Swollen Painful Leg Flashcards
What does unilateral oedema imply?
DVT or inflammation
Cellulitis
Insect bites
Trauma
What does bilateral oedema imply?
Implies systemic disease with increase venous pressure or decreased oncotic pressure
Right heart failure Decreased albumin Venous insufficiency Nifedipine or amlodipine Pregnancy
What are the risk factors for DVT?
Pregnancy Previous DVT Increased age Malignancy Surgery Thrombophilia
What are the signs of a DVT?
Unilateral swelling
Calf warmth, tenderness, swelling, erythema
Mild fever
Pitting oedema
If the Wells score for DVT is <1, what investigations should you do?
If the Wells score for DVT is >2, what investigations should you do?
1) Perform D-Dimer. If negative, DVT excluded. If positive, perform USS. If USS negative, DVT excluded.
2) Perform D-Dimer and USS. If both positive = DVT. If USS negative and D-Dimer positive, repeat USS in 1 week.
If a patient presents with a DVT without any underlying risk factors, what investigations should you do?
Thrombophilia tests before initiating anticoagulation
Look for underlying malignancy: FBC, LFT, calcium, CXR
In patients who are having major surgery, what could you give them that would decrease the risk of DVT without increasing the risk of bleeding?
Fondaparinux
What is the treatment for DVT for
a) Cancer patients?
b) Others?
a) LMWH for 6m then review
b) Warfarin and LMWH simultaneously and stop the LMWH when INR is 2-3. Treat for 3m in most.
Which patients with cellulitis should be admitted for IV antibiotics?
Class 3 or 4
Immunocompromised
Facial cellulitis
Rapidly growing cellulitis
What is the treatment of cellulitis?
Flucloxacillin is the first line
Clindamycin for patients who are allergic to penicillin
For severe cases, IV benzylpenicillin and flucloxacillin can be used
What is varicose eczema?
Due to an increase in venous pressure in the legs. Usually due to incompetent valves in the leg veins or a DVT.
Haemosiderin deposition occurs
Lipodermatosclerosis (fibrosis, tight skin) occurs
Atrophie blanche
Erythema and dryness of the skin are the main signs to look for
What is the management for varicose eczema?
Elevate legs when sitting
Keep physically active
Regular emollient or topical steroid use
What are the causes of varicose veins?
Primary mechanical factors (venous hypertension, dilatation of superficial veins)
Obstruction (DVT/tumour)
AV malformations
What are the symptoms and signs of varicose veins?
Pain Cramps Tingling Heaviness Restless legs
Atrophie blanche
Lipodermatosclerosis
Haemosiderin deposition
Itchiness
What criteria do varicose vein patients have to meet to get specially referred?
Must have;
Pain Bleeding Ulceration Superficial thrombophlebitis 'A severe impact on quality of life'
