Tromboza Venoasa Profunda

Question 1

Frecventa tvp

Answer 1

1 la mie crestre pana la 5 la mie la 80 ani
3% postinterventii
Creste in: splenectomii, ortopedice, micul bazin, politrauma, obstetricale

Africani
Caucazieni anglos
Caucazieni hispanici
Asiatici

Question 2

Factori favorizanti tvp

Answer 2

Mediu:
-clima rece si umeda
-flebita de avion
-stresul, poluarea
-nivelul de trai ridicat
-medicamente
Vitamina k, penicilina, digitala, acth, cortizon, hipertensive, ganglioplegice, sol hiperosm, anticonceptionale

INDIVID:
-factor v leiden, mutatie protromb, difibrinogenemie, deficit aantitrombina, deficit prot c sau s
-varsta >45
-antecedente tvp
-obezitate, neoplasme, ac antifosfolip, ic, ir
-insuf venoasa cronica
-policitemie, mielom multiplu, boala wald3nstrom
-alergia (hipersensib endoteliu)

Question 3

Factori declansatori

Answer 3

-traumatisme si fracturi
-interventii chirurgicale
-imobilizare
-sarcina
-terapie estrogenica/citostatica
-zbor prelungit
-cateter venos si efort musc sustinut(mb sup)

Question 4

Semne specifice tvp

Answer 4

1. Puls catarator (Mahler)
2. Febra 38 (Michaelis)
3. Neliniste, Agitatie
4. Durere/Crampe
5. Durere provocata (homans, tuse, compresie)
6. Varice pretibiale
7. Paloare/Cianoza
8. Impastare dureroasa molet
9. Edem

Question 5

Scorul wells

Answer 5

1.cancer activ
2.paralizie, imobilizare gips
3.imob la pat
4.sensibilitate la palpare
5.edem cu godeu unil.
6.marire de volum mb
7.diferenta circumferinta gamba
8.varice
9.tvp antecedente
10.alt diagn probabil

Question 6

Paraclinic tvp

Answer 6

Laborator:
- d dimeri
-tromboelastograma
-coagulograma
-hemograma
-toleranta la heparina

Question 7

Forme clinice topografice tvp

Answer 7

1. TVP membru pelvin
   *flegmatia alba dolens (femurala, ilaca externa, safena mare)
   - edem pana la coapsa, teg palide si reci, varice, durere spontana si prov, impotenta functionala, febra
   * Sidrom May-Thurner
2. Flebitele pelvisului (Ducuing)
   -venele hipogastrice cu tulb vezicale, rectale, dureri, meteorism, tuseu dureros
   - extensie la iliaca cu edem membru, edem pubian, edem genital
3. TVP cava inferioara
   -dureri lombare, iradiate in mb +edem mb
   -tulburari mictiune, defecatie, meteorism
   -edem abdomen + circ colaterala
4. TVP cava superioara
5. TVP membru toracic
   Dupa efort, traume, infectii
   -edem, cianoza, varice, durere spontan si la palpare
6. TVP vena porta
   - la nou-nascut
   -la adult: febra, frison, tahic, dureri abd, ileus,
7. Flebita Mondor
8. Tromboza venelor suprahep.
9. Tromboflebita varicoasa
10. Tromboza sinusului cavernos

Question 8

Alte forme simptomatice TVP

Answer 8

1. Flegmatia Coerulea Dollens
   Femurala + iliaca externa +spasm arterial
   - durere brusca, cianoza, edem, teg reci, scade pulsul arterial pana la soc
2. Flebite migratorii
   Superficiale sau Profunde

Question 9

Stadii evolutive TVP

Answer 9

1. Acut:
   Smenele clasice cu predom edemului

2.Convalescenta
Semne ce diminua in clino, edem si cianoza ce apar in ortostatism

3. Stabilizare
   Ramane doar edemul ortostatic

4.Sindron post trombotic

Question 10

Complicatii TVP

Answer 10

1. Embolia Pulmonara
   Scor wells modif
   - TVP suspecta,alt dgn putin prob,
   hemoptizie, tahicardie
   -neoplasm , chirurgie, antecedente
   >4 ct/eco, <4 ddimeri
2. Gangrena Venoasa
3. Sindrom post trombotic
   -varicen venectazii
   -edem
   -trofice: dermatita
   -celulita subcutanata indurativa
   (dermatoscleroza)
   -ulcer posttrombotic

Forme clinice:
Scleroasa, Edematoasa, Ulceroasa

Question 11

Stadii sdr post trombotic

Answer 11

1. Edem dispare in repaus
2. Edem dispare dupa 24 ore clinostatism, dermatita
3. Decompens limfatica si fibroza dura