31- Venous Disease Flashcards
presence of a clot
thrombus
inflammation within a vein
phlebitis
inflammation of a vein with or without presence of a clot
thrombophlebitis
most common vein for superificial thrombophlebitis
great saphenous v. more commonly than lesser saphenous v.
tenderness, induration, pain and eyrthema along course of a superficial vein. Feel a palpable cord –>
superficial thrombophlebitis
treatment superficial thromboplebitis
NSAIDs, warm compress, elevation
anticoagulation if high risk
pathophysiology of varicose veins
- inadequate muscle pump
- incompetent valves leading to reflux
- venous obstruction
—> all these lead to venous HTN–> skin changes
diagnosis of varicose veins
venous duplex ultrasound reversed flow of greater than 0.5 seconds in duration
what changes are associated with chronic venous insufficiency?
capillary microcirculatory disorders
fibrin deposition
inflammation
–> impair oxygenation of skin and tissue –> edema, hyperpigmentation, fibrosis and ulcer formation
treatment for chronic venous insufficiency
- leg elevation
- exercise
- compression therapy
- skin care
ulcer care =
- debridement
- topical agents
- growth factors
- dressings
- skin grafting
DVT aka
venous thromboembolism
thrombus remains in the deep calf veins
distal DVT
thrombus involves popliteal, femoral or iliac veins
proximal DVT
*** higher risk PE than distal
DVT risk factors
- bed rest/immobilization
- recent surgery
- obesity
- prior thromboembolism
- LE trauma
- malignancy
- oral contraceptives/ hormone replacement therapy
- pregnancy
- stroke
physical exam: palpable cord with calf pain. Calf edematous and increased in diameter compared to L. calf. R calf warm, tender, erythematous. Positive hohman sign. High wells score criteria.
DVT
hohman’s sign
pain in calf with dorsiflexion
wells score criteria
greater than 4 = high risk DVt
clinical risk scale
noninvasive modality of choice for DVT diagnosis
ultrasound
how is d-dimer used for dvt diagnosis?
d-dimer combined with wells score
patient with low wells score and negative d-dimer…
unlikely to have DVT
no further testing needed
pt with high or moderate wells should be sent to ultrasound
PE is likely to occur in up to _______ of untreated patients
50%
need to be treated with anticoagulation medications
pt with likely DVT but anticoagulation is contraindicated…
inferior vena cava filter
