3.DEEP VENOUS THROMBOSIS.pptx.ppt - DEEP VENOUS THROMBOSIS...

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KU LECTUREDEEP VENOUS THROMBOSIS
DefinitionAbnormal formation of blood clots within the deep veins of the extremities (legs) or pelvis
ImportanceAssociated with significant morbidity and mortality from thromboembolism – acute or chronic PTE.Predisposes to Chronic Venous HypertensionMost DVT subclinical / undiagnosedMany cases resolve spontaneouslyMany cases of PE / deaths / CVI in undiagnosed DVT
History1550 papyrus described DVT1664 Schenk described IVC occlusion1846 Virchow – associated DVT and PE
EtiologyVirchow’s triad- hypercoagulability- stasis- vascular intimal injury
Important risk factors1) Pregnancy/ peuperium2) Estrogens (OCs)3) Trauma – lower extremity / pelvic fractures - burns4) General anesthesia5) Immobility – bed ridden, travelling,6) Malignancy7) Age >40yrs7) Chemotherapy
Risk Factors Continued9) Coagulopathy – antithrombin III def, protein C & S def, Factor V Leiden, Antiphospholipid Ab10) Polycythemia / thrombocytosis11) Heart disease12) Strokes & neurotrauma13) Prior h/o DVT/PE14) Surgery – esp orthopedics THR15) Obesity
PathophysiologyHemostasis – platelet plug formationCoagulation –fibrin clot formationAnticoagulation – Proteins S, C, antithrombin IIIFibrinolysis – plasmin, tpa
Clinical featuresPainTendernessUnilateral leg swellingWarmthErythemaPalpable cord Pain on passive dorsiflesion (Homan’s sign)Partial dorsiflexion posture
Differential DiagnosisRight heart failureFluid overloadRenal failureHepatic failureCellulitisSuperficial thrombophlebitisSoft tissue injury – muscle tear, hematomaArterial insufficiencyLymphyedemaPost phlebitic syndrome

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