Venous Thrombo-Embolic Disease Flashcards
Where do DVTs most commonly form?
Anterior Tibial Posterior Tibial Perineal Superficial Femoral Popliteal
What are risk factors for DVT?
Age Pregnancy/COCP Trauma Surgery Past DVT Cancer Obesity Immobility Thrombophilia
What is the Well’s score?
Pretest clinical probability score for DVT
Based on common symptoms
>2 makes DVT/PE likely
What are the common symptoms of a DVT?
Calf Sx -warmth -tenderness -swelling -ertythrema Fever Pitting oedema
What is the D-dimer test?
D-dimers are increased in clotting patients
NOT SPECIFIC FOR DVT
What other clinical conditions could be included in the DDx for pain/swelling of the lower limb?
DVT Superficial thrombo-phlebitis Chronic venous insufficiency Cellulitis Acute arterial ischaemia Hyperprotinaemia
Describe Superficial thrombo-phelibitis
Inflamed vein near the surface of the skin (caused by clot)
Lumps under skin, NOT swelling of whole calf
Cold flannel over vv will reduce pain
Describe Chronic venous insufficiency
Blood pools in legs due to damaged valves in vv
Elevated BP in vv
Leathery skin
Stasis ulcers
Describe Cellulitis
Infection of deeper layers of skin/tissue
Skin becomes red, hot, swollen, painful, tender
High temp, vig shaking before
N/V
Describe Acute Limb Ischaemia
Acute thrombotic occlusion leading to extensive tissue necrosis (<6hrs) Pre-existing arterial disease common 6 P's -pale -pulseless -painful -paralysed -paraesthetic -perishingly cold
Describe hyperprotinaemia
High blood protein
Leads to peripheral oedema
Tends to be painless/
How can the DDx for leg pain/swelling be narrowed down? - History?
Rapid/acute onset? Symptoms beforehand? Pre-existing conditions? Associated symptoms? Painful/not painful?
How can the DDx for leg pain/swelling be narrowed down? - Examination?
Unilateral/bilateral Fluid based swelling? Tender? Cracked/dry skin? Reddened? Temperature?
How can the DDx for leg pain/swelling be narrowed down? - Investigations?
Urinalysis (proteinuria) FBC (infection/inflammation) Clotting screen CXR D-dimer test (clotting) Ultrasound ECG/Echo
What imaging modalities are used to investigate suspected DVT?
CXR - look for pulmonary oedema/emboli
Echo - look for heart failure
Ultrasound/CT - haematoma
CT angiography
What are the clinical features of PE?
Breathlessness (acute) Pleuritic pain Haemoptysis Syncope Pyrexia Tachypnoea Pleural effusion Hypotension
What does the severity of PE depend on?
Depends on size/number/distribution
-small often asymptomatic, large fatal
Describe the pathology of a PE
Usually arising from a venous thrombus in pelvis/legs
Clots break off - pass through venous system - R heart - pulmonary circulation
What are some less common causes of a PE?
Right ventricular thrombus (post MI) Septic emboli (RHS endocarditis) Fat/Air/Amniotic fluid emboli Neoplastic cells Parasites
What are the complications of DVT?
Deep venous insufficiency
PE
Post thrombotic/post phlebitic syndrome
What is post-thrombotic syndrome?
Chronic venous HTN developing after a DVT (20-40%
What are the sx of post-thrombotic syndrome?
Pain Swelling Hyperpigmentation Dermatitis Ulcers Gangrene Lipodermatosclerosis
How should DVTs be investigated?
D-dimer
Compression USS (non-collapsing veins)
Thrombophilia screen
How should DVTs be managed?
Mobilise pts early Heparin for immobile pts Stop COCP Use compression hosiery LMWH AND warfarin, stop LMWH when INR 2-3
