THROMBOSIS EMBOLISM What is Thrombosis Thrombosis is the
THROMBOSIS & EMBOLISM
What is Thrombosis? Thrombosis is the formation of a solid mass in the circulation from constituent of the streaming blood.
How thrombosis occur? 1. 2. 3. Virchow’s triad Changes in the vessel wall Changes in the blood flow Changes in the composition of the blood
Changes in the vessel wall Endothelial lining is damaged or removed Exposure of the collegen in vessel wall Initiation of Intrinsic pathway Thrombus formation
Arterio venous fistula
Changes in the blood flow Stasis of blood flow or turbulence blood flow In anatomical chages Eg: Aneurysmal sac In increased blood velocity - Locally – Acute inflamation - Systemically – Polycythemia - Dehydration
Changes in the Composition of the blood 1. 2. Platelet Hypercoagulable state
Platelets. . Thrombocytosis
Platelets. . Increased platelet aggregation and adhesiveness 1. Early post operative period 2. Hyperlipidieamia
Hypercoagulable state Severe haemorrhage Preganancy Systemic Lupus Erythromatosis(SLE) Anti phospholipid syndrome Oestrogen administration Inherited thrombophilia
Oral Contraceptive Pills(OCP) Oestogen incresed risk of thrombosis
Types of Thrombosis Venous Thrombosis Arterial Thrombosis Capillary thrombosis Cardiac thrombosis
Venous Thrombosis Phlebothrombosis. Thrombosis is due to stasis of blood in uninflammed veins Thrombophlebitis Thrombosis in inflammed vein
Deep Vein Thrombosis Deep vein thrombosis is the formation of a blood clot in one of the deep veins of the body, usually in the leg
DVT common in … Prolonged immobiliztion Post operative period (Pelvic and orthopedic) Pregnancy Malignancy Obesity Elderly
DVT- Clinical presentation Calf warmth/tenderness/ swelling Mild fever Pitting oedema
DVT- Investigation Doppler scan/Duplex scan
Complications of DVT Massive pulmonary embolism Smaller pulmonary embolic with or without pulmonary infarction
Prevention of DVT prophylaxis- Anticoagulant ( Enoxaparin, warfarin) Compression stockings Physiotherapy
DVT- Patient education Advise women taking estrogen of the risks and common symptoms of thromboembolic disease. Discourage prolonged immobility, particularly on plane rides and long car trips Prevent dehydration.
DVT- Patient education… During operation avoid prolonged calf compression. Passive leg exercises should be encourged whilst patient on bed. Foot of bed should be elevated to increase venous return. Early mobilization should be rule for all surgical patients.
Arterial Thrombosis Artrial thrombosis occur in 1. Distortion of vessel wall 2. Injury to the endothelium 3. Disease of the arterial wall 4. Spasm of the artery
Thrombosis in atherosclerosis Atheroma damage to the endothelium Causes turbulence flow
EMBOLISM
Embolism An embolus is a detached intravascular solid (thrombus), Liquid (Amniotic fluid) or Gaseous mass (Air, Nitrogen) carried by blood flow to a site distant from its point of origin.
EMBOLISM 1. 2. 3. 4. 5. Thromboembolism Fat Embolism Air Embolism Amniotic fluid embolism Tumor embolism
Thromboembolism Embolism of detached thrombus Eg; Pulmonary Embolism
Pulmonary Embolism
Fat Embolism Fat introduced into circulation and causes embolism Most common (90%) with fractures of long bones, less commonly following soft tissue trauma, Burns
Air Embolism Air introduced into systemic venous circulation Enters to right heart , mixed as a froth This froth enter the pulmonary circulation and causes pulmonary embolism
Air embolism occur in Operation on the head and neck A mismanaged blood transfusion During haemodialysis During Laparoscopy
Acute Decompression Syndrome • Nitrogen with O 2 dissolve in blood and tissue at high pressure • As diver surfaces , reduction of pressure the gas begins to come out as minute bubbles • If surfacing is very rapid , causes air embolism
Compression chamber
Amniotic Fluid Embolism Amniotic fluid containing meconium and squamous cells may enter the uterine veins and travel to the lungs Usually occurs during labour and placental abruption
Amniotic fluid embolism rare, but it is fatal!!!
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