Class 13 Flashcards
What is Deep Vein Thrombosis (DVT)?
Partial or full occlusion of deep vein by formation of thrombus, most commonly in lower limb. Is a serious condition, as it causes potential complication of pulmonary embolism.
What are Causes / Predisposing Factors of Deep Vein Thrombosis (DVT)?
• Trauma of all kinds, hip fracture
• Surgery, orthopedic surgery, venous catheters
• Venous stasis d/t paralysis or immobilized limbs, prolonged bed rest or during surgery
• Increased coagulability of blood & number of platelets is common after surgery or childbirth
• Middle-aged to elderly patients, particularly those who are obese
• Drugs, especially oral contraceptives
• Previous history of DVT or vascular/blood disorders
• Impaired cardiac function
• Long airplane travel (due to prolonged sitting & increased blood viscosity d/t dehydration)
What are Causes / Predisposing Factors of Deep Vein Thrombosis (DVT)?
• Trauma of all kinds, hip fracture
• Surgery, orthopedic surgery, venous catheters
• Venous stasis d/t paralysis or immobilized limbs, prolonged bed rest or during surgery
• Increased coagulability of blood & number of platelets is common after surgery or childbirth
• Middle-aged to elderly patients, particularly those who are obese
• Drugs, especially oral contraceptives
• Previous history of DVT or vascular/blood disorders
• Impaired cardiac function
• Long airplane travel (due to prolonged sitting & increased blood viscosity d/t dehydration)
What are Signs & Symptoms of Deep Vein Thrombosis (DVT)?
• Can be asymptomatic if vein is only partially occluded
• Inflammation: pain, swelling, deep muscle tenderness
• Edema around joint distal to area (unilateral)
• Fever, general malaise
• Tenderness along the vein (unilateral)
• Dependent on location
What is HOMAN’S SIGN?
(indicates deep vein thrombosis in calf, can be inaccurate & can give false positives/false negatives):
Pain in calf, & perhaps radiating into popliteal space, elicited when ankle is dorsiflexed. Same pain may occur with. squeezing calf. Using Homan’s Sign as test can be dangerous d/t possibility of dislodging thrombus; its best not used if seems apparent that situation needs to be medically investigated. When Homan’s Sign is elicited during routine massage therapy, refer for further evaluation.
What are Medical Treatments for DVT?
• Anticoagulant & thrombolytic therapy
• Bedrest & elevation (helps adhere thrombus)
• Foot & leg exercise & gradual increase in mobility (wearing supports at all times)
A deep vein thromboembolus travels from the lower limb through the heart until it blocks a pulmonary artery, becoming a ____________________.
pulmonary embolism
What is Pulmonary Embolism (PE) from DVT?
• Embolism in lung; primarily caused by dislodged thrombi from leg veins that end up passing through right side of heart into pulmonary artery.
• Smaller ones may be broken down by body & clear on their own; however, more serious pulmonary embolism may cause permanent lung damage, even death.
• PE symptoms include: shortness of breath, rapid breathing or wheezing, bloody sputum; cough, light-headedness, dizziness, fainting, sharp chest pain or back pain.
• Severe pulmonary embolism gives signs of extreme distress, breathlessness & shock.
What is an Aneurysm?
Aneurysm is bulge (dilation) of weak spot in an artery wall. Pressure conditions inside arteries cause weakened areas to bulge.
Aneurysms can occur in any artery but are most common in aorta.
They are also somewhat frequent in:
• Brain (cerebral arteries)
• Legs (femoral arteries, popliteal arteries)
• Neck (carotid arteries)
What are causes of an Aneurysm?
Congenital weakness in artery wall (often runs in families)
• atherosclerosis (see illustration on right)
• injuries, surgeries
• bacterial or fungal infections in wall of artery, e.g., that develop after recreational intravenous drug use
An aneurysm increases in size, risk of rupture increases.
Aneurysms can also be starting point for thrombosis &
embolization.
What are the 3 types of Aneurysms?
- Fusiform
- Saccular/Berry
- Dissecting
What is a Fusiform Aneurysm
Most common type of aneurysm, bulging or ballooning out of full circumference of blood vessel.
What is a Saccular/Berry Aneurysm?
Appear as round outpouching on one side of vessel, are most common form of cerebral aneurysm; typically form at junction between artery branches.
What is a Dissecting Aneurysm?
Almost always occurs in aorta (d/t speed & force of blood
ejected from heart). Blood penetrates tunica intima, usually through an atherosclerosis lesion, & infiltrates tunica media. Blood, under very high pressure, slices though aortic wall separating the media & externa layers filling the vessel wall with blood, collapsing the lumen. There is very low survival rate.
What are Signs & Symptoms Aneurysm?
• Aneurysms can develop slowly over many years & often have no symptoms.
• Aneurysms have potential to create S/S through causing pressure on neighbour structures. Can be good thing as it may cause detection of aneurysm.
Some common examples:
• Ischemia (pressure on blood supply)
• Nerve compression (pain, other neurological S/S such as numbness, paraesthesia)
• Compression in brain – range of neurological signs depending on function of affected brain tisuue
• Erosion or damage to structures, e.g. vertebral bodies from abdominal aorta fusiform aneurysm (differential diagnosis for low back pain for elderly men with hypertension)
• As thoracic aortic aneurysm grows, symptoms maybe present:
• Tenderness or pain in chest
• Back pain
• Hoarseness
• Cough
• Shortness of breath
• About 80% of abdominal aortic aneurysms are palpable as pulsating lump/bulgy structure. Most likely in patients with history of cardiovascular disease, hypertension, or peripheral vascular disease.
• When aneurysm ruptures, there can be very serious consequences depending on its size & location, eg. causing hemorrhagic stroke in brain, or acute heart failure in case of dissecting aortic aneurysm.
