Deep vein thrombosis

Question 1

Definition

Answer 1

Thrombosis within the deep leg veins

Question 2

Aetiology

Answer 2

Related to the stasis of blood, and increased blood coagulability (can be because of pregnancy)

Sluggish blood flow, or increased blood coagulability overcomes the anticoagulant activity of the body and causes a thrombus to form in the deep leg veins

The thrombus may enlarge in size as it propagates along the lumen of the vein

Associated with virchows triad:
– hyper coagulability
– vessel wall injury
– stagnation of blood

– may occur in the great saphenous vein and the popliteal vein

Question 3

Epidemiology

Answer 3

1 in 1000 people per year

Common and potentially fatal disease

Question 4

Risk factors

Answer 4

Immobility

Pregnancy

Recent surgery

Malignancy

Pregnancy

Long-hail flights

Smoking

Oral contraceptive pill

Hormone replacement therapy

Thrombophilia (increased tendency to form clots)
—- antiphospholipid syndrome (may be shown by recurrent miscarriages)

Systemic lupus erythamatosus (inflammatory condition)

Question 5

Clinical presentation

Answer 5

Almost always unilateral

Bilateral symptoms are most likely due to:
– chronic venous insufficiency
– heart failure

Mostly asymptomatic, usually goes undetected and resolves spontaneously without complication unless PE is caused

Warm, red, painful and swollen lower limb

Dilated superficial veins

Tenderness to deep calf (Homan’s sign)

Oedema in the leg or ankle

Colour changes in the leg

Can cause a pulmonary embolism:
– the emboli from the DVT can travel up the veins, through the right side of the heart and into the lungs, where it becomes a pulmonary embolism

Strokes being causes:
– if there is an atrial septal defect (hole in the septum of the heart), the emboli can pass through to the left side of the heart and then can end up in the brain causing a stroke

Question 6

DDX

Answer 6

Ruptured bakers cyst

Oedema from other causes

Cellulitis