Leg swelling Flashcards
How would a DVT present?
Unilateral
Dullish ache that’s CONSTANT
Back of calf
What signs would you be looking for?
Tenderness in posterior calf
Temp using back of your hand - the oedematous leg might be warmer
Measure the leg (>3cm bigger than other calf means it’s more likely to be a DVT)
Pulse in legs (to check for
Mildly erythematous leg
What’s the differential for when you ask about WHEN the pain comes on?
MSK pain would come and go depending on activity
Pain rating can be?
Mild-severe
What else would you screen for?
PE
- breathless
- haemoptysis
- localised pleuritic pain
- dry cough
- low grade fever
Differentials?
Varicose veins (superficial veins - these can become thrombosed and painful)
MSK pain
Calf muscle tear /trauma (also causes constant pain)
What does cellulitis look like and feel like?
Acutely:
localised area of swelling
demarcated redness, angry looking, discharge
Cellulitis will be hotter
Systemic symptoms:
- Fever
- Malaise
- Nauseas
- Vomiting
How would you differentiate between this and claudication?
Lack of oxygen to muscles during activity (typically it’s after
No swelling or redness
Weaker pulse
Risk factors
COCP & pregnancy - Oestrogen increases risk of Recent surgery Blood clotting disorders e.g. thrombophilia - factor 5 Leiden deficiency FH of PE or DVT Age Obesity Smoking Cancer - pro inflammatory state therefore increases DVT risk Recent long history Previous history of varicose veins
What is the scoring system
Wells score
What score means DVT not likely? What happens next?
If less than 2, DVT is less likely
D-Dimer within four hours
What score means the patient has a scan and what scan is this?
A score above 2 means they have a doppler ultrasound
What are other reasons for a raised D-Dimer?
It is raised in proinflammatory conditions
E.g. pregnancy
Cancer
Infections
Hence it’s difficult to differentiate using d-dimer alone
Is there a time limit for the d-dimer test?
No not necessarily, but you have to do it within 4 hours IN CASE they have a PE, so it’s not about the test’s selectivity/specificity itself
What is included in the Wells score?
circumference
tenderness
pitting oedema
more than
Wells score 0
Blood test
Wells score 1-2
???
Wells score above 3
Ultrasound
D-dimer can also be raised in?
Infection
Malignancy
Inflammation
D-dimer is sensitive or specific?
Sensitive but NOT specific
What is D-dimer useful for?
To exclude the diagnosis of DVT Provide prognosis (predicts DVT recurring)
Management of DVT
Analgesia
Leg elevation
Flowtron (compresses leg)
What are you looking for on bloods?
FBC
INR
APTT
Group and save (saving the blood results)
What are you testing with group?
ABO
Rhesus
