from leg veins (DVT)  “Saddle embolus” obstructs main Pulmonary artery  Once a Pulmonary embolus occurs, patient will be prone for recurrent emboli episodes.  Multiple emboli or shower of small emboli in small pulmonary arteries.
  11. 11.  Most arise from Intra cardiac mural thrombi  Left ventricular wall infarction and Mitral stenosis predisposes to thrombi and embolus  Arterial emboli travel to wide variety of sites  Lower limbs, Brain, intestines, kidney, spleen…….any organ.
  12. 12.  Microscopic fat globules enter circulation following fracture of long bones  Fat embolism syndrome:: Symptoms appear 1- 3 days after injury  Pulmonary insufficiency: Tachypnea, Dyspnea, Tachycardia  Neurologic symptoms: Irritability, Restlessness, Delirium, Coma  Low platelets: Petechial skin rash  Fatal in 10% of individuals
  13. 13.  Fracture long bones: Imp.  Soft tissue trauma  Burns  Parenteral lipid infusion  Sickle cell crisis  Acute pancreatitis  Liposuction  Decompression sickness
  14. 14.  Gas bubbles in circulation  100 ml of air is needed to produce clinical effect  Chest wall injury, Neck injury, Therapeutic, Intra-operative  Decompression sickness seen in Deep sea divers
  15. 15.  Amniotic fluid into ruptured uterine veins  Grave, but uncommon complication  Important obstetric complication  Sudden onset of severe dyspnea, Cyanosis, Hypotension, Shock, Seizures, Coma.  If survives… Pulmonary edema, DIC AMNIOTIC FLUID EMBOLISM
  16. 16.  An infarct is an area of ischemic necrosis caused by occlusion of arterial supply or venous drainage  Can be due to Thrombus, embolus, vasospasm, atheroma, compression of vessels, etc.,  Venous blockade Congestion
  17. 17.  Classified based on the color 1. Red (Hemorrhagic) infarct 2. White (Anemic) infarct  Red infarcts are seen in:: - Dual blood supply.. Lung, Small intestine - Loose tissues.. Lung - With venous occlusions (ovarian torsion) - Previously congested tissue
  18. 18.  White Infarcts:: - Arterial occlusions - Organs with end arterial blood supply - Solid organs.. Heart, Spleen, Kidneys, Brain  Microscopy:: - Coagulative necrosis - Liquefactive necrosis