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Surgery M4 part 1 > DVT > Flashcards

DVT Flashcards

1
Q

What is a venous thrombus?

A

formation of semi-solid coagulum within flowing blood in venous system

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2
Q

What are the types of superficial thrombophlebitis?

A
  • simple (traumatic) thrombophlebitis
  • Mondor’s disease
  • Thrombophlebitis Migrans
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3
Q

What is simple thrombophlebitis?

A

localized inflammation of the vein wall + thrombus formation in the lumen

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4
Q

What are the causes of simple thrombophlebitis?

A
  • Direct trauma
  • Venous intimal damage
    • infusion of hypertonic solutions, antibiotics & chemo & drug abuse
    • cannula insertion
  • on top of varicose vein “stasis”
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5
Q

What is the clinical picture of simple thrombophlebitis?

A
  • vein becomes tender, painful, firm, & cord-like
  • overlying skin is dusky & edematous
  • rare embolization cause its firmly attached to the wall
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6
Q

How should simple thrombophlebitis be treated?

A

PREVENTION

  • rotate IV sites every 3 days
  • diluting irritating infusions

CONSERVATIVE

  • rest & elevation + elastic bandage
  • warm compresses + NSAIDS or aspirin +- antibiotics

SURGICAL (only if extensive)

  • if thrombus propagates –> ligation of sapheno-femoral junction under local anesthesia
  • excision in cases on top of varicose veins & recurrent symptomizing phlebitis
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7
Q

What is Mondor’s disease?

A

String Phlebitis

  • spontaneous thrombophlebitis of the superficial veins over the breast & anterior chest wall towards the axilla
  • usually lateral thoracic vein, thoracoepigastric vein, & superficial epigastric vein
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8
Q

What characterizes Thrombophlebitis Migrans?

A

recurrent attacks of thrombophlebitis involving segments of previously normal superficial veins

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9
Q

What are the causes of thrombophlebitis migrans?

A
  • early stages of Burger’s disease
  • polyarteritis nodusa
  • visceral carcinoma (trousseau’s sign)
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10
Q

How should thrombophlebitis migrans be treated?

A
  • treat symptoms
  • smoking should be stopped & prohibited (in BURGER’S)
  • if persistently active: long term anti-coagulant therapy
  • if no obvious cause: search for underlying pathological process (intra-abdominal & GI malignancies or hypercoagulable states)
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11
Q

What are the common sites for DVT?

A

UPPER LIMB
- axillary vein thrombosis

LOWER LIMB

  • Soleal venous plexus calf vein thrombosis
  • ilio-femoral thrombosis -> phlegmasia alba dolens PAD
  • ilio-femoral thrombosis + deep pelvic vein thrombosis -> phegmasia cerulae dolans PCD
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12
Q

which side is more common to be affected in case of ilio-femoral thrombosis?

A

left side

  • more liable to be compressed by overlying right common iliac artery against L5
  • left iliac vein is longer
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13
Q

What are the causes leading to DVT?

A

VIRCHOW TRIAD

  • vessel wall (VASCULAR WALL INJURY)
  • velocity (HYPERCOAGULABLE STATE)
  • viscosity (CIRCULATORY STASIS)
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14
Q

What are examples of hypercoagulable states?

A
  • malignancy
  • pregnancy & peripartum period
  • estrogen therapy
  • trauma or surgery of lower extremity, hip, abdomen, or pelvis
  • inflammatory bowel disease
  • nephrotic syndrome
  • sepsis
  • thrombophilia
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15
Q

What are examples of circulatory stasis?

A
  • atrial fibrillation
  • left ventricular dysfunction
  • immobility or paralysis
  • venous insufficiency or VV
  • venous obstruction from tumor, obesity, or pregnancy
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16
Q

What are the risk factors for DVT?

A

PATIENT

  • > 60 yrs
  • obesity
  • varicose veins
  • immobility
  • pregnancy
  • puerperium
  • high-dose estrogen therapy
  • previous DVT or pulmonary embolism
17
Q

What diseases of surgical procedures are a risk for developing DVT?

A
  • trauma or surgery, esp in pelvis, hip, & lower limb
  • malignancy esp pelvic & abdominal
  • heart failure
  • recent MI
  • paralysis of lower limb
  • inflammatory bowel disease
  • polcycthaemia
18
Q

What is the pathogenesis of DVT?

A
  • primary platelet thrombus
  • mural coralline thrombus
  • occluding thrombus
  • consecutive clot
  • propagated clot
19
Q

What is the difference between thrombophlebitis & phlebothrombosis?

A

THROMBOPHLEBITIS PHLEBOTHROMBOSIS

  • inflammation of vein wall - stasis & hypercoagulability
  • pain + signs of inflammation - silent + few signs
  • short & fixed propagated clot - large & easily detachable
  • less liable to embolization - more liable to embolization
20
Q

What are the local consequences of thrombosis?

A
  • lysis
  • organization & fibrosis (CVI due to valve destruction)
  • calcification & ossification
  • extension (propagation)
21
Q

What are the distal & proximal consequences of thrombosis?

A

DISTAL

  • edema after venous collaterals open up
  • phlegmasia alba & cerula
  • post-phlebetic syndrome -> 2ndry VV -> CVI

PROXIMALLY
- detachement -> pulmonary embolism

22
Q

What is the clinical picture of DVT?

A
  • asymptomatic in 30-50%
  • detectable pulmonary embolism -> fatal
  • low grade fever that fails to settle after operation
23
Q

What are the local signs of DVT?

A
  • swelling (FROG-LEG POSITION)
  • leg is externally rotated
  • knee is flexed
  • calf is stiff
  • aching pain & heaviness on moving calf & thigh
  • tenderness on pressure on instep of sole of foot
24
Q

What are the complications of DVT?

A
  • CVI
  • VV
  • venous gangrene
  • pulmonary embolism
25
Q

What investigation should be preformed for DVT?

A
  • doppler US

- D-dimer (breakdown products of complexed fibrin)

26
Q

What are the pre-op measures that should be done?

A

MECHANICAL PROPHYLAXIS

  • elastic compression stockings
  • intermittent pneumatic compression device

PHARMA PROPHYLAXIS

  • low-dose unfractioned heparin injection 2 hours pre-op & every 8-12 hours after (requires monitoring)
  • LMWH
27
Q

What operative measures should be done to prevent DVT?

A
  • reduction of trauma to calf muscle in surgery

- elevation & massage of leg at the end of operation

28
Q

What post-op measures should be taken post-op to avoid DVT?

A
  • early ambulation
  • maintenance of adequate hydration
  • pharmacological prophylaxis
  • daily examination of calf & feet
29
Q

How should an established DVT be treated?

A

CONSERVATIVE

  • bed rest & foot elevation
  • anti coagulants
  • thrombolytic & defibrinating agents (urokinase & streptokinase)
  • post treatment compression to control leg edema
30
Q

How is DVT treated operatively?

A

VENOUS THROMBECTOMY
- extraction with a balloon Fogarty catheter

CAVAL FILTER
- use if there are contraindications, complications or failure of anticoagulants & prophylaxis

31
Q

When should heparin be given?

A

5000-100 000units/6hrs for 7 days in CALF THROMBOSIS
and for 14 days in ILIOFEMORAL THROMBOSIS
LMWH = 1mg/kg/12hrs

  • DRIP INFUSION
  • monitor PTT
  • protamine sulfate is the antidote
  • dont give in HYPERTENSION
32
Q

When should warfarin be given?

A

10mg on day 1
10 mg on day 2
5mg on day 3 for 6 months
start before we stop heparin by 3 days

  • ORALLY
  • PT monitoring
  • fresh blood transfusions & VIT K are the antidotes
  • could cause bleeding & is teratogenic
  • DONT GIVE IN PREGNANCY

Surgery M4 part 1 (47 decks)

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