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Flashcards in Swollen calf Deck (13)
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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
- Swelling
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?

(Modified) Wells


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:
WBCs- cellulitis
RBC- polycythaemia- can cause DVT
Increased platelets- cancer - causing DVT

- Clotting factors


Management of DVT- 3 key things?

o Anticoagulant
- Subcutaneous low molecular weight heparin
- Warfarin/DOAC
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?


-Volkmann's contracture


Management of allergic insect bite