Thrombophlebitis_and_Occlusive_Arterial_Disease.ppt

Thrombophlebitis_and_Occlusive_Arterial_Disease.ppt -...

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Thrombophlebitis and Occlusive Arterial Disease
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DVT Incidence rate unknown but common condition PE most life threatening consequence 200.000/ yearly 7 day mortality rate 25%
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Pathophysiology Virchows Triad venous stasis: 4x increase with travel > 4 hr endothelial injury: highest risk trauma and surgery hypercoagulable state: Factor V Leiden form at venous cusps in lower extremities central caths nidus for clot formation
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DVT Risk factors Trauma travel Hypercoagulable states Old age Malignancy Birth control pills Pregnancy Smoking
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Superfical Thrombophlebitis Varicosities form most often in Great Saphenous vein and its tributaries. Signs and Symptoms Pain redness along cord like vein Diagnosis: Doppler Treatment: analgesia, warm compresses, elastic support Severe cases: bedrest, elevation of extremity, anti- inflammatories Refractory disease: ligation and excision
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Superfical Thrombopheblitis
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DVT Clinical Features Clinical exam unreliable for detection or exclusion Pain, swelling, redness present < 50% Homans sign: Pain in calf with forced dorsiflexion unreliable predictor of DVT
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DVT Clinical Features Uncommon presentations Phlegmasia cerulea dolens: massive ileofemoral thrombis presenting as swollen cyanotic leg Phlegmasia alba dolens:(milk leg) pale white leg from arterial vasospasm. Dorsalis pedis and posterior tibial pulse diminished. Transient in nature high association with pregnancy. Both increased risk of gangrene and pulmonary emboli
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Phlegmasia cerula dolens
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Wells Clinical Prediction Rule for DVT -------------------------------------------------------------------------------- Clinical feature Points Active cancer (treatment within 6 months, or palliation)1
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Thrombophlebitis_and_Occlusive_Arterial_Disease.ppt -...

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