Difference between revisions of "Arterial Diseases - WikiClinical"
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==Thromboembolism== | ==Thromboembolism== | ||
Revision as of 14:40, 1 July 2010
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This article has been peer reviewed but is awaiting expert review. If you would like to help with this, please see more information about expert reviewing. |
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Hypertension, Systemic
Pulmonary Hypertension
Thrombosis
Thromboembolism
Description
- As the name implies, a thromboembolism is a clot (thrombus) or foreign body that blocks vessels a distance away from its original site of origin.
- The most significant sites of thromboembolic formation are the following: lungs, CNS, terminal aorta, kidneys.
Requirements for thromboembolism formation:
1. Disruption of endothelial integrity
2. Disruption of flow
3. Disruption of blood haemostasis
4. Disruption of fibrinolysis
The incidence of thromboembolism greatly increases with certain diseases including:
-Heart Disease
-Neoplasia
-Blood Disorders
-Parasitic Diseases
-Hyperadrenocorticism
Diagnosis
History & Clinical Signs
5 P's:
-Pain
-Paresis
-Pallor
-Pulselessness
-Polar (cold extremities)
Long Term Effects:
-Necrosis
Specific Problems:
- Signs are dependant on site of thromboembolism
-Neurological problems (acute)
-Renal Failure (acute)
-Dyspnoea (acute)
Laboratory Findings
- Heavily dependent on thromboembolic site
-Hyperkalemia
-Acidosis
-Increased Lactate
-Azotemia
-Elevated serum creatine phospohokinase
Radiography, Echocardiography, Angiography
-Clots may be seen by the above methods
Treatment
-Treat underlying conditions
-Pain Relief (e.g. morphine)
-Support with IV fluids
-Anticoagulants:
1. Heparin
2. Aspirin
Prognosis
-Grave
Arteriovenous Fistula
Description
- As the name implies, an arteriovenous fistula is an abnormal direct connection between an artery and a vein. This connection causes the capillary circulation to be completely ignored. We will concentrate on peripheral fistulas here.
The consequences of an arteriovenous fistula are the following:
1. Increased blood return to the right heart raises cardiac output
2. Decreased blood perfusion at the affected site
3. Venous hypertension
- Predisposing causes of arteriovenous fistula formations are: trauma, surgery, neoplasia, etc.
Diagnosis
History & Clinical Signs
- Signs depend on where the AV fistula has formed.
-Subcutaneous edema
-Warm Swelling
-Inflammation
-Pain +/-
-Palpable vibration (thrill) over fistula
-Increased pulse & heart rate
-Audible continuous murmur over the fistula site
-Branham sign (decreased heart rate with surgical occlusion of blood flow to fistula)
Angiography
-Abnormal direct connection between an artery and a vein
Ultrasonography
-Abnormal flow visualized
Treatment
-Surgical ligation of abnormal vessels to and from the fistula area
-(+/-) Amputation
Prognosis
-Good with complete ligation and cessation of blood flow through the fistula
-Poor if surgical ligation is unsuccessful at stopping blood flow through the fistula
Vasculitis
Description
- Vasculitis is an inflammatory disease of the vessels.
- Causes of vessel inflammation are due to the following: neoplasia, infection, toxins, drug reactions, trauma, drug reactions, hypersensativity reactions etc.
Diagnosis
History & Clinical Signs
-Heat
-Edema
-Pain
-Petechiation
-Thrombosis
-Hemolysis