Thrombophlebitis & DVT Flashcards
General Characteristics of DVT:
where does it occur?
what are risk factors?
DVT most often occurs in the lower extremities and pelvis.
It is associated with major surgical procedures (especially total hip replacement), prolonged bed rest, use of oral contraceptives and hormonal replacement, and inherited (factor V Leiden) and cancer associated hypercoagulable states.
increasingly air travel is being recognized as a cause.
other risk factors include, advanced age, type A blood, obesity, multiparity, inflammatory bowel disease, and lupus erythematosus.
- What are the general characteristics of Thrombophlebitis?
- what is virchow’s triad?
- Where does superficial thrombophlebitis occur?
- involves partial or complete occlusion of a vein and inflammatory changes.
- Virchow’s triad of stasis, vascular injury, and Hypercoagulability predispose a vein to development of thrombophlebitis.
- spontaneously or following trauma and occurs frequently at the site of intravenous or peripherally inserted central catheter (PICC) lines.
General Characteristics:
what is trousseau syndrome?
migratory thrombophlebitis w/ noninfectious vegetations on the heart valves (marantic endocarditis) typically in the setting of mucin secreting adenocarcinoma
-pancreatic cancer
most common Risk factors for DVT include virchow triad 1. venous stasis 2. endotheilia damage 3. hypercoagulation define #3
hypercoagulable states =
deficiencies in antithrombin III, protein C, or protein S
Mutation in factor V gene (Factor V Leiden) or Factor II gene
Hyperhomocysteinemia
Clinical Features:
- superficial thrombophlebitis: symptoms? where does it most commonly occur? physical exam signs?
- DVT:
- dull pain, erythema, TENDERNESS, and induration of the involved vein or with no symptoms. most common in the long saphenous vein. A cord may be palpable following resolution of acute symptoms.
- half of pt’s with DVT have no early signs or symptoms. Classic findings of DVT include
* Swelling involved area with HEAT AND REDNESS over the site
* Homan’s sign is unreliable
Focused General Characteristics: DVT
- where do most start?
- w/out treatment 15-30% propagate to where?
- What other veins in the upper extremity can lead to pulmonary embolism?
- calf veins
- proximal calf veins
- Upper Extremity DVT = Subclavian & Axillary vein thrombosis can lead to Pulmonary Embolism in about 30% of pt.
Upper Extremity DVT occurs in DVT of subclavian & axillary veins, and has the same risk factors as lower extremity DVT, but with SOME ADDED.
describe the added risk factors.
- traumatic damage of the vessel intima from
-heavy exertion such as **Rowing **Wrestling **Weight Lifting
(Paget-Schroetter Syndrome) - from extrinsic compression at the level of the thoracic inlet (thoracic outlet obstruction)
- insertion of central venous catheters or pacemakers
What is clinical features are specific to upper extremity DVT?
Superior Vena Caval Syndrome:
facial swelling, blurred vision, dyspnea
*this is progressive occlusion of the SVC; bronchogenic cancer is leading cause; patient may complain of fullness of the head, tightness of shirt collars, necklaces, rings. Cerebral and central nervous system edema may cause headache, visual disturbance, and impaired consciousness. skin is purple and taunt
What is Thoracic Outlet Syndrome?
a group of disorders that occur when the blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) become compressed.
This can cause UNILATERAL arm pain w/ hand weakness
**shoulder,neck,and numbness in fingers
Laboratory Findings for DVT!!!
1. what is the preferred study for DVT?
- Duplex Ultrasound is the preferred study for DVT. Negative results in a patient with a high suspicion for DVT indicate the need for further study.
Laboratory Studies:
- What is the preferred study for DVT?
- What is the most accurate method for definitive diagnosis?
- What degradation product is used for diagnosis of DVT?
- Duplex Ultrasonography is the preferred study for DVT. Negative results in a patient with a high suspicion for DVT indicates the need for further study.
- Venography is the most accurate method for definitive diagnosis of DVT, but is associated with increased risk and rarely is needed
- D-Dimer is a fibrin degradation product that is elevated in the presence of thrombus. An elevated D-dimer does not sufficiently diagnose thrombophlebitis; most hospitalized patients will have an elevated level. A negative D-dimer test (<500 ng/dL), however suggests that ultrasonography may be omitted.
radial pulses weaken durin ginspiration and during extension of the arm of the affected side while rotating the head to the same side
Adson Test
-DVT
Radial pulses become weaker and painful symptoms are reproduced while abducting the shoulder of the affected side with the humerus externally rotated
Wright Test
WHich test when diagnosis DVT is HIGHLY SENSITIVE but not very specific?
D-Dimers
–helps to rule out a DVT w/ pt. not rule in
Which test in diagnosing DVT and can be elevated due to other causes?
D-Dimers
Helps to RULE OUT DVT w/pt not rule in
