Thrombosis - is a vascular disease caused by rapid and excessive blood clotting associated with impaired blood flow in the lumen of the vessel and, as a consequence, trophic disorders of soft tissue and internal organs.
Favourite localization of thrombosis are deep vein trunk upper and lower extremities, which accounted for about 70% of all cases, however, the occurrence of possible blood clot in any arterial or venous vessels both large and small caliber.
most threatening to the quality of life and health of the patient is considered to be deep vein thrombosis of the femoropopliteal segment of the lower limb, as it is this localization in most cases, is the source of floating thrombi that can appeal pulmonary embolism, often having fatal.
Thrombosis both venous and arterial vessels is caused by a combination of three main pathogenetic reasons: violation of the integrity of the vascular wall (the action of infectious toxins or direct mechanical damage), i
addition of specific etiological causes of thrombosis, there are common risk factors, the totality of which increases the possibility of occurrence of thrombosis in a particular person.These factors include older age, delivery was by Caesarean section, the operational benefits in the field of trauma endured abdominal surgery followed by a long period of rehabilitation, long-term use of medications that affect blood clotting processes, smoking, overweight.
thrombosis occurs not only among older people with health problems, but also in young people who are forced to spend large amounts of time in the "sitting" and prefer to inactive lifestyles.
Patients who had undergone a serious operation, as well as those who are forced for a long time to comply with bed rest likely to develop venous thrombosis, as for an adequate return blood flow to the heart lack of muscle contraction in the lower extremities, in this connection, the conditions are created to slow blood flow.
Among the causes of thrombosis of the upper extremities in the first place is prolonged catheterisation of large vessels of the upper body as well as the establishment of the implants (pacemakers, kardiofibrillyator).
Among the female half of humanity thrombosis largely affects persons receiving long-term hormonal contraception, as well as women in travail in the early postpartum period.
serious infectious diseases accompanied by intoxication of the body a long, often complicated by the emergence of symptoms of thrombosis due to the damaging effect of toxins on the vascular wall.
artery thrombosis is not only their clinical features, but differs in its defiant etiological factors.First instigator of arterial thrombosis is atherosclerotic vascular lesions, not only accompanied by the formation of plaques in the intima of the vessel, but also a dense clot, 90% consists of connective tissue.
Another common localization is the heart of thrombosis.In the cavities of the heart may occur as a result of thrombus formation of a vortex blood flow that occurs in acute ischemic myocardial injury, congenital and acquired heart defects with regurgitation, the implantation of artificial heart valves, myocarditis infectious and toxic origin.
Usually thrombosis in pure form practically does not meet, and in most cases occurs on the background of other diseases associated with vascular lesions of arterial and venous (diabetes, arterial occlusive disease, rheumatism).
thrombosis Symptoms depend on the localization process, the degree of obstruction of vascular lumen, and has its own characteristics as venous and arterial thrombosis type.
Symptoms of venous thrombosis in the deep veins of the lower extremities of the main (iliac, femoral, popliteal Vienna) are increasing swelling, pastoznost soft tissue on the affected side, crawling, aching drawing pain in the course of vascular bundle, trophic changes of the soft tissues.
hepatic portal vein thrombosis is accompanied by symptom, indicating the development of portal hypertension (functional dyspepsia, splenomegaly, accumulation of ascites, gastrointestinal bleeding).
to thrombosis in the renal vein is characterized by one-sided aching pain in the lumbar region, nephritic syndrome and hematuria.The typical renal colic in this situation is not observed.
Thrombosis of the jugular vein is a common pathology among patients suffering from drug addiction and malignant tumors, and is characterized by the development of septic complications, as well as swelling of the optic nerve.
arterial thrombosis often localized in the brain and heart and cause diseases such as ischemic stroke and acute coronary syndrome.Manifestations of ischemic stroke, caused by the imposition of thrombotic masses in the atherosclerotic lesions intima vascular circle of Willis are: headache, varying degrees of impairment of consciousness, disturbance of sensitivity and motor activity in one half of the body.For acute coronary syndrome is characterized by the appearance of typical anginal pain, marked pallor of the skin, impaired consciousness, failure of the heart, shortness of breath and sometimes pain in the upper abdomen.
Acute thrombosis is an emergency condition and is most often localized in a pool of blood vessels.Acute thrombosis of the legs occurs when the obstruction of the iliac, femoral and popliteal arteries and is characterized by the following symptoms:
- caused acute pain in the affected lower limb;
- violation of all kinds of sensitivity (pain, tactile, temperature) and the appearance of paresthesias;
- severe cold snap and pale skin;
- the impossibility of palpating pulsation of the vascular bundle below the thrombosis;
- acute transient violation of motor activity of the affected limb (paresis, paralysis);
- strengthening of pain on palpation of the soft tissues;
- development of muscle contracture, which is a sign of the onset of irreversible changes in the soft tissues.
There is a generally accepted international classification of arterial thrombosis, which is allocated according to three degrees of severity.At the first level there are no clinical manifestations.The second stage is characterized by acute symptoms of the appearance of all of the above, except for muscle contraction and subfascial edema.The third degree is irreversible and in most cases is accompanied by limb amputation.
To confirm the diagnosis of acute thrombosis and the establishment of the localization of a blood clot in the lumen patient must hold a Doppler ultrasound scan of the lower limbs, and in the absence of contraindications - angiography.
clear definition of thrombus localization allows for effective minimally invasive surgical treatment methods, among which the most widely used: percutaneous transluminal endovascular thrombolysis and aspiration thrombectomy.The first method involves the local administration in thrombotic mass fibrinolytic agents (urokinase dose of 100 000 IU).In the second technique is made not dissolve the thrombus and its removal by means of a balloon catheter.
Postoperatively mandatory component of therapy is the appointment of anticoagulant therapy in the maintenance dose and lifelong reception of antiplatelet (aspirin daily dose of 100 mg).
intestine supplied with blood vessels of the mesentery, and, as we know, in any vessel of the human body can cause thrombosis.With the defeat of the mesenteric vessels of the mesentery, a so-called "mesenteric thrombosis."Due to the fact that the localization of thrombosis in 90% of cases observed in the segment of superior mesenteric artery, affected all departments of the small intestine and the large intestine to the hepatic flexure with severe clinical symptoms and the rapid onset of necrosis of the intestinal wall.
pathogenetic mechanisms of mesenteric thrombosis are similar to myocardial infarction with the only difference that the intestinal thrombosis has no specific clinical symptoms and is often diagnosed only at the terminal stage, when the risk of death is very high.Risk for the disease are persons of advanced age, regardless of gender, have chronic diseases of vascular origin:
- atherosclerotic disease (atherosclerotic plaques affected vessels are the source for layering thrombotic masses);
- hypertension (provoking the destruction of atherosclerotic plaques in the impact of high blood pressure);
- surgery on the abdominal organs (the formation of thrombotic masses in the vessels as a compensatory reaction for bleeding).
In most cases, the root cause of thrombosis bowel any localization is atherosclerotic lesion vascular intima.The initial symptoms of thrombosis due to local circulatory disturbance of the intestine due to the occlusion of vascular lumen.Due to the long trophic disorders in the intestinal wall destructive changes occur up to the perforation of the intestinal wall and peritonitis.
distinctive characteristic symptom of mesenteric arterial thrombosis is the presence of so-called prodromal period, lasting about a month.The symptoms of prodromal period include: periodic aching abdominal pain, flatulence, nausea and vomiting, which has a clear dependence of the meal, loose stools.Some people say not rapid but progressive weight loss.The appearance of the above symptoms caused by narrowing of the arteries due to the imposition of the intima of atherosclerotic masses.Venous thrombosis is characterized by a rapid course, and the clinical picture develops over several days.The initial manifestations of venous thrombosis of the intestine is to increase the body temperature to subfebrile, discomfort during bowel without some of the pain.
fundamental symptom that always accompanies mesenteric venous thrombosis is a strong pain in the maximum coronary disease stage (the first 6-12 hours), do not respond, even taking narcotic analgesics.For ease pain patients take a forced situation in the "fetal position".Small relief comes only when using antispasmodic drugs in injectable form (Riabal 2 mL intramuscularly).Pain syndrome in 80-90% of cases, followed by disorders of stool (diarrhea with blood in the stool).
An objective examination of the patient a marked pallor, compensatory hypertension, slowing heart rate.Palpation of the abdomen causes pain and resistance on the part of the anterior abdominal wall.Laboratory indicators of blood in the coronary stage thrombosis is moderately expressed leukocytosis.
after 12 hours of onset of heart attack comes a stage, the maximum duration of which is about 24 hours.In this period of pain is reduced and the fore signs of intoxication (increased heart rate, pain localization in accordance with which of the intestine underwent necrosis, increase of leukocytes in the blood).
Within 36 hours of the first symptoms of thrombosis develops clinical peritonitis, which is characterized by a significant deterioration of the patient due to severe intoxication and electrolyte disturbances.Pain in the abdominal cavity do not have a clear localization and aggravated by the slightest movement.An objective examination of the patient is determined by the great dryness, decreased skin turgor and mucous membranes, a sharp drop in blood pressure up to the development of hypotensive shock, decreased heart rate.Laboratory indicators of peritonitis is marked leukocytosis.
to establish a definite diagnosis "mesenteric thrombosis" to determine the localization of the pathological process, the patient is recommended to perform angiography of mesenteric vessels, which will be revealed in the absence of contrast filling thrombosed lumen.When available patient contraindications to the use of angiography (idiosyncrasy contrast agent) to a patient it is advisable to perform diagnostic laparoscopy (endoscopic examination of the intestinal walls, as well as the presence of pulsation in the mesenteric vessels) or laparotomy (change research areas of the intestine and their subsequent resection).
main focus of treatment of mesenteric thrombosis is the use of surgical technique, since the disease has a rapid and severe complications for.Drug therapy is used only as a symptomatic treatment to relieve the patient's condition and prepare for operations.
duration of arterial thrombosis is less than two days and in the absence of adequate therapy are fatal, caused by intoxication shock.Venous thrombosis usually has a long duration with high mortality even in the postoperative period.In this regard, mesenteric thrombosis belongs to the category of diseases with an unfavorable prognosis for the patient's life.
Thrombosis hemorrhoids should be assessed as a complication of hemorrhoids due to a sharp spasm rectal sphincter associated with impaired blood supply to the hemorrhoid.When prolonged ischemia is an increase of edema site followed by necrosis.Most often develops outer thrombosis, in which ischemic changes were observed in the external hemorrhoids.
no significant etiological causes 100% of provoking thrombosis of hemorrhoids does not exist, but there are predisposing factors to the disease - birth, anal sex, work involving heavy physical labor, alcoholism.
thrombosis haemorrhoid is characterized by acute debut and the rapid development of clinical symptoms.The main complaint that the patient presents at this thrombosis is a severe pain, clearly associated with straining and having no connection with the act of defecation.Patients describe the pain as a "feeling of having a foreign body in the rectum."
An objective examination of the patient's attention is drawn to the change in color from pink to nodes purple-blue, swollen perianal skin and the inability to reposition nodes.
This pathology requires urgent diagnosis and immediate treatment, since it is possible the rapid development of necrosis with the development of abscess.Diagnosis In most cases it is easy and accessible even for the initial examination of the patient.