Wednesday, September 3, 2008

Deep Vein Thrombosis

Deep Vein Thrombosis





It is thrombosis of part or all deep venous system of extremities.





Predisposing factors:-


Virchaw's triad :-


1) Abnormal blood flow.


2) Abnormal constituent.


3) Abnormal blood wall.






1) Abnormal blood flow:-



@immobilization. (Fracture, trauma, driver long standing, pregnancy, paralysis, postoperative)


@ Heart failure.( CVA , MI , CHF )


(These tows are the most important)


@ Compression of vein by trauma.


@ Causes of loss of fluid and dehydration (hypovolemic shock).





2) Abnormal constituent:-



@ Contraceptive.


@ Thrombocytosis.


@ Protein C & S deficiency.


@ Anti thrombin III deficiency. (Acquired deficiency of anti thrombin III occur in nephritic syndrome)


@ polycythemia , leukemia , lymphoma .


@ SCA .


@ paraproteinemia.


@ abnormal Hbc


@ Malignancy (mostly : pancreas , lung , and prostate ).


@ Antiphospholipid syndrome, present in SLE patient.








3) Abnormal blood wall:-



@ Trauma of vein (during IV line, surgery)


@ Drug abuser.


@ Vascullitis (primary or secondary to CT disease).


@ H / O varicose vein.


@ H/O thrombophilitis.




NB:-



In any DVT patient ask about:-


Trauma, occupation , travel , immobilization , heart disease .




Differential diagnosis:-


Swelling of one leg:


- DVT.


-Cellulites.


- Lymphoma.


- Rupture of picker's cyst.


- Hematoma.




Complications:-


@ Pulmonary embolism and infarction. (Most important)


@ Post pheleptic syndrome.




Investigation:-



( Not in order)



@ The most diagnostic vienogram and dopllar ultrasound (dopllar most important)


@ CBC : for polycythemia-------- increase ESR


@ AVG for pulmonary embolism.


@ Chest X –ray to exclude lung disease.


@ ECG to detect pulmonary embolism. ( S1Q3T3 classical sign for PE)


@ Immunoelectrophoresis for paraproteinemia.


@ PT , PTT for proteinC , S and antithrombinIII level.


@ Tumor markers.


@ Antiphospholipid antibodies.


@ Antinuclear antibodies for CT disease.


@ Abdominal US to look to mass in abdomen cause compression.

1 comment:

EvanDouglas said...

Deep vein thrombosis is a blood clot in a deep vein in the body. Blood clots that develop in a vein are also known as venous thrombosis.

veins