patho exam 2 important to know

intrinsic

activates in response to injury

extrinic

activated when blood leaks out of vessel and enters tissue space

vitamin k is required

for the liver to make four of the clotting factors

thrombus

stationary clot

embolus

travelling clot

patients at risk for clots

surgical procedures, indwelling catheters, A Fib, mechanical heart valves

Thrombocytopenia

platelet count falls below 150,000 (due to decreased production or increased destruction of platelets)

hemophilia

genetic deficiencies in specific clotting factors

von Willebrand’s Disease

most common inherited coag disorder (decrease in that factor which is responsible for proper platelet aggregation)

promotion

inhibits fibrin destruction (hemostatics) or provides missing clotting factor (clotting factor concentrates)

removal

clot dissolves by drug ( thrombolytic)

prevention

inhibit specific clotting factors (anticoags) or inhibit platelet action (antiplatelet)

anti platelets

lengthens clotting time and prevents clots from forming or growing larger

ADP receptor blockers

irreversibly alters plasma membrane of platelet to interrupt the ability of ADP to bind to the receptor

anticoagulants

prevention of new clots from forming

preventing growth of existing clots

when is PTT necessary

heparin iv; not necessary for subq

enoxaparin air bubble

the air bubble helps push all of the medication out of the syringe and into the subq tissue

it creates a small air lock in the tissue, preventing the med from leaking back up the injection track to skin surface, thereby helping to reduce bruising

memory trick WARF

w-watch INR levels

a-avoid foods high in vitamin k )kale,spinach)

r-report any unusual bleeding or bruising

f- follow up regularly with healthcare provider

what affects INR levels

increases: antibiotics, amiodarone, HF, COPD, decreased vitamin K consumption, alcohol, grapefruit juice

decreases: oral contraceptive, malignancy, diarrhea, increased vitamin K consumption, alcohol

memory trick heparin works fast

heparin starts in a hurry but is gone in a hurry

memory trick warfarin

warfarin is a weaker start and takes up to a week to work

thrombolytics

promotes process of fibrinolysis by converting plasminogen to enzyme plasmin

must be given within 12 hours of MI symptoms and 3 hours of thrombotic stroke

antifibrinolytics

opposite action of anticoagulants

shorten bleeding time to slow blood flow

used to prevent and treat excessive bleeding following surgical procedures

all prevent fibrin from dissolving to enhance the stability of the clot

use cautious in patients with a history of thromboembolic disease

parietal cells

help kill viruses and bacteria

produce and secrete cells (surface epithelial cells)

primary site of action for many acid-controller drugs

mucoid cells

protector

protector

mucus-secreting cells (surface epithelial cells)

provide a protective mucous coat

protect against self-digestion by HCI

hydrochloric acid (HC1)

secreted by parietal cells when stimulated by food

maintains pH of 1-4

secretion stimulated by

• large fatty meals

• excessive amounts of alcohol

• emotional stress

PUD

erosion of the GI mucosa

risk factors

• #1: H.Pylori

• meds: steroids, NSAIDS

• lifestyle: stress/smoking/ETOH

• Family hx

helicobacter pylori (H.pylori)

bacteria

responsible for 90% of duodenal ulcers

risk factor for stomach cancer if left untreated

testing for H.pylori

non-endoscopic

1. urea breath test

2. stool fecal antigen test

3. blood test for antibodies

Endoscopic

direct culture/PCR

PUD- gastric ulcers

less common

symptoms: gnawing, sharp pain, anorexia, weight loss

pain may be worse after eating

may be associated with gastric cancer

PUD- duodenal ulcers

more common

symptoms: no s/s or burning pain

younger ages 30-50

pain improves after eating

many heal spontaneously

GERD

caused by weak (LES)

• alcohol, tobacco, caffeine, peppermint, medications, fatty foods,chocolate, obesity, hiatal hernia

s/s: heartburn, upper abdominal pain, regurgitation/hypersalivation, respiratory symptoms

Proton pump inhibitor

reduce the secretion of acid in the stomach by binding to enzyme

heal 90% of ulcers within 4-8 weeks

H2 Blockers

blocks the effect of histamine at H2 receptors in the parietal cells of the stomach inhibiting gastric acid secretion

H2 blockers

acts by blocking H2 receptors in stomach to decrease acid production

should be administered with meals and okay to take with antacids but not at the same time

antacids

neutralizes stomach acid

otc (chewable, liquid, or pill form