Clin Med Exam #3 Review

vasoconstriction, platelet plug formation, blood coagulation, and fibrinolysis

what are the 4 phases of blood clot formation

von willebrands factor

what mediates primary hemostasis

megakeratocytes and endothelial cells

what synthesizes von willebrands factor

factor 8

vonwillehands factor is associated/binds/activates what factor

thromboxane A2 and serotonin

what is released during primary hemostasis that causes vasoconstriction

ADP

what is released during primary hemostasis that causes attract and activate more platelets

fibrinogen

what forms the bridge between adjacent platelets

GPIIb/IIIa

what is the most abundant receptor

GPIIb/IIIa

what receptor does fibrinogen bind to

fibrin

what is created by clotting factors and fibrinogen and strengthens the bond

platelet adhesion

what is it called when platelets adhere to the subendothelial

platelet aggregation

what is is called when platelets adhere to each other

8, 9, 11, and 12

what are the factors associated with the intrinsic pathway

TF, 3, and 5

what are the factors associated with the extrinsic pathway

10, 2, 1

what are the factors associated with the common pathway

PTT

what is the test for intrinsic pathway

PT/INR

what is the best for extrinsic pathway

initiation, amplification, and propagation

what are the phases of the new coagulation cascade

bleeding test

qualitative test that measures platelet function

1-6 min

what is the normal bleeding time

no

are bleeding tests good predictors for surgical bleeding

platelet function assays

qualitative measure of platelet function

heparin

is PTT associated with heparin or warfarin

warfarin

is PT/INR associated with heparin or warfarin

intrinsic

is heparin associated with the intrinsic or extrinsic pathway

extrinsic

is warfarin associated with the intrinsic or extrinsic pathway

150,000-450,000

what is the normal platelet count

~10 days

what is the life span of platelets

>50,000

what is the platelet count needed for dental/oral surgical procedures

<20,000

pts with how many platelets may experience spontaneous bleeding

< 10,000

pts with how many platelets may have a serious hemorrhage and intracranial bleeding

hemostatic disorders

disorders that disrupts any of the processes or steps involved in normal hemostasis

thrombocytopenia

when platelets drop below 150,000 =

petechial rash

what is a hallmark sign of thrombocytopenia

- platelet production

- distribution iin cirulation

- platelet in circulation

- diilution

what are the causes of thrombocytopenia

splenomegaly

abnormal enlargement of the spleen

increase

will splenomegaly increase or decrease platelet sequestration

von willebrands disease

what is the most common inherited abnormality affecting platelet function

type 1

is the majority of von willebrands disease type 1, 2, or 3

mucocutaneous bleeding, easy bruising, menorrhagia, GI, and/or gingival bleeding

what are the clinical findings of von willebrands disease

increase

does von willebrands disease cause an increase or decrease in PTT

hemophilia A

factor 8 deficiency =

hemophilia B

factor 9 deficiency =

hemophilia C

factor 11 deficiency =

fibrinogen

fact 1 deficiency affects what

dysfibrinogenemia

defect producing abnormal fibrinogen

fibrin stabiliization

what does factor 13 do

2, 7, 9, and 10

vit K deficiency impairs the production of what factors

vit K deficiency and liver disease

what are the acquired qualitative coagulation disorders

F8-vWF

liver disease causes deficiencies in all factors except what

antithrombin 3

what is the key to preventing clot formation

8 and 5

what factors do protein C act on

2 and 10

what factors do antithrombin 3 act on

protein c and s

what restricts thrombin activity and prothrombin conversion

dependent

is protein c and s deficiency vit k dependent or independent

factor 5 leiden

what is the most common type of inherited thrombophilia

desmopression (DDAVP)

what is the synthetic analogue of ADH and triggers the release of vWF-8

antifibrinolytic drugs

what helps impairs the breakdown of the blood clot

e-aminocaproic acid and tranexamic acid

what are examples of antifibrinolytic drugs

gelfoam

which topical hemostatic materials/options

- provide physcial matrix for clotting

surgicel

which topical hemostatic materials/options

- regenerated cellulose that promotes coagulation

avitene

which topical hemostatic materials/options

- microfibrillar collagen plus

- platelet adherence and activation

bone wax

which topical hemostatic materials/options

- beeswax + salicyclic acid

- plugs pores

thrombin

which topical hemostatic materials/options

- apply to gelfoam for topical application

- can not be used with surgicel

tisseel

which topical hemostatic materials/options

- fibrin glue

- combines thrombin and fibrinogen

- treat raw ooziing surfaces

Antiplatelet drugs

do antifibrinolytic or antiplatelet drugs work better

heparin

what enhances the activity of AT3

warfarin

what is a vit K antagonist

pressure, epinephrine, and topical agents

what are some local measures that can be used to control bleeding

20% hepatic a. and 80% portal v.

what is the blood supply for the liiver

hepatitis

inflammation of the liver =

preicteric phase

these are signs of what phase of hepatitis

- fatigue, nausea, poor appetite, and upper right quadrant pain

icteric phase

these are signs of what phase of hepatitis

- jaundice, dark urine, hepatomegaly, and splenomegaly

fecal-oral

what is the main transmission route for hep A and E

RNA

is hep A and E a DNA or RNA virus

A and B

what hep viruses have a vaccine

DNA

is hep B DNA or RNA

heterosexual encounter

what is the most common transmission for hep B

RNA

is hep C DNA or RNA

chronic carrier state

hep C pts are most likely in what state

< 10 %

what % of hep B pts are in the chronic carrier state

no

is there a vaccine for hep C

no

is there a vaccine for hep D

RNA

is hep D DNA or RNA

fulminant hepatitis

complication associated with acute viral hepatitis that is most common in elderly

cirrhosis

long term irreversible hepatocellular damage

jaundice, icteric sclera, spider telangiectasia, palmar erythema, glossitis, angular cheilosis, ascites, asterixis, hepatic encephalopathy, gynecomastia, candidiasis, petechiae, and parotid enlargement

what are the signs fo liver failure

ascites

fluid within the peritoneal cavity

ascites

what has this physical examiination

- abdomiinal distension, flank dullness, shifting dullness, fluid wave, evidence of pleural effusions

portal HTN

fibrosis and scarring causes increases resistance to hepatic blood flow

alanine aminotransferase (ALT)

what is the aminotransferase that is highly specific to the liver

bilirubin

metabolic byproduct of hemoglobin and myoglobin

alkaline phosphatase

hydrolase enzyme found iin plasma membranes throughout the body

albumin

what is the most abundant plasma protein

ascites, encephalopathy, INR, bilirubin, and albumiin

what is looked at when classify for child-pugh

liver by hepatic microsomal enzymes

amide LAs are metabolized where and by what

blood plasma by pseudocholinesterase

ester LAs are metabolized where and by what

dysepsia

condition of impaired digestion

gastritis

inflammation of stomach lining

Helicobacter pylori

what is the common bacteria causative of gastritis