Clotting Question

[grandslam521]

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Why doesn't blood clot in the penis during erection? Since most of the blood remains in the penis during the erection, I would think the stasis would promote coagulation quite a bit.

 

[Depakote]

A normal erection is usually sort term enough to avoid any sort of significant coagulation.

However priapisim (prolonged erection) is a serious medical concern b/c stasis does lead to clotting and can cause damage to the erectile tissue.

 

[bambi]

An erection is caused by increased blood FLOW, the blood doesn't go there and just sit around.

 

[Depakote]

An erection is caused by increased blood FLOW, the blood doesn't go there and just sit around.

uhhh.

 

[Sol Rosenberg]

Why doesn't blood clot in the penis during erection? Since most of the blood remains in the penis during the erection, I would think the stasis would promote coagulation quite a bit.

Why would it coagulate? There is no release of either Factor XII or tissue factor (Factor III) unless there is an injury to the penis (ouch!)

 

[SomeDoc]

An erection is caused by increased blood FLOW, the blood doesn't go there and just sit around.

👍

 

[SomeDoc]

A normal erection is usually sort term enough to avoid any sort of significant coagulation.

However priapisim (prolonged erection) is a serious medical concern b/c stasis does lead to clotting and can cause damage to the erectile tissue.

Side effect of trazodone. May show up on step I.

 

[SomeDoc]

An erection is caused by increased blood FLOW, the blood doesn't go there and just sit around.

This is how drugs like Viagra work (the "fils").

Phosphodiesterase inhibitors=inhibit cGMP breakdown=>more cGMP=>vascular relaxation=> increased blood flow.

 

[grandslam521]

An erection is caused by increased blood FLOW, the blood doesn't go there and just sit around.

The veins may not be completely occluded, but the venous drainage is at a minimum. Not sure exactly how much drainage occurs, but it can't be much.

 

[thechad]

Read the first few pages of chapter 4 in Robbins. The endothilial cells prevent coagulation (I don't remember the specifics, something about heparin-like molecule and something else).

EDIT: I think it's ch. 4 at least, the one about hemodynamics and thrombosis.

 

[SpookyDoc]

Why doesn't blood clot in the penis during erection? Since most of the blood remains in the penis during the erection, I would think the stasis would promote coagulation quite a bit.

oshi--- stop having sex IMMEDIATELY. EVERYBODY.

 

[Sol Rosenberg]

Read the first few pages of chapter 4 in Robbins. The endothilial cells prevent coagulation (I don't remember the specifics, something about heparin-like molecule and something else).

EDIT: I think it's ch. 4 at least, the one about hemodynamics and thrombosis.

Yeah, the endothelial cells secrete AT3 (antithrombin 3) which binds to thrombin in the presence of heparin and inactivates the thrombin. This is why our blood doesn't spontaneously clot.

 

[Depakote]

when you have stasis, you:

-disrupt laminar flow causing platelets to contact the endothelium
-prevent dilution of activated clotting factors by blood flow
-****** inflow of clotting factor inhibitors, allowing thrombi to build up
-promote endothelial cell activation predisposing to local thrombosis, leukocyte adhesion

(also chapter 4 of Robbins)

 

[TMP-SMX]

NO is a vasodilator and prevents platelet aggregation.

 

[nogolfinsnow]

I hope I remember this thread in a couple years. Wouldn't it be great as a resident to ask 3rd year students where the clot arose in your patient who just had a PE, and when they all say DVT from the legs, you say "well no, actually, this guy has a really big wanger, and during a monstrous romp with his wife he clotted, then threw the clot, and now he's here."

 

[Droopy Snoopy]

I hope I remember this thread in a couple years. Wouldn't it be great as a resident to ask 3rd year students where the clot arose in your patient who just had a PE, and when they all say DVT from the legs, you say "well no, actually, this guy has a really big wanger, and during a monstrous romp with his wife he clotted, then threw the clot, and now he's here."

That's how I want to go.

 

[FutureInternist]

I hope I remember this thread in a couple years. Wouldn't it be great as a resident to ask 3rd year students where the clot arose in your patient who just had a PE, and when they all say DVT from the legs, you say "well no, actually, this guy has a really big wanger, and during a monstrous romp with his wife he clotted, then threw the clot, and now he's here."

I had an attending ask me a similar Q about how it was possible for a person w/ a functional IVC filter to still get a PE from a clot that originated below the filter.
He wanted us to know that the L testicular/ovarian vein drained directly into the renal v at a level higher than the IVC filter. 😕

 

[confuse]

We get clots all the time but the small ones get cleared away.
This is a potential research topic. 👍

 

[nogolfinsnow]

I had an attending ask me a similar Q about how it was possible for a person w/ a functional IVC filter to still get a PE from a clot that originated below the filter.
He wanted us to know that the L testicular/ovarian vein drained directly into the renal v at a level higher than the IVC filter. 😕

Well, consider that one filed away in the memory bank then 👍

 

[TMP-SMX]

We get clots all the time but the small ones get cleared away.
This is a potential research topic. 👍

60% of autopsies find PE in the lungs.

 

[iduwanna]

60% of autopsies find PE in the lungs.

where else would you find them?

 

[Depakote]

where else would you find them?

pulmonary artery. 😉

 

[TMP-SMX]

where else would you find them?

Hah. You know what I meant. Autopsies for any reason.