Pathoma - Embolism - Fundamentals Of Pathology

Front 1

Define embolism.

Back 1

Intravascular mass that travels and occludes downstream vessels. (En intravaskulær masse som vandrer og tilstopper/tetter igjen nedstrøms blodkar)

Front 2

The MC source of an embolus is _____________.

Back 2

a thrombus, called a thromboembolus (>95%)

Front 3

What is a thromboembolus?

Back 3

A thrombus that dislodges (slite løs)

Front 4

What is an atherosclerotic embolus?

Back 4

A piece of an atherosclerotic plaque breaks off and travels down the blood vessel and lodges somewhere else.

Front 5

What is this? Where did it come from?

Back 5

An embolus.

It's an atherosclerotic embolus due to the white cholesterol crystals in the middle ("cholesterol clefts")

Front 6

A fat embolus is classically seen with what?

Back 6

Bone fractures. Particularly long bones. Also soft tissue trauma.

Front 7

When does a bone embolus from a bone fracture occur?

Back 7

It develops while the fracture is still present, or shortly after repair.

Front 8

What clinical presentation would you see with fat embolus?

Back 8

(1) Dyspnea (fat embolus to the lung)
(2) Petechiae on the skin overlying the chest

Front 9

_____ embolus is seen with decompression sickness (Dykkersyke, trykkfallssykdom). Explain how this happens.

Back 9

The dive forces nitrogen to dissolve in the blood. When the diver rapidly ascends, the nitrogen can precipitate out of the blood creating small gas bubbles which can lodge in the tissues.

Front 10

What are "the bends" and "the chokes"?

Back 10

The bends - Muscle and joint paint in decompression sickness

The chokes - Respiratory symptoms

Front 11

What can decompression sickness present with?

Back 11

Joint and muscle pain, and respiratory symptoms

Front 12

What is Caissons disease?

Back 12

Chronic form of decompression sickness.

It is characterized by multifocal ischemic necrosis of the bone.

Front 13

In what surgic procedure might we see gas embolus formation?

Back 13

Laparoscopic surgery. In this procedure we pump air into the abdomen.

Front 14

What type of embolus may form during labor?

Back 14

Amniotic fluid embolism. Occurs during labor or delivery.

Front 15

A woman during labor is having shortness of breath and neurologic symptoms. What might be going on? Explain.

Back 15

Amniotic fluid embolus. Presents with dyspnea, neurologic symptoms and DIC.

Front 16

Why could a woman with amniotic fluid embolus get DIC?

Back 16

Amniotic fluid is loaded with tissue thromboplastin

Front 17

When you're looking at the emboli of a patient with an amniotic fluid embolus in the lungs (for example), what do you see in the microscope?

Back 17

Squamous cells and keratin debris from fetal skin (the babys' skin was sloughing off over time in the amniotic fluid)

Front 18

PE is usually due to a _______________ that arises due to a _____.

Back 18

thromboembolus; DVT

Front 19

In PE, the embolus usually comes from a DVT in the lower extremity, usually involving what?

Back 19

(1) Femoral veins
(2) Iliac veins
(3) Popliteal veins

Front 20

Most often, PE is clinically ____________ (silent/devastating).

Back 20

silent

Front 21

Why is a PE often clinically silent?

Back 21

(1) The lung has a dual blood supply.
- Bronchial a. from aorta to lung
- Pulmonary a. going into the lung

(2) Embolus is usually small and self-resolves.

Front 22

Pulmonary infarction due to embolus require a couple of things to happen due to the dual blood supply of the lungs. List them.

Back 22

(1) Obstruction of large- and medium-sized.
(2) The patient needs to have a pre-existing cardiopulmonary compromise.

Front 23

____% of PE's cause infarction.

Back 23

About 10%

Front 24

What are clinical features of PE?

Back 24

(1) Shortness of breath
(2) Hemoptysis
(3) Pleuritic chest pain
(4) Pleural effusion

Front 25

A type of CT that may be used in PE. What would it show?

Back 25

Spiral CT shows a vascular filling defect in the lung.

Front 26

A V/Q scan in PE would show __________.

Back 26

mismatch

Front 27

How could you identify that a DVT is present in the lower extremities of a patient with PE?

Back 27

Doppler ultrasound.

Front 28

What hematologic lab may be elevated in PE?

Back 28

D-dimer

Front 29

The gross exam of a pulmonary infarction shows a _________-shaped, __________ infarct.

Back 29

Wedge-shaped (dichotomous branching) hemorrhagic infarct. It's hemorrhagic because the second blood supply is bringing blood into the dead tissue, and the tissue is loose.

Front 30

Sudden death in cases of saddle emboli are due to _____________.

Back 30

electromechanical dissociation... the heart is pumping but the blood supply is totally blocked, so the patient undergoes sudden death.

Front 31

What may happen with a patient that has small emboli lodging in the lungs over time?

Back 31

Chronic emboli that are reorganized over time result in pulmonary HTN.

Front 32

When an embolus lodges in the systemic circuit, where does it most commonly arise from? What is it usually due to?

Back 32

(1) MC arise in left heart
(2) Usually due to thromboembolus

Front 33

An embolus that travels down systemic circulation from the left heart is MC to occlude flow to _______________.

Back 33

lower extremities

Front 34

What is another substance that can damage the endothelium producing vessel thrombosis?

Back 34

Antiphospholipid antibodies (lupus anticoagulant anticardiolipin antibodies).