This document discusses diseases of the veins in the extremities, including deep vein thrombosis (DVT), thrombophlebitis, varicose veins, and pulmonary embolism. It provides an overview of the pathogenesis, risk factors, clinical presentation, diagnosis and treatment of each condition. For DVT, localization, signs and symptoms are explained. Diagnostic tests for DVT include ultrasound and CT or MRI. Treatment involves anticoagulation medication or thrombolytic therapy. Complications of DVT can include pulmonary embolism. Superficial thrombophlebitis and varicose veins are also summarized.
This document presents information on two patient cases of deep vein thrombosis (DVT). The first case describes a 67-year-old male with left lower limb swelling and pain for 5-6 days who was found to have DVT in the distal superficial femoral vein and popliteal vein based on a Doppler ultrasound. The second case describes a 45-year-old male with right lower limb swelling and pain for 4 days who had a history of left nephrectomy and was also found to have DVT based on a Doppler ultrasound. Both patients were started on anticoagulation therapy.
The document summarizes key information about liver emergencies seen in the emergency department. It covers topics such as definitions of different types of liver failure (acute, chronic, fulminant), common causes of acute liver failure including paracetamol poisoning and viral hepatitis, complications of liver failure like encephalopathy and infections, criteria for liver transplantation in acute liver failure, management of acute liver failure including supportive care and transplantation, spontaneous bacterial peritonitis in patients with cirrhosis, and Budd-Chiari syndrome which is a rare cause of liver failure due to blockage of hepatic veins. Imaging modalities, investigations, and treatment approaches are also discussed for different liver conditions.
A 17-year-old male basketball player collapsed during practice and suffered cardiac arrest. An autopsy later revealed he had hypertrophic cardiomyopathy (HCM), a genetic heart condition where the heart muscle becomes abnormally thick. HCM is a leading cause of sudden cardiac death in young athletes. The patient had previously noticed some shortness of breath with exertion but it did not limit his activity. He was found to have a heart murmur as a child but it was never investigated. HCM causes the left ventricle to become thickened and stiff, which can obstruct blood flow out of the heart and cause heart failure, chest pain, arrhythmias, and sudden cardiac death.
This document discusses pulmonary thromboembolism (PE), which refers to blood clots (thrombi) traveling from deep veins to the lungs. Most clots originate in the lower extremities. Risk factors include inherited conditions, surgery, trauma, immobilization, cancer and pregnancy. PE can cause hypoxemia and pulmonary hypertension. Diagnosis involves clinical assessment, D-dimer testing, chest imaging like CT pulmonary angiogram (gold standard), ventilation-perfusion scanning and echocardiogram. Treatment aims to relieve symptoms and prevent complications like right heart strain.
Dilated cardiomyopathy is defined as dilatation and impaired contraction of the left ventricle not caused by ischemic or valvular heart disease. The document discusses the epidemiology, etiology, pathology, genetics, clinical features, diagnosis, and management of idiopathic dilated cardiomyopathy. Key points include:
- The annual incidence is 5-8 per 100,000 people with increased risk in males, blacks, and those with hypertension or chronic beta-agonist use.
- Causes include genetic mutations, viral infections, autoimmune diseases, and drugs. Pathology shows dilatation, myocyte hypertrophy and death, and extracellular matrix remodeling.
- Diagnosis involves ECG
Chest pain can have many potential causes. A thorough history and physical exam are important to help determine the likely diagnosis and guide appropriate testing. Key aspects of the history include characteristics of the pain such as location, radiation, onset and nature. The physical exam focuses on identifying potential causes of the pain or associated symptoms. Initial tests may include an ECG, blood tests, chest x-ray and echocardiogram to help differentiate causes such as heart disease, pulmonary embolism, pneumonia or musculoskeletal issues. Further tests are guided by the initial findings.
A 64-year-old man presented with sudden onset of pain and loss of sensation in his right leg. Examination found absent pulses, decreased sensation, and an inability to move his toes, indicating acute limb ischemia. The document discusses the etiology, pathophysiology, clinical evaluation, investigations including Doppler ultrasound and angiography, and treatment approaches for acute limb ischemia including thrombolytics, surgery, and amputation. The goal of therapy is to restore blood flow, preserve the limb if possible, and prevent recurrence through anticoagulation.
An overweight middle-aged man presented with acute shortness of breath, elevated blood pressure, coarse lung sounds, low oxygen saturation, and leg swelling. His initial evaluation found signs of severe congestive heart failure including pulmonary edema. Further assessment is needed to determine the underlying cause, guide treatment, and classify the type and severity of heart failure.
This document presents information on two patient cases of deep vein thrombosis (DVT). The first case describes a 67-year-old male with left lower limb swelling and pain for 5-6 days who was found to have DVT in the distal superficial femoral vein and popliteal vein based on a Doppler ultrasound. The second case describes a 45-year-old male with right lower limb swelling and pain for 4 days who had a history of left nephrectomy and was also found to have DVT based on a Doppler ultrasound. Both patients were started on anticoagulation therapy.
The document summarizes key information about liver emergencies seen in the emergency department. It covers topics such as definitions of different types of liver failure (acute, chronic, fulminant), common causes of acute liver failure including paracetamol poisoning and viral hepatitis, complications of liver failure like encephalopathy and infections, criteria for liver transplantation in acute liver failure, management of acute liver failure including supportive care and transplantation, spontaneous bacterial peritonitis in patients with cirrhosis, and Budd-Chiari syndrome which is a rare cause of liver failure due to blockage of hepatic veins. Imaging modalities, investigations, and treatment approaches are also discussed for different liver conditions.
A 17-year-old male basketball player collapsed during practice and suffered cardiac arrest. An autopsy later revealed he had hypertrophic cardiomyopathy (HCM), a genetic heart condition where the heart muscle becomes abnormally thick. HCM is a leading cause of sudden cardiac death in young athletes. The patient had previously noticed some shortness of breath with exertion but it did not limit his activity. He was found to have a heart murmur as a child but it was never investigated. HCM causes the left ventricle to become thickened and stiff, which can obstruct blood flow out of the heart and cause heart failure, chest pain, arrhythmias, and sudden cardiac death.
This document discusses pulmonary thromboembolism (PE), which refers to blood clots (thrombi) traveling from deep veins to the lungs. Most clots originate in the lower extremities. Risk factors include inherited conditions, surgery, trauma, immobilization, cancer and pregnancy. PE can cause hypoxemia and pulmonary hypertension. Diagnosis involves clinical assessment, D-dimer testing, chest imaging like CT pulmonary angiogram (gold standard), ventilation-perfusion scanning and echocardiogram. Treatment aims to relieve symptoms and prevent complications like right heart strain.
Dilated cardiomyopathy is defined as dilatation and impaired contraction of the left ventricle not caused by ischemic or valvular heart disease. The document discusses the epidemiology, etiology, pathology, genetics, clinical features, diagnosis, and management of idiopathic dilated cardiomyopathy. Key points include:
- The annual incidence is 5-8 per 100,000 people with increased risk in males, blacks, and those with hypertension or chronic beta-agonist use.
- Causes include genetic mutations, viral infections, autoimmune diseases, and drugs. Pathology shows dilatation, myocyte hypertrophy and death, and extracellular matrix remodeling.
- Diagnosis involves ECG
Chest pain can have many potential causes. A thorough history and physical exam are important to help determine the likely diagnosis and guide appropriate testing. Key aspects of the history include characteristics of the pain such as location, radiation, onset and nature. The physical exam focuses on identifying potential causes of the pain or associated symptoms. Initial tests may include an ECG, blood tests, chest x-ray and echocardiogram to help differentiate causes such as heart disease, pulmonary embolism, pneumonia or musculoskeletal issues. Further tests are guided by the initial findings.
A 64-year-old man presented with sudden onset of pain and loss of sensation in his right leg. Examination found absent pulses, decreased sensation, and an inability to move his toes, indicating acute limb ischemia. The document discusses the etiology, pathophysiology, clinical evaluation, investigations including Doppler ultrasound and angiography, and treatment approaches for acute limb ischemia including thrombolytics, surgery, and amputation. The goal of therapy is to restore blood flow, preserve the limb if possible, and prevent recurrence through anticoagulation.
An overweight middle-aged man presented with acute shortness of breath, elevated blood pressure, coarse lung sounds, low oxygen saturation, and leg swelling. His initial evaluation found signs of severe congestive heart failure including pulmonary edema. Further assessment is needed to determine the underlying cause, guide treatment, and classify the type and severity of heart failure.
PPI-INDUCED BICYTOPENIA: MATTER OF CONCERN by RxVichuZ! ;)RxVichuZ
This presentation deals with bicytopenia induced by proton pump inhibitors, that were reported and published as a Case Report by researchers from China.
References have been provided as a separate textbox under each slide, for extensive referencing into the same.
The document outlines several parameters for assessing quality of care in the intensive care unit (ICU). It discusses objective criteria for ICU admission including vital signs, laboratory values, imaging results, ECG findings, and physical exam findings. It also describes the roles and responsibilities of nurses in the ICU in monitoring patients, administering treatments, and advocating for patients. Key indicators of quality that are mentioned include mortality rates, complication rates, length of stay, adherence to best practices, rates of errors and infections, staff satisfaction, and patient satisfaction.
This document provides an overview of the management of hypertensive crisis. It begins with definitions of hypertensive urgency and emergency. It then covers etiology, pathophysiology, clinical evaluation, workup, and management. The goals of management are to lower blood pressure gradually in hypertensive urgencies, and more rapidly in emergencies to prevent end organ damage, while avoiding too rapid a drop in pressure. Drugs discussed for acute treatment include sodium nitroprusside, nicardipine, clevidipine, labetalol, and esmolol. Special scenarios like myocardial ischemia and aortic dissection are also addressed.
The document discusses Advance Trauma Life Support (ATLS). It describes ATLS as a general guideline for managing trauma patients that focuses on urgent problems during the critical "Golden Hour" period. The key components of ATLS include triage, primary survey and resuscitation (addressing ABCDE - Airway, Breathing, Circulation, Disability, Exposure), secondary survey to identify all injuries, and definitive care involving specialist treatment of injuries identified. The goal of ATLS is to prioritize assessment and rapid intervention for life-threatening injuries during the initial stages after trauma occurs.
1) Acute coronary syndromes (ACS) describe conditions caused by coronary plaque rupture and include ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina.
2) Plaque rupture triggers blood clot formation, which can partially or completely block blood flow to the heart. STEMI involves complete blockage, while NSTEMI and unstable angina involve partial blockages.
3) Diagnosis involves ECG, cardiac enzyme tests, and angiography. Treatment depends on diagnosis but commonly includes aspirin, blood thinners, beta-blockers, and procedures like thrombolysis or angioplasty to restore blood flow.
Hepato Renal Syndrome (HRS) is a form of kidney failure that occurs in patients with advanced chronic liver disease. It results from intense renal vasoconstriction caused by interactions between the systemic and portal circulatory systems. HRS has no underlying kidney pathology and typically develops spontaneously or in response to precipitating events like infections, bleeding, or large volume paracentesis. Diagnosis is based on criteria and HRS carries the worst prognosis of all liver disease complications. Treatment involves terlipressin and liver transplantation provides a definitive cure.
Sepsis – pathophysiology and managementVidhi Singh
- Sepsis is a systemic inflammatory response caused by infection that can progress to severe sepsis and septic shock. Severe sepsis is defined as sepsis with organ dysfunction, while septic shock involves hypotension refractory to fluid resuscitation along with lactate levels over 2 mmol/L despite fluid resuscitation.
- The pathophysiology involves an initial infection that triggers a systemic inflammatory response and release of cytokines and mediators, leading to endothelial damage, coagulation abnormalities, hypotension, and ultimately multiple organ dysfunction if not treated.
- Treatment involves early goal-directed therapy within 3-6 hours including antibiotics, fluid resuscitation, vasopressors, inotropes, and measures to optimize
Critical care medicine specializes in caring for the most seriously ill patients. These patients are best treated in an intensive care unit (ICU) staffed by experienced personnel. Some hospitals maintain separate units for special populations (eg, cardiac, trauma, surgical, neurologic, pediatric, or neonatal patients). ICUs have a high nurse:patient ratio to provide the necessary high intensity of service, including treatment and monitoring of physiologic parameters.
Neuroleptic malignant syndrome (NMS) is a life-threatening condition caused by the use of neuroleptic drugs characterized by mental status changes, rigidity, fever, and dysautonomia. Diagnosis requires exposure to neuroleptics and two of the four cardinal symptoms. Treatment involves stopping the causative agents, supportive care, and specific treatments like dantrolene or bromocriptine. Prognosis depends on severity and medical complications, with reported mortality rates of 5-20%.
This document discusses pulmonary embolism (PE). Some key points:
- PE causes 50,000-200,000 deaths annually in the US, with an incidence of 500,000 cases.
- Risk factors include stasis, injury to veins, and coagulation issues.
- PE occurs when clots, usually from deep leg veins, travel to the lungs and block vessels. This can strain the right ventricle.
- Symptoms include sudden dyspnea, tachycardia, chest pain, hemoptysis. No single symptom confirms PE.
- Diagnosis involves CXR, blood tests, V/Q scan, CT, and angiogram. ECG may show right
Postoperative complications and managementyoursshijo
This document discusses postoperative complications, their management, and assessments. It notes that complications can be general, like fever or infection, or specific to the type of surgery. Key time periods for complications are immediate postoperative, days 3-5, and after 5 days. The first postoperative assessment establishes baseline status and identifies any issues. Ongoing assessments monitor for complications and guide treatment. Factors like blood pressure, pain, and fluid balance must be considered.
The document discusses the mechanisms of secretory and osmotic diarrhea, describing how secretory diarrhea is caused by excessive electrolyte secretion into the intestinal lumen driven by bacterial toxins or prostaglandins, while osmotic diarrhea results from the presence of poorly absorbed carbohydrates or minerals in the intestinal lumen that draw water into the gut. It provides examples of specific causes for each type of diarrhea and explains the clinical manifestations and consequences of large volume diarrhea caused by secretory mechanisms.
Damage Control Resuscitation (DCR) is a systematic approach for managing major trauma patients at risk of exsanguinating hemorrhage. It incorporates permissive hypotension to minimize blood loss while hemorrhage is uncontrolled, haemostatic resuscitation using blood products instead of crystalloids to prevent coagulopathy, and early hemorrhage control through surgery. DCR aims to decrease mortality and morbidity by recognizing patients at risk of hemorrhagic shock, providing adequate tissue oxygenation through hypotensive resuscitation while limiting further blood loss and clot disruption, and preventing the triad of hypothermia, acidosis and coagulopathy through haemostatic resuscitation and blood product administration according to a
Approach to young hypertensive patientsChandan Kumar
1. The document discusses hypertension in young adults, including definitions of different types of elevated blood pressure (e.g. hypertensive urgency, emergency), risk factors, clinical presentation, causes (primary vs. secondary), evaluation approach, and ambulatory blood pressure monitoring.
2. Most young adults with hypertension have primary/essential hypertension with no identifiable cause, though secondary hypertension can occur in about 10% of cases. Evaluation aims to confirm the diagnosis, assess cardiovascular risk, detect target organ damage, and identify secondary causes.
3. Ambulatory blood pressure monitoring provides blood pressure readings outside the office and can help identify white coat hypertension or masked hypertension, which have implications for risk stratification and treatment.
22.2.2018 acute limb ischemia vs critical limb ischemiaMai Parachy
This document summarizes the key differences and management recommendations for acute limb ischemia (ALI) and critical limb ischemia (CLI). It defines ALI as an acute condition lasting less than 2 weeks characterized by severe limb hypoperfusion, while CLI is a chronic condition lasting over 2 weeks characterized by rest pain and non-healing wounds. For ALI, the recommended treatments include heparin, oxygen, analgesia, and emergent revascularization via catheter-directed thrombolysis or surgical embolectomy. For CLI, the recommendations include physiological testing, imaging to guide revascularization, and endovascular or open surgical procedures based on the lesion location. Revascularization aims to improve tissue perfusion and prevent amputation for
Deep vein thrombosis (DVT) and Pulmonary embolism (PE)Aminul Haque
Deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively referred to as venous thromboembolism (VTE), constitute a major global burden of disease.
This document provides an overview of cardiac trauma, including both blunt and penetrating trauma. It discusses the history of cardiac surgery and treatments. For blunt cardiac trauma, it covers injury patterns, roles of ECG, cardiac enzymes, radiology, and clinical management. Penetrating cardiac trauma has higher mortality than blunt trauma. Prehospital considerations are to scoop and run the patient. The document advises when emergency department thoracotomy may be indicated for resuscitation of penetrating trauma. It concludes with reminding readers to maintain a high suspicion for cardiac trauma.
Thrombotic and nonthrombotic pulmonary embolismGamal Agmy
This document discusses various types of pulmonary embolism including thrombotic, nonthrombotic, septic, fat, amniotic fluid, tumor, air, talc, cement, iodinated oil, and foreign body embolism. It provides details on multidetector CT findings of acute pulmonary embolism including the tram-track sign and rim sign seen on contrast-enhanced images. Imaging findings of chronic thromboembolic pulmonary hypertension include vascular abnormalities such as webs/bands and parenchymal abnormalities like bronchial artery dilatation and mosaic perfusion patterns.
This document provides information on a lecture for 5th year medical students on purulent inflammatory diseases of bones, joints, and soft tissues. The lecture covers topics such as acute hematogenous osteomyelitis, omphalitis, mastitis in newborns, necrotic phlegmon, lymphadenitis, and furuncles/carbuncles. Details are given on the pathogenesis, classification, clinical presentation, diagnosis, and treatment of these conditions.
PPI-INDUCED BICYTOPENIA: MATTER OF CONCERN by RxVichuZ! ;)RxVichuZ
This presentation deals with bicytopenia induced by proton pump inhibitors, that were reported and published as a Case Report by researchers from China.
References have been provided as a separate textbox under each slide, for extensive referencing into the same.
The document outlines several parameters for assessing quality of care in the intensive care unit (ICU). It discusses objective criteria for ICU admission including vital signs, laboratory values, imaging results, ECG findings, and physical exam findings. It also describes the roles and responsibilities of nurses in the ICU in monitoring patients, administering treatments, and advocating for patients. Key indicators of quality that are mentioned include mortality rates, complication rates, length of stay, adherence to best practices, rates of errors and infections, staff satisfaction, and patient satisfaction.
This document provides an overview of the management of hypertensive crisis. It begins with definitions of hypertensive urgency and emergency. It then covers etiology, pathophysiology, clinical evaluation, workup, and management. The goals of management are to lower blood pressure gradually in hypertensive urgencies, and more rapidly in emergencies to prevent end organ damage, while avoiding too rapid a drop in pressure. Drugs discussed for acute treatment include sodium nitroprusside, nicardipine, clevidipine, labetalol, and esmolol. Special scenarios like myocardial ischemia and aortic dissection are also addressed.
The document discusses Advance Trauma Life Support (ATLS). It describes ATLS as a general guideline for managing trauma patients that focuses on urgent problems during the critical "Golden Hour" period. The key components of ATLS include triage, primary survey and resuscitation (addressing ABCDE - Airway, Breathing, Circulation, Disability, Exposure), secondary survey to identify all injuries, and definitive care involving specialist treatment of injuries identified. The goal of ATLS is to prioritize assessment and rapid intervention for life-threatening injuries during the initial stages after trauma occurs.
1) Acute coronary syndromes (ACS) describe conditions caused by coronary plaque rupture and include ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina.
2) Plaque rupture triggers blood clot formation, which can partially or completely block blood flow to the heart. STEMI involves complete blockage, while NSTEMI and unstable angina involve partial blockages.
3) Diagnosis involves ECG, cardiac enzyme tests, and angiography. Treatment depends on diagnosis but commonly includes aspirin, blood thinners, beta-blockers, and procedures like thrombolysis or angioplasty to restore blood flow.
Hepato Renal Syndrome (HRS) is a form of kidney failure that occurs in patients with advanced chronic liver disease. It results from intense renal vasoconstriction caused by interactions between the systemic and portal circulatory systems. HRS has no underlying kidney pathology and typically develops spontaneously or in response to precipitating events like infections, bleeding, or large volume paracentesis. Diagnosis is based on criteria and HRS carries the worst prognosis of all liver disease complications. Treatment involves terlipressin and liver transplantation provides a definitive cure.
Sepsis – pathophysiology and managementVidhi Singh
- Sepsis is a systemic inflammatory response caused by infection that can progress to severe sepsis and septic shock. Severe sepsis is defined as sepsis with organ dysfunction, while septic shock involves hypotension refractory to fluid resuscitation along with lactate levels over 2 mmol/L despite fluid resuscitation.
- The pathophysiology involves an initial infection that triggers a systemic inflammatory response and release of cytokines and mediators, leading to endothelial damage, coagulation abnormalities, hypotension, and ultimately multiple organ dysfunction if not treated.
- Treatment involves early goal-directed therapy within 3-6 hours including antibiotics, fluid resuscitation, vasopressors, inotropes, and measures to optimize
Critical care medicine specializes in caring for the most seriously ill patients. These patients are best treated in an intensive care unit (ICU) staffed by experienced personnel. Some hospitals maintain separate units for special populations (eg, cardiac, trauma, surgical, neurologic, pediatric, or neonatal patients). ICUs have a high nurse:patient ratio to provide the necessary high intensity of service, including treatment and monitoring of physiologic parameters.
Neuroleptic malignant syndrome (NMS) is a life-threatening condition caused by the use of neuroleptic drugs characterized by mental status changes, rigidity, fever, and dysautonomia. Diagnosis requires exposure to neuroleptics and two of the four cardinal symptoms. Treatment involves stopping the causative agents, supportive care, and specific treatments like dantrolene or bromocriptine. Prognosis depends on severity and medical complications, with reported mortality rates of 5-20%.
This document discusses pulmonary embolism (PE). Some key points:
- PE causes 50,000-200,000 deaths annually in the US, with an incidence of 500,000 cases.
- Risk factors include stasis, injury to veins, and coagulation issues.
- PE occurs when clots, usually from deep leg veins, travel to the lungs and block vessels. This can strain the right ventricle.
- Symptoms include sudden dyspnea, tachycardia, chest pain, hemoptysis. No single symptom confirms PE.
- Diagnosis involves CXR, blood tests, V/Q scan, CT, and angiogram. ECG may show right
Postoperative complications and managementyoursshijo
This document discusses postoperative complications, their management, and assessments. It notes that complications can be general, like fever or infection, or specific to the type of surgery. Key time periods for complications are immediate postoperative, days 3-5, and after 5 days. The first postoperative assessment establishes baseline status and identifies any issues. Ongoing assessments monitor for complications and guide treatment. Factors like blood pressure, pain, and fluid balance must be considered.
The document discusses the mechanisms of secretory and osmotic diarrhea, describing how secretory diarrhea is caused by excessive electrolyte secretion into the intestinal lumen driven by bacterial toxins or prostaglandins, while osmotic diarrhea results from the presence of poorly absorbed carbohydrates or minerals in the intestinal lumen that draw water into the gut. It provides examples of specific causes for each type of diarrhea and explains the clinical manifestations and consequences of large volume diarrhea caused by secretory mechanisms.
Damage Control Resuscitation (DCR) is a systematic approach for managing major trauma patients at risk of exsanguinating hemorrhage. It incorporates permissive hypotension to minimize blood loss while hemorrhage is uncontrolled, haemostatic resuscitation using blood products instead of crystalloids to prevent coagulopathy, and early hemorrhage control through surgery. DCR aims to decrease mortality and morbidity by recognizing patients at risk of hemorrhagic shock, providing adequate tissue oxygenation through hypotensive resuscitation while limiting further blood loss and clot disruption, and preventing the triad of hypothermia, acidosis and coagulopathy through haemostatic resuscitation and blood product administration according to a
Approach to young hypertensive patientsChandan Kumar
1. The document discusses hypertension in young adults, including definitions of different types of elevated blood pressure (e.g. hypertensive urgency, emergency), risk factors, clinical presentation, causes (primary vs. secondary), evaluation approach, and ambulatory blood pressure monitoring.
2. Most young adults with hypertension have primary/essential hypertension with no identifiable cause, though secondary hypertension can occur in about 10% of cases. Evaluation aims to confirm the diagnosis, assess cardiovascular risk, detect target organ damage, and identify secondary causes.
3. Ambulatory blood pressure monitoring provides blood pressure readings outside the office and can help identify white coat hypertension or masked hypertension, which have implications for risk stratification and treatment.
22.2.2018 acute limb ischemia vs critical limb ischemiaMai Parachy
This document summarizes the key differences and management recommendations for acute limb ischemia (ALI) and critical limb ischemia (CLI). It defines ALI as an acute condition lasting less than 2 weeks characterized by severe limb hypoperfusion, while CLI is a chronic condition lasting over 2 weeks characterized by rest pain and non-healing wounds. For ALI, the recommended treatments include heparin, oxygen, analgesia, and emergent revascularization via catheter-directed thrombolysis or surgical embolectomy. For CLI, the recommendations include physiological testing, imaging to guide revascularization, and endovascular or open surgical procedures based on the lesion location. Revascularization aims to improve tissue perfusion and prevent amputation for
Deep vein thrombosis (DVT) and Pulmonary embolism (PE)Aminul Haque
Deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively referred to as venous thromboembolism (VTE), constitute a major global burden of disease.
This document provides an overview of cardiac trauma, including both blunt and penetrating trauma. It discusses the history of cardiac surgery and treatments. For blunt cardiac trauma, it covers injury patterns, roles of ECG, cardiac enzymes, radiology, and clinical management. Penetrating cardiac trauma has higher mortality than blunt trauma. Prehospital considerations are to scoop and run the patient. The document advises when emergency department thoracotomy may be indicated for resuscitation of penetrating trauma. It concludes with reminding readers to maintain a high suspicion for cardiac trauma.
Thrombotic and nonthrombotic pulmonary embolismGamal Agmy
This document discusses various types of pulmonary embolism including thrombotic, nonthrombotic, septic, fat, amniotic fluid, tumor, air, talc, cement, iodinated oil, and foreign body embolism. It provides details on multidetector CT findings of acute pulmonary embolism including the tram-track sign and rim sign seen on contrast-enhanced images. Imaging findings of chronic thromboembolic pulmonary hypertension include vascular abnormalities such as webs/bands and parenchymal abnormalities like bronchial artery dilatation and mosaic perfusion patterns.
This document provides information on a lecture for 5th year medical students on purulent inflammatory diseases of bones, joints, and soft tissues. The lecture covers topics such as acute hematogenous osteomyelitis, omphalitis, mastitis in newborns, necrotic phlegmon, lymphadenitis, and furuncles/carbuncles. Details are given on the pathogenesis, classification, clinical presentation, diagnosis, and treatment of these conditions.
Acute gastrointestinal infections (AGI);-a group of infectious diseases of different etiology (viral, bacterial, fungal, parasitic), characterized by fecal-oral route of transmission, primarily involving the gastrointestinal tract.
Among infectious diseases in children acute intestinal infections require special attention. Only acute respiratory illness exceed them by the spread of morbidity, and in the structure of mortality from infectious causes in Ukraine AGI take 2-3 place.
According to the WHO classification, all human diarrheal diseases are divided into infectious and noninfectious. Infectious diarrhea are divided into invasive (inflammatory, blood) and secretory (noninflammatory, watery).
A 65-year old male smoker presented with acute worsening of breathlessness. On examination, he had a pulse of 110 beats/min, blood pressure of 130/80 mmHg, and wheezing in both lungs. Chest X-ray and CT scan showed a pulmonary embolism. Risk factors for pulmonary embolism include inherited or acquired thrombophilias, endothelial injury, stasis, and hypercoagulability. Common symptoms are related to pulmonary infarction or nonthrombotic pulmonary embolism, which can masquerade as other illnesses, complicating diagnosis.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Pulmonary embolism presenation by Henok OnchoHenok Oncho
A pulmonary embolism is a blockage in the lungs caused by a blood clot that forms elsewhere in the body and travels through the bloodstream. Symptoms include shortness of breath, chest pain, and anxiety. Diagnosis involves tests like CT scans, ventilation-perfusion scans, and pulmonary angiograms. Treatment focuses on anticoagulant medications like heparin to prevent further clotting and reduce the risk of additional embolisms. Nursing care monitors the patient's oxygenation status and educates them on preventing future clots.
This document discusses deep vein thrombosis (DVT), including protocols for diagnosis and treatment. It presents three case studies of patients diagnosed with DVT and treated accordingly. Provoked and unprovoked DVT are defined, and it is noted that guidelines for extended anticoagulation consider these factors. Complications like post-thrombotic syndrome are also discussed. Treatment typically involves anticoagulation with heparin or warfarin. Lifestyle modifications and compression stockings may help prevent post-thrombotic syndrome.
This document discusses special features of diagnosing and managing purulent inflammation in children. It focuses on systemic inflammatory response syndrome (SIRS) and sepsis. Key points include:
- SIRS is an immune response to infection characterized by systemic inflammation. Sepsis is SIRS plus a documented infection. Severe sepsis involves organ dysfunction.
- Early diagnosis and treatment of the infection site is important to clear microorganisms from the blood and prevent organ damage. Empiric broad-spectrum antibiotics are initially used.
- Specific conditions covered include acute hematogenous osteomyelitis (bone infection spread via blood), which typically involves long bones and is usually caused by Staphylococcus aureus.
1. The document discusses various diseases that affect the external nose and nasal vestibule including nasal deformities, meningoencephalocele, glioma, benign and malignant tumors, furuncle, and vestibulitis.
2. Common nasal deformities include saddle nose, hump nose, crooked nose, and deviated nose which can be corrected through rhinoplasty or septorhinoplasty.
3. Meningoencephalocele is a herniation of brain tissue through a congenital bony defect, while glioma is a residual portion of encephalocele.
4. Benign tumors include rhinophyma and papilloma, while basal cell
This document provides an overview of pulmonary embolism (PE), including its definition, risk factors, types, natural history, symptoms, signs, investigations, diagnosis, and management. PE is defined as obstruction of the pulmonary artery or its branches by material such as thrombus. It discusses diagnostic tests like CT, VQ scan, echocardiogram and their role in determining pretest probability. Management involves anticoagulation with drugs like heparin, warfarin, rivaroxaban. Thrombolysis may be used for massive PE while inferior vena cava filters can be placed in patients who cannot receive anticoagulation.
The postpartum period lasts 6 weeks after childbirth. During this time, the body undergoes both retrogressive and progressive changes. Psychologically, most women experience the taking-in, taking-hold, and letting-go phases as they adjust to their new role as parents. Nursing care focuses on assessment and support of the physiological changes like uterine involution and lactation. Pain management, nutrition, and ensuring adequate rest are also priorities in the postpartum period.
Acute pulmonary embolism - risk stratification and managementPrithvi Puwar
what is the guideline recommendation and ideal to be done in management of acute pulmonary embolism. the presentation includes risk stratification, recommendation and approach to investigations (guidelines based) and management options with evidence.
Deep Venous Thrombosis and Pulmonary Embolism : Diagnostic Approach and Curre...Bassel Ericsoussi, MD
This document summarizes guidelines for diagnosing and treating deep vein thrombosis (DVT) and pulmonary embolism (PE). It discusses the clinical presentation and risk factors for PE. Diagnostic tests covered include D-dimer, ventilation-perfusion scanning, ultrasound, and CT angiography. Biomarkers like BNP and troponin are also reviewed. Treatment guidelines and prognostic factors like right ventricular dysfunction are outlined.
The document discusses pulmonary embolism, which is the blockage of pulmonary arteries by blood clots or other materials. It defines pulmonary embolism and discusses its incidence, risk factors including deep vein thrombosis, clinical features such as chest pain and dyspnea, pathophysiology involving right heart strain, diagnostic studies, and treatment including anticoagulation with heparin and warfarin as well as surgical interventions in severe cases.
The document discusses various diseases and conditions that can affect the external nose and nasal vestibule. It describes cellulitis, nasal deformities like saddle nose and hump nose, and various types of tumors including dermoid cysts, encephaloceles, and basal cell carcinoma. It also discusses injuries to the nose including nasal fractures and injuries to the paranasal sinuses. Other conditions mentioned include furuncles, vestibulitis, stenosis of the nares, and epistaxis (nosebleeds). The treatments involve antibiotics, steroids, surgery, and procedures to repair nasal fractures and deformities.
- Pulmonary embolism affects approximately 500,000 individuals per year in the US, with around 50,000 deaths annually.
- Deep vein thrombosis accounts for over 95% of pulmonary emboli. Risk factors for DVT and thus PE include surgery, trauma, cancer, prolonged immobility, and genetic or acquired hypercoagulable states.
- Diagnosis is suggested by symptoms like dyspnea and chest pain but requires imaging tests like CT pulmonary angiogram, ventilation-perfusion scanning, or echocardiogram to confirm the presence of emboli. Treatment involves anticoagulation with heparin or warfarin.
This document discusses the clinical aspects of veins, including:
1) The anatomy of the venous system in the leg, including deep and superficial veins.
2) The physiology of venous blood flow, which is governed by arterial pressure, the calf musculovenous pump, gravity, and venous valves.
3) Common vein disorders like venous thrombosis, thrombophlebitis, and chronic venous insufficiency which can result from valve damage or reflux and cause complications like ulceration.
Deep vein thrombosis is a blood clot that forms in the deep veins, usually of the legs. It can dislodge and travel to the lungs, causing a pulmonary embolism. Risk factors include surgery, trauma, cancer, and prolonged immobility. Symptoms may include leg pain, swelling, redness, and warmth. Diagnosis involves assessing risk factors and testing such as ultrasound, venography, MRI, or D-dimer blood test. Treatment focuses on blood thinners to prevent clot growth and embolism.
Deep vein thrombosis is a blood clot that forms in the deep veins, usually of the legs. Risk factors include prolonged bed rest, surgery, trauma, cancer, and genetic hypercoagulable states. Symptoms include leg pain, swelling, and shortness of breath. Ultrasound is commonly used for diagnosis. Treatment involves anticoagulation with heparin or warfarin to prevent pulmonary embolism complications.
Deep vein thrombosis (DVT) is a blood clot that forms in the deep veins, usually of the legs. Virchow's triad describes the three main factors that contribute to DVT formation: venous stasis, hypercoagulability, and endothelial injury. Clinical signs of DVT include calf pain, swelling, and tenderness. Diagnosis involves a clinical prediction model like the Wells criteria along with D-dimer testing and ultrasound imaging. Treatment consists of anticoagulation with heparin or warfarin to prevent pulmonary embolism and further complications.
The document discusses deep vein thrombosis (DVT), including definitions, risk factors, clinical features, diagnosis, treatment, and prevention. DVT is the presence of a blood clot in a deep vein, most commonly in the legs, and can cause pulmonary embolism if parts of the clot break off and travel to the lungs. Risk factors include surgery, trauma, cancer, older age, and genetic or acquired hypercoagulable states; treatment involves anticoagulation with blood thinners like heparin and warfarin.
Deep vein thrombosis (DVT) is a blood clot that forms in the deep veins, usually of the legs. It can be asymptomatic or cause leg pain, swelling, warmth, and redness. Risk factors include prolonged bed rest, surgery, cancer, and inherited or acquired hypercoagulable states. Diagnosis involves the Wells criteria for pre-test probability followed by D-dimer testing and duplex ultrasound imaging of the legs. Treatment aims to prevent pulmonary embolism and includes bed rest, leg elevation, compression stockings, and anticoagulation medications like heparin or warfarin. Differential diagnoses include cellulitis, arthritis, and peripheral edema from other causes.
Venous thromboembolism refers to blood clots forming in the veins, which can break off and travel to the lungs (pulmonary embolism). Deep vein thrombosis is a blood clot that forms deep in the leg veins and can progress upwards. Superficial vein thrombosis involves shallow leg veins near the skin surface. Risk factors include surgery, trauma, cancer, genetic conditions. Symptoms include leg pain/swelling. Diagnosis involves D-dimer testing and ultrasound imaging of leg veins. Treatment is blood thinners to prevent clot growth and embolism.
This document discusses hemostasis, thrombosis, pulmonary embolism, risk factors, diagnosis, and treatment of venous thromboembolism. It defines key terms like thrombus, embolus, and saddle pulmonary embolism. Diagnostic tests covered include D-dimer, ventilation-perfusion scan, and CTA. Treatment involves anticoagulants like heparin, LMWH, factor Xa inhibitors, and thrombolytic therapy. Long-term management uses warfarin or novel oral anticoagulants. Prophylaxis is also discussed.
Deep vein thrombosis (DVT) is a blood clot that forms in a deep vein, usually in the legs. The incidence of DVT ranges from 5-9 per 10,000 people annually. Risk factors include surgery, trauma, cancer, older age, and genetic conditions. Symptoms can include leg pain and swelling. Diagnosis involves blood tests, ultrasound imaging, or CT/MRI. Treatment aims to prevent clot growth and pulmonary embolism. Initial treatment includes anticoagulants like heparin or low molecular weight heparin. Long term treatment uses oral anticoagulants like warfarin for 3-6 months.
This document summarizes common venous disorders, including varicose veins, superficial thrombophlebitis, deep vein thrombosis (DVT), and their causes, risk factors, symptoms, diagnosis, and treatment. Some key points:
- Varicose veins are abnormally dilated and tortuous veins caused by increased pressure and valve incompetence. Risk factors include family history, pregnancy, and obesity. Treatment includes compression stockings, sclerotherapy, and surgery.
- DVT occurs when blood clots form in the deep veins, usually in the legs. It can cause leg swelling/pain and potentially fatal pulmonary embolism. Risk increases with age, surgery, trauma, cancer, and genetic factors. Ul
Venous thromboembolism is a condition where a blood clot forms in a vein. Deep vein thrombosis is a blood clot that forms in deep leg veins and can dislodge and travel to the lungs, called a pulmonary embolism. Risk factors include prolonged bed rest, surgery, cancer, pregnancy, oral contraceptives, and genetic conditions. Diagnosis involves a clinical assessment, D-dimer blood test, and ultrasound or venography imaging of the legs. Treatment consists of blood thinners like heparin and warfarin to prevent further clotting and embolism.
Inflammation of the lymph nodes, blood and lymph vessels. Inflammation of gla...shahajipawale0
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This document provides information on deep vein thrombosis (DVT), including its definition, risk factors, diagnosis, and treatment. Some key points:
- DVT is a blood clot (thrombus) that forms in a deep vein, usually in the legs. It can dislodge and cause a pulmonary embolism if it reaches the lungs.
- Risk factors for DVT include immobility, surgery, older age, and genetic or acquired hypercoagulable states. The Virchow's triad of factors contributing to clot formation are venous stasis, endothelial injury, and hypercoagulability.
- Diagnosis involves a clinical assessment, D-dimer testing
Deep venous thrombosis is the formation of a blood clot in the deep veins, usually in the legs. It can progress and cause a pulmonary embolism, a potentially life-threatening blockage in the lungs. Risk factors include prolonged bed rest, obesity, older age, and inherited or acquired hypercoagulable states. Diagnosis involves ultrasound, venography or MRI. Treatment is usually blood thinners to prevent clot extension and embolism.
This document provides information about deep vein thrombosis (DVT). It defines DVT as a blood clot that forms in a deep vein, usually in the leg. Risk factors include prolonged bed rest, surgery, cancer, and inherited coagulation disorders. Symptoms may include calf pain or swelling. Diagnosis is usually made using ultrasound imaging of the legs. Treatment involves blood thinners like heparin or warfarin to prevent clot growth and reduce risk of pulmonary embolism. Nursing care focuses on preventing stasis, monitoring for embolism signs, and providing comfort measures like leg elevation and compression stockings.
1) Deep vein thrombosis is a blood clot that forms in the deep veins, usually of the legs. It can break off and travel to the lungs, blocking blood flow (pulmonary embolism).
2) Risk factors include prolonged bed rest, surgery, cancer, and inherited or acquired hypercoagulable states. Symptoms include leg pain, swelling, warmth, and redness. Diagnosis involves a clinical evaluation along with D-dimer testing and ultrasound imaging of the legs.
3) Treatment focuses on blood thinners to prevent clot growth and reduce the risk of embolism. Left untreated, a DVT can lead to long-term leg damage or potentially fatal blockages in
This document discusses pulmonary embolism (PE), which occurs when a blood clot forms in the lungs. It defines PE, lists risk factors like immobilization and oral contraceptive use, and describes the two main types - thrombotic and non-thrombotic. Signs and symptoms include dyspnea, tachypnea, and hypoxemia. Diagnostic tests include D-dimer, CT scans, ventilation-perfusion scans, and angiograms. Treatment involves anticoagulants like heparin and warfarin to prevent further clotting. Nursing care focuses on monitoring for complications, managing pain and anxiety, and educating patients about anticoagulant therapy and risk reduction.
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1. Disease of veins of theDisease of veins of the
extremities.extremities.
Pulmonary embolismPulmonary embolism
2. PLAN OF LECTURE
1. Actuality of theme.
2. Acute deep vein thrombosis of the lower
extremities and pelvis.
3. Paget-Schroetter Syndrome
4. Thrombophlebitis of superficial veins of the
lower extremities.
5. Varicose veins of the lower extremities.
i. 6. Postthrombotic syndrome (disease) of the
lower extremities.
7. Pulmonary embolism.
3. Venous thromboembolic complications (deep
vein thrombosis, thrombophlebitis of superficial
veins, pulmonary embolism) are among the main
causes of postoperative mortality !!!
4. Deep Vein Thrombosis of the lower limbs
(phlebothrombosis, DVT)
Wirkhov Rudolf
Creation of blood clot in the deep
veins - PHLEBOTHROMBOSIS
PATHOGENESIS:
Virchow’s triad:
•The changes of the vascular wall
•Slower flow
•Increased blood coagulation
properties
8. DVT is distinguished
depending on their
localization in the
extremities
Anatomical (Proximal or Distal)
Lower Extremity Thrombosis
(LET)
- LET 1 (Calf veins AT , PT, PER)
- LET 2 (POPV, SFV, DFV)
- LET3 (Ilio - femoral)
LET4 ( Caval)
9. Thrombosis of inferior vena cava
Inferior vena cava filter
for the prevention of
pulmonary embolism
10. Lower extremity DVT - Clinic
The main complaints of patients:
•Swelling of the extremities (shin, hip - depending
on the height thrombosis)
•Pain in the calf muscles when walking, perhaps in
the hip and inguinal region during movements
•Cyanosis of the skin in distal extremities
•Asymptomatic course in immobilized patients is
possible
•Sometimes pulmonary embolism may be the first
symptom of DVT
11. Typical symptoms during examination
of the patients with DVT
•Swelling of the extremities
(measuring a circumference shins
and thighs on 3 levels must be done)
•Pain in according to the location of
the vascular trunk at the hips and
groin is present during palpation
•Change the color of the skin on
cyanotic (in case of arteries spasm -
pallor)
•Intensified picture of the
subcutaneous veins on the lower limb
12. The Homans' Sign for DVT
1. In the supine position, the knee of
the suspected leg of the patient
should be flexed
2. The examiner should then forcibly
and abruptly dorsiflex the patient's
ankle
3. The examiner observes whether or
not the patient reports pain in this
calf and popliteal region
* Pain indicates a positive sign.
13. Lowenberg’s test
A cuff from the
sphygmomanometer
is imposed on the leg.
If at pressure of 80-
100 mmHg a pain
arises in the tibia
muscle, then this test
is considered to be
positive.
14. Moses Test: tenderness over calf
muscles on squeezing the muscles
from side to side. Not done now for
the fear of embolism
15. Clinic of DVT of the upper extremity
Paget-Schroetter
Syndrome - thrombosis
of subclavian vein
18. DVT Treatment
IMMEDIATE START of entering of direct
anticoagulants intravenously or
subcutaneously (Heparin, preferably -
LMWH)
It is possible begin to appointment the
tablets of new modern oral anticoagulants
(RIVAROXABAN, DABIGATRAN)
Immobilization because of the risk of
pulmonary embolism
Elevated limbs position
Elastic compression
Duration of Anticoagulation - more than 3
months
19. DVT Treatment
In the case of phlegmasia cerulea dolens or DVT in
young people it is possible:
•systemic or catheter thrombolysis;
•opened thrombectomy from the veins of the thigh
and pelvis;
•fasciotomia or even amputation!
21. Etiology of acute thrombophlebitis
Most common it is on
base of varicose disease
Post Traumatic
Infection
Migratory
thrombophlebitis in the
patients with Buerger's
disease
Hypercoagulation
After vein catheterization
22. Acute thrombophlebitis - RISKS
Migration of
thrombus through
the femoral-
saphenous
junction or
through the veins-
perforators in deep
veins and
development of
phlebothrombosis
Festering of
the inflamed
varicose
nodule
PE
23. Acute thrombophlebitis - clinic
Painful SEALS on
surface of saphenous vein
Local signs of
inflammation
Low-grade fever
Swelling of the part of
extremity
Differentiation (cellulitis,
erysipelas, lymphangitis,
nodulus erythema,
allergic reaction)
24. Acute thrombophlebitis - DIAGNOSIS
ULTRASOUND
DIAGNOSTICS with
"Compression test"
gives 100%
confirmation of the
diagnosis and it is the
main method of
diagnosis prevalence
of thrombotic
process!!!
26. Acute thrombophlebitis
TREATMENT
If there is a local proces: anti-
inflammatory, anticoagulant, elastic
bandaging, active mode; locally -
application of semi-alcohol
bandages, anti-inflammatory gel.
If process is ascending and
thrombus is located about 3-5 cm to
the femoral-saphenous and
popliteal-saphenous junctions:
emergency operation (cross-ectomy,
vein-stripping) for the prevention of
transition of thrombotic process into
the deep veins and development of
pulmonary embolism.
27. Pulmonary embolism (PE)
PE remains one
of the most
frequent causes
of death in
surgical
hospitals in all
world!!!
28.
29. Thrombus gets into the
Pulmonary artery from
the venous system
(phlebothrombosis -
DVT; thrombophlebitis -
subcutaneous veins)
30. Pulmonary embolism - Clinic
1. Pain syndrome
2. The syndrome of acute respiratory failure
3. The syndrome of acute circulatory failure
(collaptoid)
4. The syndrome of acute right-ventriculus
failure
5. The syndrome of acute cardiac arrhythmias
6. syndrome acute coronary insufficiency
7. Cerebral syndrome
8. Abdominal syndrome
31. Pulmonary embolism - Clinic
The classic presentation of pulmonary
embolism is the abrupt onset of pleuritic chest
pain, shortness of breath, and hypoxia.
However, most patients with pulmonary
embolism have no obvious symptoms at
presentation. Rather, symptoms may vary from
sudden catastrophic hemodynamic collapse to
gradually progressive dyspnea. The diagnosis
of pulmonary embolism should be suspected in
patients with respiratory symptoms
unexplained by an alternative diagnosis.
32. PE
Signs and Symptoms
Patients with pulmonary embolism may present with atypical
symptoms, such as the following:
Seizures
Syncope
Abdominal pain
Fever
Productive cough
Wheezing
Decreasing level of consciousness
New onset of atrial fibrillation
Hemoptysis
Flank pain
Delirium (in elderly patients)
33. PE
Signs and Symptoms
Physical signs of pulmonary embolism include the
following:
Tachypnea (respiratory rate >16/min): 96%
Rales: 58%
Accentuated second heart sound: 53%
Tachycardia (heart rate >100/min): 44%
Fever (temperature >37.8°C): 43%
Diaphoresis: 36%
S 3 or S 4 gallop: 34%
Clinical signs and symptoms suggesting thrombophlebitis: 32%
Lower extremity edema: 24%
Cardiac murmur: 23%
Cyanosis: 19%
35. Pulmonary embolism - the basis of
instrumental diagnostics
CT angiography Pulmonary
scintigraphy
PULMONOGRAPHY
Overload in the right
heart on ECG and
Ultrasound
36. Pulmonary embolism - Treatment
1. Anticoagulation
(immediate 10 000 IU of
heparin intravenously),
followed by a choice of
anticoagulant (LMWH,
indirect oral
anticoagulants).
2. Thrombolytic therapy
(when there is decrise of
blood pressure and threat of
overload right heart).
3. Symptom therapy
(antibiotics, oxygen
therapy, monitoring ABP).
4. Surgical treatment
(embolectomy)
37. Varicose veins (varicose disease)
of the lower extremities
Varicose disease belongs to
chronic diseases of the veins
- suffer up to 60% of people
38.
39. The disease begins at an early age:The disease begins at an early age:
An examination of students Bochum High SchoolAn examination of students Bochum High School
(England) 10% reported that in age of 10 to 12 years they(England) 10% reported that in age of 10 to 12 years they
have found the first varicose veins andhave found the first varicose veins and
4 years later, 30% of these same young people were already4 years later, 30% of these same young people were already
had the signs of varicose veinshad the signs of varicose veins
The incidence depends on the age and sex:The incidence depends on the age and sex:
Men from 3% at age 30 years to 20%-50% aged over 70Men from 3% at age 30 years to 20%-50% aged over 70
yearsyears
Women from 20% at the age of 30 years to 50% aged over 70Women from 20% at the age of 30 years to 50% aged over 70
Varicose disease of the lower extremities
40. Varicose disease of the lower extremities -
etiology and pathogenesis
• They are placed throughout
the length of the veins of the
lower extremities
•The normal outflow of venous
blood flow is always
unidirectional and rising
•Venous valves prevent reverse
blood flow down
Normal venous outflow
41. Risk factors of development of the HVD
Favorable factors
Heredity
Female gender
Old age
Deep vein thrombosis
Adiposity
Hormonal factors
Pregnancy
The use of oral contraceptives
Lifestyle
Long-term stay in a standing or
sitting position
Sedentary lifestyle
The food is poor in fiber
42. Change of blood flow
Genetic predisposition, risk factors
Chronic inflammation in the wall of the veins and valves
Remodeling of the walls of veins and valves
Incompetence of the valves anf blood reflux
HVD
Adapted from JJ Bergan et al. N Engl J Med 2006 355:488-498
Venous hypertension and inflammation are the base ofVenous hypertension and inflammation are the base of
all symptoms and signs HVDall symptoms and signs HVD
43. 1. Failure of
saphenous-femoral
anastomosis
2. Reflux in
perforating veins
3. Failure of
saphenous-popliteal
anastomosis
4. Blood reflux
through the varicose
veins
Blood reflux through the varicose veins
Varicose disease of the lower extremities -
etiology and pathogenesis
44. Varicose disease of the lower extremities - symptoms
PainPain
ItchinessItchiness
Feeling of heaviness in legsFeeling of heaviness in legs
Night crampsNight cramps
Feeling of edemaFeeling of edema
The symptom of Restless LegsThe symptom of Restless Legs
ParesthesiaParesthesia
Foot fatigueFoot fatigue
PulsationPulsation
Symptoms
They appear and / or amplified after prolonged stay in a
sitting position or standing in the heat, in the premenstrual
period, when taking a hot bath
45. CEAP classification
C0а The lack of visible or palpable signs of venous disease
C1а Reticulate veins and telangiectasia
Telangiectasia: conglomerate of the constantly dilated
subcutaneous veins less than 1 mm in diameter
Veins are like a net, cyanotic constantly dilated
subcutaneous veins, usually more than 1mm and less than 3
mm in diameter
C2а
Varicose veins
Permanently dilated subcutaneous vein
3 mm in diameter, standing
C0s The lack of visible or palpable signs of venous disease + symptoms
(pain, fullness, heaviness, itching, cramps)
C1s Telangiectasia or veins like a net +
symptoms
C2s
Varicose vein + symptoms
Clinical manifestations
46. CEAP classification
C4а Skin changes
a) Pigmentation: brown pigment darkening of the skin that
usually develops in the ankle, but may extend to the entire
foot and leg;
b) eczema, erythema, with bubbles, wet or scale-like skin
inflammation on legs;
c Lipodermatosclerosis: it is localized seal of skin sometimes
with contracture of the scar;
d) White atrophy: white colored and atrophic part of the skin,
often circular, that is surrounded by the spots of enlarged
capillaries and sometimes hyperpigmentation.
C3а Edema
Significant increasing the volume
of fluid in the subcutaneous tissue
C3s
Edema + symptoms
C4s
Skin changes + symptoms
47. CEAP classification
C5а Skin changes with healed ulcer
C6а
Skin changes
with opened ulcer
C5s
Skin changes with healed ulcer
+ symptoms C6s
Skin changes with opened
ulcer + symptoms
48. Etiological classification
Ес – congenital, congenital vein dysfunction
Ep – primary, acquired dysfunction of the veins
Es – secondary, dysfunction of the veins are secondary (PTS)
En – dysfunction veins are absent
49. Anatomical classification
As - superficial, damaged superficial veins
Ad - deep, deep veins damaged
Ap - perforating, perforating veins damaged
An - are not damaged veins
50. Pathophysiology Classification
Pr - reflux, clinical symptoms coursed by reflux of the blood
Po - obstruction, the clinical symptoms caused by occlusion
Pr, o - clinical symptoms caused by the both reasons
Pn - the lack of venous disorders
51. Varicose diseases - Treatment
Conservative therapyConservative therapy
- Compression therapy- Compression therapy
- Drug treatment- Drug treatment
Surgical treatmentSurgical treatment
- Open surgery- Open surgery
- Intravenously thermal radiofrequency ablation,- Intravenously thermal radiofrequency ablation,
sclerotherapysclerotherapy
52. Varicose diseases - Treatment
С1 С2 С3 С4 С5 С6С0
Зміна способу
життя
Консервативна
терапія
Компресійна
терапія
Місцеве
лікування
Склеротерапія,
хірургічне
лікування
53. Elastic crepe bandage – stockings
20-30 mm Hg
Elevation of limbs
Above the level of heart
Graded compression stockings
55. Calcium dobesilate monohydrate
500mg
Improves lymph flow, reduce
edema;
1 capsule twice in a day for 3
weeks and followed by 1 capsule
once a day at least for a month
after meals.
Diosmin + hesperidin (phlebotropic
drug)
Protects venous valves / anti
inflammatory
57. Varicose diseae - operative therapy, aimed at the
elimination of vertical and horizontal reflux of blood
flow
Small-traumatic
procedure of laser
ablation
Traditional venous
extraction
58. POST THROMBOTIC DISEASE (SYNDROME) - PTS
PTS, PTFS, PTFS -
severe pathology of
venous system caused
by the lesions of deep,
perforating and
saphenous veins of the
lower limbs as a result
of deep vein
thrombosis
62. PTS
diagnostics (the main - Ultrasound)
Occluded
Femoral vein
Insufficient
perforant vein
Phlebography with partly recanalized deep veins
63. PTS - treatment
С1 С2 С3 С4 С5 С6С0
Зміна способу
життя
Консервативна
терапія
Компресійна
терапія
Місцеве
лікування
Склеротерапія,
хірургічне
лікування
64. PTS - treatment
1. Surgical interventions
aimed at the elimination
of vertical and horizontal
refluxes of blood flow
2. In case of deep vein
obstruction -
reconstructive operations
3. If there is a valvular
insufficiency into the
large veins - correction of
valves
65. TREATMENT OF THE ULCERS
If ulcer is good
granulating, there is
no any signs of
infection, large size
ulcers - dermatoplasty
must be performed
Нарушения функции вен могут быть врожденными (congenital) (Ес), первичными (primary) (Ep), вторичными (secondary) (Es) или могут отсутствовать (En). Эти состояния являются взаимоисключающими. Врожденные нарушения, имеющиеся при рождении, могут быть распознаны в последующие периоды жизни. Их вклад в этиологию хронического заболевания вен составляет 1-3 %.
Первичные нарушения функции вен рассматриваются как нарушения, вызванные неизвестными причинами, но не являющиеся врожденными. Их вклад в этиологию наибольший и составляет 70-80 % всех случаев заболевания1.
Вторичные нарушения функции вен являются приобретенными, они вызваны хроническими заболеваниями вен, например тромбозом глубоких вен. Их вклад в этиологию составляет 18-25 %1.
Анатомически заболевание поражает поверхностные (superficial) (As), глубокие (deep) (Ad) или перфорантные (perforating) (Ap) вены. Могут наблюдаться любые сочетания.
Для более точной локализации поражения поверхностных, глубоких и перфорантных вен указывают их анатомические названия.
Клинические симптомы хронического заболевания вен, обусловленные только рефлюксом (reflux) (Pr), встречаются в 88 % случаев, только закупоркой вен (obstruction) (Po) — в 12 %, обеими причинами (Pr,o) — в 43 % случаев. Отсутствие нарушений венозного кровотока обозначают Pn. При диагнозе указывают только один фактор.