Flashcards in Swollen calf Deck (13)
What are the differential diagnoses for bilateral calf swelling?
> More likely to be systemic or central vessels
Specific system review/history taking questions to ask to assess risk of DVT?
- V t
Ask about PE symptoms
- Chest pain
- Coughing up blood
Questions to ask to rule out septic arthritis for calf swelling?
- Does movement of joints elicit pain?- excruciating
- Any wounds?
Questions to rule out cellulitis?
- Insect bite/wounds? (also consider allergic reaction to insect bite in this case)
- Is swelling getting rapidly bigger?
Questions for bilateral swelling to rule out pelvic tumour?
- Abdominal pain?
- Blood in faeces?
- Unusual vaginal bleeding?
- Weight loss/fever/malaise?
What do you look for on examination if you suspect DVT?
Inspection and palpation of calf:
- Cuts, bites, wounds or superficial infections
Also inspect toes for fungal infection entry route
- Warmth- calor
- Redness/erythema- rubor
o Pitting vs non pitting oedema
o Location of swelling
- If joint= septic arthritis
- If not joint, but thigh or calf= compartment syndrome
- If popliteal fossa down into calf= ruptured Baker's cyst
o Extent of swelling
- use tape measure to see circumference of both limbs
- Mark swelling/erythema with pen to monitor progression
- Lymphadenopathy- palpate lymph nodes in popliteal fossa and groin- indicates infection
> Palpate abdomen- check for right/left lower quadrant masses that could compress iliac veins
> Neurovascular exam of limb
- Check sensation
- Check motor
- gentle passive movement - be v slow to avoid dislodging DVTs
- If pain in joint= septic arthritis
- If pain in calf= compartment syndrome
- movement against resistance
- Check pulse
^Distal to the swelling
If compromised- surgical emergency, could indicate compartment syndrome
- Check temperature- if pyrexic - more likely to be infection than DVT
Which scoring system measures DVT risk?
What score on the Wells scoring system indicates likely risk of DVT?
> or equal to 2
Investigations for DVT
- Do wells score
- Serum D- dimer (fibrin degradation products)
-If negative, used to exclude (not confirm) DVT if wells score is less than 2 (if more than 2, do D dimer and ultrasound to exclude)
- Doppler ultrasound scan
- sensitive, rapid, non invasive + can also detect Baker's cysts
- To look for:
RBC- polycythaemia- can cause DVT
Increased platelets- cancer - causing DVT
- Clotting factors
Management of DVT- 3 key things?
- Subcutaneous low molecular weight heparin
o Compression stockings
o Lifestyle advice
- Lose weight
- Move around/exercise on long haul travel
- Stop oral contraceptive/HRT
Short case: signs indicating compartment syndrome
- Absent sensation
- Absent pulses distal to swelling
- Tense, shiny, red, swollen
- Painful on passive movement (not on joints)
What is compartment syndrome and what can it cause?