venous diseases Flashcards
phlebothrombosis
dvt
virchows triad
stasis hypercoagulability vein wall injury
major causes of dvt
childbirthbtrauma immobility travel oral contraceptives obesity estrogen postop visceral neoplasm(Y?)
polycythemia thrombocytosis protein c s def thrombophilia etc
recent mi heart failure nephrotic synfrome
paget shroetter syndrome
primary upper limb dvt
subclavian vein compression in thoracic outlet syndrome
secondary upper limb dvt causes
cvp line pacemaker thrombocytosis malignancy surgery radiotherapy
common sites for thrombosis in leg veins
soleus veins femoral vein/iliofemoral vein (Y?)
phlegmasia alba dolens
dvt of femoral vein
painful congestion nd edeema with lymphangitis
white leg
phlegmasia cerulea dolens
extensive dvt of iliac and pelvic veins
blue leg
venous gangrene
eraliest symptom of dvt
fever?
features of dvt
fever pain swelling
tense tender warm pale shiny leg
can also b asymptomatic
features of pulm embolism
signs of dvt
homans moses neuhofs
inverted champagne bottle
homans sign
passive forceful dorsiflexion of foot
extndd knee
tenderness in calf
mose s sign
gentle squeezing of lower part of calf side to side
pain
neuhof s sign
palpatind deep in calf muscles
linton s test
apply tourniquet to sfj
walk
elevate limb
persisting prominent superficial veins
dd dvt
ruptured bakers cyst
ruptured plantaris tendon calf muscle hematoma cellulitis superficial thrombophlebitis
investigations dvt
VENOUS DOPPLER WITH DUPLEX SCANNING
venogram………..
radioactive iodine 125 fibrinogen study…..
hemogram
d dimer
ventilation perfusion scanning pulm ct pulm angio
treatment dvt general measures
rest elevation of limb bandaging the entire limb with crepe
anticoagulants
dvt fixed thrombus
high dose of heparin 25k units per day x 7 dys
warfarin 3-6 months( start from day 1 of heparin therapy)
heparin dosage for dvt
80 units/kg bolus of heparin followed by 15 units/kg infusion
drug of choice during pregnancy nd postpartum
lmwh
dvt free thrombus
fibrinolysins
venous thrombectomy using fogarty venous catheter
ivc filter
ralma operation may husni operation
fibrinolysin for dvt
streptokinase 6 lakhs nd then 1 lakh hourly
tpa
urokinase
reptilase
prevention of dvt
catetgorize
position
pressure bandage massaging early ambulation hydration
low dose heparin 5k subcutaneously 2 hrs before surgery
elastic stockings electric stimulation pneumatic compresssion
dextran
stop ocps nd estrogens prior to surg
stop smoking
effects and sequelae of dvt
pulm embolism infection gangrene chronic venous insufficiency..... recurrent dvt
tao commonly seen in
males smokers tobacco users south asia jewish lower socioeconomic factors rec feet injuries poor hygiene
si>300
pyi>40
before 45?
what is tao?
nonatherosclerotic inflammatory disorder
cell mediated hypersensitivity to type 1 nd 111 collagen
segmental progressive occlusive inflammatory disease of small nd medium sized vessels
pathogenesis of tao
co nicotinic acid carboxyhb vasospasm hyperplasia thrombosis obliteration panarteritis nerve involvement ischemia compensatory decompensatory critical limb ischemia
classification of tao
types I ul 2 crural or infrapopliteal 3 femoropopliteal 4 aortoiliofemoral 5 generalised
clinical features of tao
intermittent claudication rest pain ulceration gangrene recurrent migratory superficial thrombophlebitis absence or feeble pulses raynauds phenomenon
investigations tao
hb% sugar abpi arterial doppler duplex ct angio transfemoral retrtograde angio-corkscrew inverted tree/spider collaterals distal run off transbrachial angiogram us abdomen biopsy?
treatment tao
stop smoking aspirin 75 mg od prostacyclins ticlopidine praxilene carnitine? statin cilostazole? analgesics xanthine nicotinate naftidofuryl gene therapy (vegf) beurgers position nd exercise chiropady.... chemical sympathectomy surgery-omentoplasty profundoplasty lumbarv sympathectomy amputation ilzarov method
care of foot in tao
avoid hot cold trauma dryness
oil
socks
heel raise
