Sandbox Ochuko: Difference between revisions

Revision as of 18:52, 29 April 2015

Rudolf Virchow noted several factors affecting the clot formation, which are as follows:

1) Alterations in blood flow (stasis): Blood flows throughout the circulatory system, without significantly stopping or slowing any where. In certain pathological conditions where the blood flow slows down or stops, it causes:

Increase in platelet to endothelium contact
Decrease the dilution of clotting factors

This increases the risk of clot formation and form microthrombi, which further grow and propagate.

2) Injury to the vascular endothelium: Intrinsic or secondary to external trauma (eg, catheterization) can cause intimal damage and stimulates clot formation. See Coagulation.

3) Alterations in the constitution of blood (hypercoagulability): It is the propensity to develop thrombosis due to an abnormality in the system of coagulation.

These three conditions are collectively known as Virchow's triad and lead to intravascular coagulation, forming a mass of red blood cells, leukocytes, and fibrin.

This video explains the process of thrombosis:

Ventricular Tachycardia

Common causes of ventricular tachycardia include ischemic heart disease, illicit drugs (cocaine and methamphetamine), structural heart disease (including congenital heart diseases such as tetralogy of Fallot), inherited channelopathies, drug toxicity (digoxin, drugs that prolong the QT interval) and electrolyte disturbances (such as hypokalemia, hypomagnesemia, and hypocalcemia).

Table 1. Common Bacterial Pathogens in Neutropenic Patients
Gram-Positive Pathogens
Coagulase-negative staphylococci Staphylococcus aureus, including methicillin-resistant strains Enterococcus species, including vancomycin-resistant strains Viridans group streptococci Streptococcus pneumoniae Streptococcus pyogenes
Gram-Negative Pathogens
Escherichia coli Klebsiella species Enterobacter species Pseudomonas aeruginosa Citrobacter species Acinetobacter species Stenotrophomonas maltophilia

Bloodstream infections caused by endogenous flora and reactivation of latent infections account for a majority of initial febrile episode in neutropenic patients with cancer. Common bacterial isolates that cause bacteremia in the setting of neutropenia are listed in Table 1.^[1] Certain endogenous microorganisms may be reactivated and exit latency during immunosuppression. These include herpes simplex virus, varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, hepatitis B and C viruses, and Mycobacterium tuberculosis. Exogenous pathogens carried by contaminated blood products, medical equipment and devices, water sources, and health care workers represent less common sources of infection. These include Clostridium difficile, respiratory syncytial virus, vancomycin-resistant enterococci, and other multidrug resistant bacteria.^[2]

Fungal infections often take place in the setting of prolonged or profound neutropenia after administration of empirical therapy. Candidiasis may range in severity from mucosal or cutaneous infection to septicemia, endocarditis, or disseminated infection. Aspergillus, on the contrary, typically causes life-threatening infection of the sinuses and lungs, particularly after protracted neutropenia.^[3]

@@ Line 1: / Line 1: @@
 __NOTOC__
+[[Rudolf Virchow]] noted several factors affecting the clot formation, which are as follows:
+) Alterations in blood flow ([[stasis]]): Blood flows throughout the circulatory system, without significantly stopping or slowing any where. In certain pathological conditions where the blood flow slows down or stops, it causes:
+* Increase in platelet to endothelium contact
+* Decrease the dilution of clotting factors
+This increases the risk of clot formation and form microthrombi, which further grow and propagate.
+) Injury to the vascular endothelium: Intrinsic or secondary to external trauma (eg, catheterization) can cause [[Tunica intima|intimal]] damage and stimulates clot formation. See [[Coagulation]].
+) Alterations in the constitution of blood ([[hypercoagulability]]): It is the propensity to develop thrombosis due to an abnormality in the system of coagulation.
+These three conditions are collectively known as [[Virchow's triad]] and lead to intravascular [[coagulation]], forming a mass of [[red blood cell]]s, [[leukocyte]]s, and [[fibrin]].
+'''This video explains the process of thrombosis:'''
+{{#ev:youtube|X_POCRsy7i4}}

Cardiovascular	No underlying causes
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Acetaminophen and Oxycodone, Aclarubicin, Albendazole, Alemtuzumab, Alkylating antineoplastic agent, Alkylators, Arsenicals, Auranofin, Azathioprine, Aztreonam, Boceprevir, Busulphan, carbamazepine, Carboplatin, Cefadroxil, Ceftazidime, Certolizumab pegol, Chlorpromazine, Chloramphenicol, Chlorpropamide, Cidofovir, Clomipramine, Colchicine toxicity, Cytotoxic drugs and radiation, Dactinomycin, Doxorubicin, Ethosuximide, Febuxostat, Flucytosine, Gold, Gemifloxacin mesylate, Idarubicin, indomethacin , Interferon beta- 1a, Lincomycin Hydrochloride Minocycline hydrochloride, Non steroidal anti-inflammatory drugs, Ofatumumab, Omacetaxine, Oxaprozin, Oxcarbazepine, Penicillamine, phenacemide , Phenylbutazone, Piperacillin, Pralatrexate, propylthiouracil , Pyrimethamine, Rabeprazole, Radium chloride, sulfonamides, Tamoxifen, Tolbutamide, Tolazamide, Trifluoperazine, Trimethadione, Thiothixene, Valganciclovir hydrochloride
Ear Nose Throat	No underlying causes
Endocrine	Thyroid carcinoma
Environmental	Tobacco use, Environmental/occupational (eg, benzene)
Gastroenterologic	Portal hypertension, Intestinal lymphangiectasia, Hepatitis
Genetic	Ataxia telangiectasia, Barth syndrome, Chediak-Higashi disease, defect in synthesis of adenosylcobalamin, DNA repair deficiencies, Down syndrome, Dubowitz syndrome, familial monosomy 7, Fanconi anaemia, genotoxic therapy, glutathione synthase deficiency, glycogen storage diseases, mutagen exposure, mutagen-detoxification (GSTq1-null), neurofibromatosis 1, Niemann-Pick disease, Nijmege breakage syndrome, Noonan syndrome, organic acid metabolism defect, Pearson syndrome, Seckel syndrome, Severe combined immunodeficiency, T- B+ due to JAK3 deficiency, trisomy 8 mosaicism, Wiskott-Aldrich syndrome
Hematologic	Sickle cell disease, Reticular dysgenesis, Paroxysmal nocturnal haemoglobinuria, Non-Hodgkin lymphoma, Myelpathic anemia, Myeloma, Myelofibrosis, Myelodysplastic syndrome, Megaloblastic anaemia, Malignant histiocytosis, Leucoerythroblastic anaemia, Large granular lymphocytic leukemia, Langerhans cell histiocytosis, Ineffective erythropoiesis, Hypoplastic myelodysplastic syndromes , Hypersplenism, Hodgkin lymphoma, Histiocytosis X, Hepatosplenic T-cell lymphoma, Hemoglobin H disease, Hematopoietic cell transplantation, Hairy cell leukaemia, Haemoglobin SC disease, Haemoglobin E disease, Graft versus host disease, Familial myelofibrosis, Familial histiocytic reticulosis, Eosinophilic fasciitis , Cyclical neutropenia, Congenital neutropenia (Kostmann's or Shwachman-Diamond syndrome), Common variable hypogammaglobulinaemia, Chronic myeloid leukaemia, Chronic lymphocytic leukaemia, Bleeding (Excessive), Autoimmune lymphoproliferative syndrome type 2, Autoimmune lymphoproliferative syndrome type 1, Aplastic anemia, Amegakaryocytic thrombocytopenia, Aggressive NK-cell leukemia, Acute lymphoblastic leukemia
Iatrogenic	No underlying causes
Infectious Disease	Q fever, Parvovirus B19 infection, Oklahoma tick fever, Mycobacterium tuberculosis, Legionella pneumophila, Lassa fever, Human immunodeficiency virus , Epstein-Barr virus Seronegative, Dengue, Brucellosis
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	No underlying causes
Nutritional/Metabolic	Vitamin C deficiency, Vitamin B12 deficiency, Marasmus, Malabsorption syndrome, Kwashiorkor, Iron deficiency, Intrinsic factor deficiency, Folate deficiency, Copper deficiency
Obstetric/Gynecologic	Pregnancy
Oncologic	Thymoma , Prostate cancer, Metastatic neoplasm, Melanoma, Germ cell tumors (embryonal dysgenesis), Ewing sarcoma, Chondrosarcoma, Cancer treatment
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	Anorexia nervosa
Pulmonary	No underlying causes
Renal/Electrolyte	Renal failure, chronic
Rheumatology/Immunology/Allergy	Systemic lupus erythematosus, Rheumatoid disease, Osteopetrosis autosomal recessive 2, Osteopetrosis lethal Osteoclastoma, Ankylosing spondylitis
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	Topoisomerase II interactive agents, Plummer-Vinson syndrome, Obesity, Idiopathic , Glue vapors, Dyskeratosis congenita Shwachman-Diamond syndrome, Diamond-Blackfan anemia, Castleman disease, Bloom's syndrome

Cardiovascular	Aortic aneurysm rupture, aortic arch syndrome, aortic isthmus stenosis, aortic regurgitation, aortic stenosis, aortocaval compression syndrome, atrial myxoma, atrioventricular node conduction block, B type natriuretic peptide, baroceptor dysfunction in the elderly, capillary leak syndrome, cardiac tamponade, cardiogenic shock, carotid sinus hypersensitivity, carotid sinus syndrome, coarctation of aorta, complete heart block, constrictive pericarditis, cor triatriatum, dehydration, dissecting aortic aneurysm, distributive shock, Eisenmenger's syndrome, embolism, endotoxic shock, gray baby syndrome, heart arrhythmia, heart block, heart failure, heart injury, hemorrhagic shock, hemorrhagic shock and encephalopathy syndrome, hypertrophic obstructive cardiomyopathy, hypovolemic shock, idiopathic hypotension, iliac artery aneurysm rupture, internal bleeding, ischaemic heart disease, myocardial infarction, myocardial ischemia, obstructive shock, orthostatic hypotension, pericardial effusion, pericarditis, perimyocarditis, post-tussive syncope, postural hypotension, pulmonary embolism, shock, sick sinus syndrome, supraventricular tachycardia , syncope, tetralogy of Fallot, traumatic shock, tricuspid stenosis, vasovagal syncope, ventricular fibrillation, WPW syndrome
Chemical / poisoning	Acetaldehyde, adiponitrile , copper, cyanides, demeton-S-methyl, diazinon , dioxathion, disulfoton , ethion , fensulfothion, fenthion, honey bee bite, indian tobacco, malathion, methidathion, methiocarb, methomyl, mushroom poisoning , parathion, phosdrin, poison hemlock, profenofos, scorpion bite, sodium nitrite, terbufos, tetraethyl pyrophosphate , tetrodotoxin, tobacco , wasp bite
Dermatologic	Gray baby syndrome, mastocytosis
Drug Side Effect	Acetophenazine, alcuronium, alfuzosin, aliskiren, alseroxylon, ambenonium, ambrisentan, amifostine, aminoglutethimide, amitriptyline, amlodipine, amoxapine, amphotericin B, amrinone, amyl nitrate, antipsychotic agents, apomorphine, azilsartan medoxomil, B type natriuretic peptide, baclofen, beta blockers, bethanechol, bethanidine, bortezomib, bosentan, bretylium, bromocriptine, bupivacaine, cabergoline, calcium channel blockers, candesartan, captopril, chloroquine, chlorpheniramine, chlorpromazine, chlorthalidone, cilazapril, cinacalcet, cinnarizine, clevidipine, clomipramine, clonidine, colchicine, cyclobenzaprine, deserpidine, desferrioxamine, desipramine, dexmedetomidine, diazoxide, dichlorvos , dicobalt edetate, dicrotophos , diltiazem, diphenhydramine, dipyridamole, disopyramide, distigmine, diuretics, donepezil , dothiepin, doxazosin, doxepin, enalapril, epidural anaesthesia, eplerenone, epoprostenol, etoposide, felodipine , fenoldopam, fentanyl, fosinopril, general anaesthesia, glyceryl trinitrate, granulocyte-macrophage colony stimulating factor, gray baby syndrome, guanadrel, guanethidine, guanfacine, haloperidol, hexamethonium, hydralazine, hydroxyzine, imipramine, indapamide, indoramin, interleukin 2, iodine containing radiocontrast media, irbesartan, isosorbide dinitrate, isosorbide mononitrate, isoxsuprine, isradipine, ketanserin, labetalol, l-dopa, levomepromazine, levosimendan, lidocaine , lisinopril, lithium, lofexidine, losartan, mecamylamine, methyldopa, metirosine, metolazone, minoxidil, morphine, moxonidine, nefazodone, neostigmine, niacin, nicorandil, nifedipine, nimodipine, nitroprusside, nortriptyline, olanzapine, olmesartan, omapatrilat, opioid poisoning, paliperidone, pentamidine, perazine, pergolide, phenothiazines, phenoxybenzamine, phentolamine, pimobendan, pinacidil, pipothiazine, piribedil, pramipexole, prazosin, protamine sulfate, protriptyline, quetiapine, ramipril, rasagiline, reboxetine, reserpine, rilmenidine, risperidone, rituximab, ropinirole, rotigotine, sassafras oil, serotonin syndrome, sildenafil, silodosin, sodium nitroprusside, spironolactone, streptokinase, sulphonamides, tacrine, tadalafil, tamsulosin, terazosin, tetrabenazine, tizanidine, tolazoline, tramadol, treprostinil, trifluperidol, trimethaphan, trimipramine, tubocurarine, urapidil, valerian, valsartan, vardenafil, verapamil, ziconotide, zotepine
Ear Nose Throat	No underlying causes
Endocrine	Achalasia-addisonianism-alacrima syndrome, ACTH deficiency, Addison's disease, addisonian crisis, adrenal hemorrhage, adrenogenital syndrome, adrenoleukodystrophy , Allgrove syndrome, APECED syndrome , B type natriuretic peptide, carcinoid syndrome , congenital adrenal hyperplasia, diabetes insipidus, diabetic autonomic neuropathy, diabetic ketoacidosis, hyperosmolar hyperglycemic nonketotic coma, hypoaldosteronism, hyporeninemic hypoaldosteronism, hypothyroidism, Myxedema, myxedema coma, panhypopituitarism, pituitary insufficiency, pseudohypoaldosteronism, Renon-Delille syndrome, serotonin syndrome, triple-A syndrome
Environmental	Snake bite, zero gravity
Gastroenterologic	Achalasia-addisonianism-alacrima syndrome, acute liver failure , acute pancreatitis, acute viral gastroenteritis, Allgrove syndrome, bowel strangulation, deglutition syncope, diarrhea, duodenal ulcer bleeding, gastric ulcer bleeding, gastric volvulus, hepatic vein thrombosis, hepatitis, intususception, mastocytosis , necrotizing enterocolitis, paralytic ileus, peritonitis , postprandial hypotension, retroperitoneal haemorrhage, small bowel obstruction, splenic rupture, superior mesenteric artery occlusion, triple A syndrome, tropical sprue , variceal bleeding, vomiting
Genetic	Achalasia-addisonianism-alacrima syndrome, acute intermittent porphyria, Allgrove syndrome, APECED syndrome, Bartter syndrome, corticosteroid-binding globulin deficiency , familial juvenile hyperuricemic nephropathy type 2, hereditary peripheral nervous disorder, hereditary sensory and autonomic neuropathy type 3, pseudohypoaldosteronism, Renon-Delille syndrome, Riley-Day syndrome, triple A syndrome, Wohlwill-Andrade syndrome
Hematologic	Acute intermittent porphyria, anemia
Iatrogenic	After a major surgery, blood transfusion , dialyzer hypersensitivity syndrome, epidural anesthesia, gastric acid stimulation test using histamines, general anesthesia, mechanical ventilation, post-operative, renal dialysis, transfusion reaction
Infectious Disease	Acute viral gastroenteritis, botulism, cholera, dengue hemorrhagic fever, hantavirus, lassa fever, rocky mountain spotted fever , septic shock, septicemia , toxic shock syndrome, vibrio vulnificus, Waterhouse-Friederichsen syndrome, Weil syndrome
Musculoskeletal / Ortho	Cervical spine injury, fracture of bone, vertebral fracture
Neurologic	Autonomic failure, autonomic neuropathy, Binswanger's disease , Bradbury-Eggleston syndrome, diabetic autonomic neuropathy, DOPA decarboxylase deficiency, dopamine beta hydroxylase deficiency, dysautonomia, glossopharyngeal neuralgia, Guillain-Barre syndrome, hemorrhagic shock and encephalopathy syndrome, hereditary peripheral nervous disorder, hereditary sensory and autonomic neuropathy type 3, multiple system atrophy, neurogenic shock, Parkinson's disease, polyradiculitis, Riley-Day syndrome, seizures, Shy-Drager syndrome, syringomyelia, tabes dorsalis, vasovagal syncope, Wohlwill-Andrade syndrome
Nutritional / Metabolic	Dehydration,excessive dieting,kwashiorkor
Obstetric/Gynecologic	Aortocaval compression syndrome, ectopic pregnancy rupture, ovarian hyperstimulation syndrome, postpartum haemorrhage, pregnancy, puerpural shock, septic abortion , uterine rupture
Oncologic	Atrial myxoma, carcinoid syndrome , mastocytosis , pheochromocytoma, serotonin-secreting tumor
Opthalmologic	No underlying causes
Overdose / Toxicity	Acetophenazine, alcuronium, alfuzosin, aliskiren, alseroxylon, ambenonium, ambrisentan, amifostine, aminoglutethimide, amitriptyline, amlodipine, amoxapine, amphotericin B, amrinone, antipsychotic agents, apomorphine, azilsartan medoxomil, baclofen, beta blockers, bethanechol, bethanidine, bortezomib, bosentan, bretylium, bromocriptine, bupivacaine, cabergoline, calcium channel blockers, candesartan, captopril, chloroquine, chlorpheniramine, chlorpromazine, chlorthalidone, cilazapril, cinnarizine, clevidipine, clomipramine, clonidine, colchicine, cyclobenzaprine, deserpidine, desferrioxamine, desipramine, dexmedetomidine, diazoxide, dichlorvos , dicobalt edetate, dicrotophos , diltiazem, diphenhydramine, dipyridamole, disopyramide, distigmine, diuretics, donepezil , dothiepin, doxazosin, doxepin, enalapril, epidural anaesthesia, eplerenone, epoprostenol, etoposide, felodipine , fenoldopam, fentanyl, fosinopril, general anaesthesia, glyceryl trinitrate, granulocyte-macrophage colony stimulating factor, guanadrel, guanethidine, guanfacine, haloperidol, hexamethonium, hydralazine, hydroxyzine, imipramine, indapamide, indoramin, interleukin 2, irbesartan, isosorbide dinitrate, isosorbide mononitrate, isoxsuprine, isradipine, ketanserin, labetalol, l-dopa, levomepromazine, levosimendan, lidocaine , lisinopril, lithium, lofexidine, losartan, magnesium overdose, mecamylamine, methyldopa, metirosine, metolazone, minoxidil, morphine, moxonidine, nefazodone, neostigmine, niacin, nicorandil, nifedipine, nimodipine, nitroprusside, nortriptyline, olanzapine, , olmesartan, omapatrilat, opioid poisoning, paliperidone, pentamidine, perazine, pergolide, phenothiazines, phenoxybenzamine, phentolamine, pimobendan, pinacidil, pipothiazine, piribedil, pramipexole, prazosin, protamine sulfate, protriptyline, quetiapine, ramipril, rasagiline, reboxetine, reserpine, rilmenidine, risperidone, rituximab, ropinirole, rotigotine, sassafras oil, sildenafil, silodosin, sodium nitroprusside, spironolactone, streptokinase, sulphonamides, tacrine, tadalafil, tamsulosin, terazosin, tetrabenazine, tizanidine, tolazoline, tramadol, treprostinil, trifluperidol, trimethaphan, trimipramine, tubocurarine, urapidil, valerian, valsartan, vardenafil, verapamil, ziconotide, zotepine
Psychiatric	Anorexia nervosa, depression
Pulmonary	Post-tussive syncope, pulmonary edema, pulmonary embolism, tension pneumothorax
Renal / Electrolyte	Bartter syndrome, dehydration, familial juvenile hyperuricemic nephropathy type 2, hypermagnesaemia, hypokalemia, hyponatremia
Rheum / Immune / Allergy	Amyloidosis, anaphylactic shock, anaphylactoid reaction, blood transfusion , dialyzer hypersensitivity syndrome, food additive allergy, Guillain-Barre syndrome, honey bee bite, mastocytosis, scorpion bite, transfusion reaction, urticaria, wasp bite, Wohlwill-Andrade syndrome, x-ray studies using contrast media
Sexual	Renon-Delille syndrome
Trauma	Blood vessel trauma, burns, cervical spine injury, chemical burn, fracture of bone, heart injury, pericardial effusion, shaken baby syndrome, tension pneumothorax, traumatic shock
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Alcohol, alcohol withdrawal syndrome, decompression sickness, deglutition syncope, dehydration, fatigue, heat exhaustion, hypothermia, insufficient fluid intake, low salt diet, micturition syncope, prolonged bed rest, snake bite, syncope, volume depletion , zero gravity

Sandbox Ochuko: Difference between revisions

Revision as of 18:52, 29 April 2015

Ventricular Tachycardia

Causes by Organ System

Causes in Alphabetical Order

Causes of Hypotension

Causes

Life Threatening Causes

Common Causes

Causes by Organ System

Causes in Alphabetical Order

References

Overview

Causes

Life Threatening Causes

Common Causes

Diagnosis

Focused Initial Rapid Evaluation

Complete Evaluation

Treatment

Do's

Don'ts

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