Chapter 059 Bleeding and Thrombosis (Part 9) ppsx
Chapter 059. Bleeding and Thrombosis (Part 9) ppsx
... medications, and the association between minor defects in aggregation or secretion in these assays and bleeding risk is not clearly established Acknowledgment Robert I. Handin, MD, contributed this chapter ... pregnancy, and medications affect levels of many coagulation factors and their inhibitors. Antithrombin is decreased by heparin and in the setting of acute thrombosis. Protein C and S levels ... been used to assess bleeding risk; however, it has not been found to predict bleeding risk with surgery, and it is not recommended for use for this indication. The PFA-100 and similar instruments...
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Chapter 059. Bleeding and Thrombosis (Part 1) pdf
... Chapter 059. Bleeding and Thrombosis (Part 1) Harrison's Internal Medicine > Chapter 59. Bleeding and Thrombosis Bleeding and Thrombosis: Introduction The ... procoagulant and anticoagulant forces. The procoagulant forces include platelet adhesion and aggregation and fibrin clot formation; anticoagulant forces include the natural inhibitors of coagulation and ... flow; however, it is also prepared to clot blood rapidly to arrest blood flow and prevent exsanguination. After bleeding is successfully halted, the system remodels the damaged vessel to restore...
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Chapter 059. Bleeding and Thrombosis (Part 2) potx
... factor) to factor XIIIa, which covalently cross-links and thereby stabilizes the fibrin clot. Figure 59-2 Chapter 059. Bleeding and Thrombosis (Part 2) Coagulation is initiated by tissue factor ... FIX and FX, which in turn, with FVIII and FV as cofactors, respectively, results in thrombin formation and subsequent conversion of fibrinogen to fibrin. Thrombin activates FXI, FVIII, and ... Fibrin formation and dissolution. A. Fibrinogen is a trinodular structure consisting of 2 D domains and 1 E domain. Thrombin activation results in an ordered...
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Chapter 059. Bleeding and Thrombosis (Part 3) docx
... Chapter 059. Bleeding and Thrombosis (Part 3) Sites of action of the four major physiologic antithrombotic pathways: ... thrombin and the other clotting factors in coagulation. Antithrombin neutralizes thrombin and other activated coagulation factors by forming a complex between the active site of the enzyme and the ... sensitive markers of blood clot formation, and some have been validated for clinical use to exclude the diagnosis of deep venous thrombosis (DVT) and pulmonary embolism in selected populations....
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Chapter 059. Bleeding and Thrombosis (Part 4) potx
... Chapter 059. Bleeding and Thrombosis (Part 4) Approach to the Patient: Bleeding and Thrombosis Clinical Presentation Disorders of hemostasis ... contributed to the bleeding or thrombotic state. In addition, the history can give clues as to the etiology by determining (1) the bleeding (mucosal and/ or joint) or thrombosis (arterial and/ or venous) ... trauma/surgery-induced bleeding? Spontaneous hemarthroses are a hallmark of moderate and severe factors VIII and IX deficiency and, in rare circumstances, of other clotting factor deficiencies. Mucosal bleeding...
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Chapter 059. Bleeding and Thrombosis (Part 5) ppt
... Chapter 059. Bleeding and Thrombosis (Part 5) Epistaxis is a common symptom, particularly in children and in dry climates, and may not reflect an underlying bleeding disorder. ... hereditary hemorrhagic telangiectasia and in boys with vWD. Clues that epistaxis is a symptom of an underlying bleeding disorder include lack of seasonal variation and bleeding that requires medical ... cauterization. Bleeding with eruption of primary teeth is seen in children with more severe bleeding disorders, such as moderate and severe hemophilia. It is uncommon in children with mild bleeding...
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Chapter 059. Bleeding and Thrombosis (Part 6) doc
... factor pathway inhibitor. Chapter 059. Bleeding and Thrombosis (Part 6) Underlying Systemic Diseases that Cause or Exacerbate a Bleeding Tendency Acquired bleeding disorders are commonly ... obesity, and genetic predispositions. Factors that increase risks for venous and both venous and arterial thromboses are shown in Table 59-3. Age Antiphospholipid antibody syndrome Previous thrombosis ... surgery and the patients' underlying medical state, although a count of approximately 80,000/µL is likely sufficient. History of Thrombosis The risk of thrombosis, like that of bleeding, ...
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Chapter 059. Bleeding and Thrombosis (Part 7) pptx
... to the threshold for thrombosis and result in deep venous thrombosis (DVT). Note: The magnitude and duration of risk portrayed in the figure is meant for example only and may not precisely ... Venous thrombosis: A multicausal disease. Lancet 353:1167, 1999.] Laboratory Evaluation Careful history taking and clinical examination are essential components in the assessment of bleeding and ... provides a global assessment of hemostasis. The bleeding time has been used to assess bleeding risk; however, it does not predict bleeding risk with surgery and is not recommended for this indication....
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Chapter 059. Bleeding and Thrombosis (Part 8) pptx
... abnormalities is shown in Table 59-4. Chapter 059. Bleeding and Thrombosis (Part 8) Screening Assays The most commonly used screening tests are the PT, aPTT, and platelet count. The PT assesses ... reagents to clotting factor deficiencies and to inhibitors such as heparin and lupus anticoagulants. Thus, aPTT results will vary from one laboratory to another, and the normal range in the laboratory ... overestimate the bleeding risk of a mildly elevated INR in this setting. The aPTT assesses the intrinsic and common coagulation pathways, factors XI, IX, VIII, X, V, II, fibrinogen, and also prekallikrein,...
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Chapter 039. Nausea, Vomiting, and Indigestion (Part 9) ppsx
... Further Readings Chapter 039. Nausea, Vomiting, and Indigestion (Part 9) Helicobacter pylori Eradication H. pylori eradication is clearly indicated only for peptic ulcer and mucosa-associated ... implantation, and gastroplication, have been investigated in patients with refractory GERD with variable results and some adverse consequences. Some patients with functional heartburn and functional ... to proton pump inhibitors, and those who have esophageal motor disturbances. Fundoplications are performed laparoscopically when possible and include the Nissen and Toupet procedures in which...
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