Thrombo emobolitic disorders

Question 1

Definition

Answer 1

Venous TE.

• DVT is development of thrombi in deep veins in extremities or pelvis.
• PE is lodging of thrombus or embolus in pulmonary circulation from distant site. Massive, submassive, small to moderate.

Question 2

Aetiology

Answer 2

DVT- clot can dislodge and go to lungs=PE
Immobilisation
post op, trauma
OCP or oestrogen
visceral CA
Pregnancy
Travel
age, hx of TE, haematological disorders eg thrombophilia, obesity, CHF, over 30 mins anaesthesia, smoking and abdo obesity, central venous catheter or pm, varicose veins, collagen vascular disease, nephrotic syndrome, myeloproliferative disorders, pollution.
PE-
Same plus SC injury, COPD, DM, acute illness, autoimmune disease.
Rare- RV thrombus post MI, septic emboli, fat/air/amniotic fluid emboli, neoplastic cells, parasites.

Question 3

Differentials

Answer 3

DVT-
Ruptured bakers cyst
Cellulitis, tendinitis
Muscle or soft tissue injury, stress fracture
Varicose veins
Sciatic compression
Abcess, septic arthritis
Lymphoedema
Claudication
PE-
MI, tamponade, pericarditis, CHF, aortic dissection.
Pneumonia, Pneumothorax, pleuritis, chest wall pain.
GI ulcer, gastritis, oesophageal rupture.
Anxiety
Asthma

Question 4

Symptoms

Answer 4

DVT-
Non specific eg unilateral pain, tender, swelling, erythema.
PE-
Acute SOB, sharp stabbing pleuritic CP, haemoptysis, syncope, dry cough.

Question 5

Management

Answer 5

DVT-
Encourage mobility
LMWH initally, low dose
Warfarin for 3 months then reassess. 
Compression stockings
IVC filter to prevent PE
Thrombolysis if very severe
Thrombectomy, catheter directed Tlysis, thromboreduction. 
PE- 
Address RFs
Heparin
Warfarin
Factor Xa inhibition
Thrombin inhibition
Thrombolysis
IVC filter
Embolectomy

Question 6

Signs

Answer 6

DVT-
Calf warmth, tenderness, swelling, erythema. 
Superficial V distension
Mild fever
Pitting oedema.
PE-
Tachyc/p
Haemoptysis
Pyrexia
Cyanosis
Hypotension
Raised JVP
Pleural rub and effusion

Question 7

Diagnsois

Answer 7

-DVT-
D dimer (fibrin degradation product), US, haematology (thrombophilia), CA screen
-PE-
FBC, UE, clotting, D dimer. ABG.
CXR linear atelectasis, PA dilation, small effusion, wedge opacities or cavaitation.
ECG tachyc or RBBB. Rule out MI.
CT pulmonary angiography.

Question 8

Paradoxical embolus

Answer 8

DVT clot through ASD into arterial system= CVA

Question 9

Explanation

Answer 9

• DVT is where a blood clot blocks a vein in your leg. So blood builds up behind it causing swelling, pain, redness and warmth. It can happen if blood it too still so if you are immobile for a long time. Other things also increase the risk such as trauma, surgery, travel, some drugs, pregnancy, and cancer.
• it can dislodge and travel to the heart and then down into the lungs. If it lodges in a small blood vessel here, it can cause damage to the lungs and problems breathing.
• lifestyle mobility and compression stockings. And looks out for lung symptoms.
• drugs- heparin, warfarin 3 month trial. If more severe can do IVC filter, thrombolysis , thombectomy.