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7- Surgery > Thromboembolitic Dx > Flashcards

Thromboembolitic Dx Flashcards

1
Q

What is Venous thromboembolism

A

Blood clots forms in the vein which can break free and enter circulation as an embolus and lodge and obstruct a blood vessel

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2
Q

Most common type of Venous thromboembolism

A

Deep vein thrombosis

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3
Q

What is the name of a superficial venous thrombosis

A

Phlebitis or superficial thrombophlebitis

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4
Q

Main Origin of DVT

A

Leg starting at the calf

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5
Q

Virchow triad

A

Venous stasis
Endothelial damage
hypercoagulable state

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6
Q

Factors contributing to venous stasis

A

Prolonged bedrest
cast on the leg
Limb paralysis from stroke or spinal cord injury
extended travel in vehicle

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7
Q

Factors contributing to hypercoagulable state

A

Surgery and trauma which decrease flow of blood increasing chances of blood clots, and general anesthetic used lead to venous vasodilation which increases chances of clots

Malignancy
increased estrogen
all stages of pregnancy
first three months postpartum
elective abortion
oral contraceptive pills

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8
Q

Inherited disorders of coagulation

A

Protein s, c or antithrombin III deficiencies

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9
Q

Acquired Disorders of coagulation

A

Nephrotic syndrome with urinary loss of antithrombin III
antiphospholipid antibodies accelerating coagulation

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10
Q

Inflammatory disease leading to to hypercoagulability State

A

SLE
sickle cell disease
IBD

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11
Q

Factors causing endothelial injury

A

Trauma
surgery
invasive procedures
Iatrogenic - cv catheters

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12
Q

PathoPhysiology of DVT

A

Conversion of prothrombin to Thrombin
Fibrin deposition
Coagulation cascade
Propagation of clot due to risk factors
Embolism

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13
Q

Majority of cases how many legs are affected individuals

A

1

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14
Q

Clinical presentation of DVT

A

Calf pain or tenderness
Warm local skin
Swelling below the knee indistal DVT
Swelling up to groin in proximal DVT
Superficial venous dilatation
Redskin
cyanosis
leg fatigue

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15
Q

Examination hallmarks in DVT

A

Palpate distal pulses
capillary refill
palpation and movement of all joints for acute arthritis
Homans sign - Pain in posterior calf or knee with forced Dorsiflexion of the foot
while knee is fully extended
Exam of possible underlying factors

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16
Q

Signs of pulmonary embolism

A

Breathlessness
chest pain
coughing with blood stains sputum
hemoptysis
Wheezing
lightheadedness
fainting
Unexplain anxiety
accelerated heartbeat

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17
Q

Wells clinical prediction guide for DVT parameters

A

Active cancer
paralysis or Recents immobilization
Recent bedridden for more than three days or major surgery
localized tenderness
entire leg swelling
calf swelling more than 3 cm
Pitting edema
collateral superficial veins
alternative diagnosis

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18
Q

Investigation of DVT

A

Blood test- d dimers and INR
imaging studies

19
Q

Techniques to measure d dimer

A

Elisa
Latex agglutination
blood agglutination test

20
Q

Imaging in DVT

A

Venography
Radiolabeled fibrinogen
Ultrasound
Plethysmography
Mri

21
Q

Differentials of DVT

A

Cellulitis
thrombophlebitis
arthritis
Asymmetric peripheral edema due to congestive heart failure,liver disease ,renal failure or nephritic syndrome
lymphangitis
hematoma
lymphedema
ruptured baker cyst
superficial thrombophlebitis
varicose veins

22
Q

Treatment options of DVT

A

Anticoagulation
thrombolytic therapy
surgery
filters
compression stockings

23
Q

Types of anticoagulation

A

Heparin
warfarin

24
Q

Percentage of DVT occuring in deep veins of upper extremities

A

4-13%

25
Q

Most commonly affected veins of leg

A

Superficial femoral vein
Popliteal vein
Posterior tibial vein
Peroneal vein

26
Q

Main cause of upper extremities DVT

A

Endothelial injury caused by central venous catheter , pacemakers , injection drug use

Superior vena cava syndrome

Subclavian vein compression at thoracic outlet from normal or accessory 1st rib or fibrous band

27
Q

Common complications of DVT

A

Pulmonary embolism
Postphlebitic syndrome
Chronic venous insufficiency

28
Q

Less common complications of DVT

A

Phlegmasia alba dolens
Phlegmasia cerulean dolens
Venous gangrene
Thrombophlebitis

29
Q

Symptoms and signs of superficial thrombophlebitis

A

Palpable, indurated, cordlike, tender, subcutaneous venous segment

30
Q

Unilateral leg swelling differential

A

DVT
Cellulitis
Ruptured Baker cyst
Harmatoma
Trauma
Lymphoedema
Tendonitis

31
Q

Differential of bilateral leg swelling

A

DVT
Drugs - CCB
Right heart failure
Hypoalbunemia
Liver failure
Chronic kidney disease

32
Q

Wells criteria for assessment

A

Active cancer

Paralysis, paresis, or recent cast immobilization of the lower
extremities

Recently bedridden >3 days or major surgery within 4 weeks

Localized tenderness along the distribution of the deep venous system

Swelling of entire leg

Calf swelling by >3 cm compared to the asymptomatic leg
(measured 10 cm below tibial tuberosity)

Pitting edema (greater in the symptomatic leg)

Swollen unilateral superficial veins (nonvaricose)

Alternative diagnosis as likely as or more likely than deep vein thrombosis

33
Q

If wells criteria is low what are your next steps in investigations

A

Check D dimer ,
If positive then do emergency Doppler US
If negative then exclude DVT

34
Q

If wells criteria is moderate or high what are your next steps in investigations

A

Emergency Doppler US
If negative do D dimer
If positive do anticoagulation therapy

35
Q

What is d dimer

A

Product of fibrinolysis , indicates presence and lysis of thrombi

36
Q

Medical conditions SSOCIATED WITH ELEVATED D DIMER

A

Liver disease
Trauma
Pregnancy
Infection
Rheumatoid factor positive
Inflammation
Cancer
Recent surgery
Intracardiaque thrombi
SSdx
Nephrotic syndrome
Acute renal failure

37
Q

Goal of treatment of DVT

A

PE prevention
Symptom relief
Prevention of DVT recurrence, and complications

38
Q

DVT treatment

A

Initial - injectable heparin unfractioned or LMWH

Longer treatment within 24-48h - vitamin K antagonist like warfarin , factor Xa inhibitors like Rivaroxaban or apixaban , direct thrombin inhibitors like dabigatran

Systemic thormbolytic therapy (tPA, streptokinase, urokinase )

39
Q

Supportive measures in DVT

A

Analgesics 3-5 NSAIDS
Elevation of legs by pillow

40
Q

Duration of DVT treatment t

A

With transient risk factors 3-6 months

Non modifiable risk factors , idiopathic DVT or recurrent DVT at least 6 months

41
Q

Most common complication of DVT treatment

A

Bleeding

42
Q

Where do you place inferior vena cava filter

A

IVC below renal veins via catheterization of internal jugular vein or femoral vein

43
Q

Examination of DVT

A
44
Q

Heparin monitoring in DVT

A

7- Surgery (13 decks)

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