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Path Emboli
KYCOM Block 11
44
Pathology
Graduate
10/30/2013

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Term
define emboli
Definition
occlusion or obstruction of mass transported in circulation
detached intravascular soild or gas
Term
what are 5 common sites of emboli origin
Definition
systemic vein or right heart
left heart of main artery
mesenteric/portal vein
crossed embolism
retrograde embolism
Term
what is the usually route of an arterial emboli
Definition
systemic
Term
what is the usually route of an venous emboli
Definition
pulmonary
Term
what is the usually route of an portal vein emboli
Definition
hepatic emboli
Term
what is the usually route of an paradoxial emboli (crossed emboli)
Definition
passes through ASD or VSD and into general circulation
Term
what are the 9 causes of emboli
Definition
thromboembolis
fat droplets
nitrogen or air bubbles
amniotic fluid
cholesterol (athlerosclerotic)
endocarditis vegitations
tumor
bone marrow
foreign body (bullet)
Term
what are the two types of thromboemboli
Definition
pulmonary/deep vein thrombosis

systemic/arterial
Term
what is the number one cause of pulmonary emboli
Definition
deep leg vein origion from bed rest or trauma
Term
what is the MOA of the damage of a pulmonary emboli
Definition
prevents blood from going into the lungs
Term
what are some of the complications of a small pulmonary emboli
Definition
could lodge in branching arterioles of pulmonary artery
asymptomatic if not occlusive but could lead to pulmonary hypertension in the future
Term
what are some of the complications of a large pulmonary emboli
Definition
could occlude main pulmonary artery (saddle emboli) causing sudden death
Term
define systemic emboli
Definition
emboli traveling in the arterial circulation
Term
what are the causes of systemic emboli (5)
Definition
intracardiac mural thrombi (80%)
left atrium dilation or fibrillation
heart valve vegetations
aortic mural thrombi
ulcerated atherosclerotic plaques
Term
where is an athlerosclerotic plaque most likley to form
Definition
bifurcations
Term
where are the most common sites of systemic embloli
Definition
lower extremities 75%
brain, intestine, kidney, spleen
Term
what is the cause of a fat droplet emboli (3)
Definition
fracture of long bone
trauma of soft tissue
liver with fatty changes
Term
what are the consequences of a large fat droplet emboli
Definition
occluding branching arterioles of pulmonary artery
Term
what are the consequences of a small fat droplet emboli
Definition
pass through pulmonary circulation to left heart and cause emboli in brain
Term
what are the signs of a fat droplet emboli(6)
Definition
90% asymptomatic
can be fatal
neurological
anemia
thrombocytopenia
petechial rash
Term
how big does a gas emboli need to be to cause obstruction
Definition
>100mL
Term
what are three causes of gas emboli
Definition
obstretic surgery
chest wall surgery
decompression sickness
Term
explain why decompression sickness causes emboli
Definition
sudden change in atmospheric pressure causes high pressure air to be inhaled increasing nitrogen in the blood and if the diver ascends too rapidly and depressurized nitrogen expands in the tissues and bubbles out of solution it can make a gas emboli
Term
how does amniotic fluid cause an emboli (2)
Definition
tear in placenta, rupture in uterine vein
allows amniotic fluid into maternal circulation
Term
what are 6 signs of a amniotic fluid emboli
Definition
dyspenia
cyanosis
DIC
shock
seizure
coma
Term
what do the consequences of an emboli depend on (3)
Definition
contralateral vascular supply to the tissue
tissue vulnerability to ischemia
diameter or caliver of occlusion
Term
what are common outcomes of few small emboli (2)
Definition
asymptomatic or could cause infarction
Term
what are common consequences of many small emboli (2)
Definition
decrease in volume of pulmonary circulation
pulmonary hypertension
right ventricle failure
Term
what are the common cosequences of a medium emboli (2)
Definition
hemorrhage
infarction
Term
what are the common consequences of a large emboli (2)
Definition
sudden death
saddle emboli
Term
define infarction
Definition
ischemic necrosis due to itssue anoxia
Term
what are the layers of an infarct
Definition
infarcted center
hemorrhagic line
normal tissue
Term
what are 4 common cause of infarction
Definition
occlusion or artery or venous drainage
MI
cerebral infarct: stroke
twisting of vessel
Term
what are two examples of twisting of a vessel causing infarct
Definition
ovarian torsion
testicular torsion
Term
why is a venous infarct not as terrible as an arterial
Definition
tend to cause congestion and get bypassed
Term
what are the two kinds of infarct
Definition
white - ischemic
red - hemorrhagic
Term
what is the cause of an ischemic infarct
Definition
arterial occlusion
Term
what is the cause of a hemorrhagic infarct
Definition
venous occlusion causes congestion
Term
where does a red infarct often occur
Definition
tissues with dual blood supply: lungs, SI, liver
Term
where does a white infarct often occur
Definition
solid compact organs with little collateral circulation: spleen, kidney, heart, brain
Term
what happens in the brain if it has an infarct
Definition
liquified necrosis
Term
how can a white infarct be identified
Definition
pale, dry, wedge or conical
necrotic lesion
Term
what natural mechanisms can lessen the severity of an emboli
Definition
if the tissue has dual blood supply or collateral vessels

if the occlusion is slow the body can reorganize and make collateral circulation

some cells are more resistant to hypoxia (some aernt...)

good outcome if there hasnt been ischemia or cyanosis. tissue can bounce back
Term
what tissues have low tolerance for hypoxia, how long until damage starts (5)
Definition
neurons 3-4 min
myocardial cells 20-30 min
fibroblasts, seletal muscle: hours
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