28. Swollen Calf Flashcards
What are the top 4 differential diagnoses for an acutely swollen calf?
DVT
Cellulitis
Ruptured baker’s cyst
Muscular strain
What are the top 5 differential diagnoses of bilateral swollen legs?
Right heart failure Lymphoedema Venous insufficiency Pregnancy Vasodilators
What specific questions should you ask about an acutely swollen calf?
Hypercoagulable blood Qs, stasis, vessel injury
Breathlessness, chest pain, haempotysis (PE)
Cuts, insect bites, other wounds (cellulitis, septic arthritis)
Abdo pain, blood in faeces, unusual vaginal bleeding, FLAWS (pelvic malignancy)
Increasing in size/ spread (cellulitis)
Radiotherapy or surgery (damaged lymohatic drainage)
Does pain occur on movement? (septic arthritis)
Swollen calf- what would you look for on examination?
cuts, bites, superficial infections location of swelling extent of swelling- measure with tape Lymohadenopathy- suggests infection abdo masses- mass in RLQ suggests tumour compressing right iliac vein Neuromuscular status (sensation, motor, pulses) Pain on passive movement Pyrexia
How would you diagnose DVT?
Wells score (predicts probability of DVT)
D dimer
US scan
FBC
How would you manage DVT?
Anticoagulation- LMWH or NOAC
Compression stockings
Lifestyle advice
List 3 less common causes of an acutely swollen calf
Septic arthritis
Allergic response
Compartment syndrome
List 3 risk factors in thrombotic disease
Long distance travel
Oestrogen + Progesterone based therapies
Obesity
How can you differentiate cause of swollen calf based on location?
Septic arthritis: over joint
Compartment syndrome: confined to certain compartment
Ruptured synovial sac (baker’s cyst): emerges from popliteal fossa + track down into calf
How can D-dimer exclude or include diagnoses?
Normal- DVT unlikely
High- 30-40% have DVT
List 3 congenital mutations that make blood more likely to clot
Factor V Leiden mutation
Prothrombin G20210A mutation
Antithrombin III deficiency
List 4 conditions that make blood more likely to clot
Malignancy
Antiphospholipid syndrome
Disseminated intravascular coagulation
Polycythaemia
List 3 drugs that make blood more likely to clot
cOCP
HRT
Heparin induced thromboytopenia
What components of the clotting cascade does warfarin interfere with?
Warfarin is a competitive antagonist of vitamin K (cofactor needed to synthesise factors II, VII, IX, X, protein C + S)
Why does LMWH need to be started before relying solely on warfarin?
It takes a few days to deplete existing coagulation factors
Warfarin can cause paradoxical increase in clotting as protein C + S (anticoagulant) are depleted before the procoagulant factors
