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DVT ppt.pptx

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DVT ppt.pptx

  1. 1. Deep Vein Thrombosis Dr Mahmood Emergency Medicine Resident MEM
  2. 2.  A 67 old male patient presented with c/o painful swelling of left lower limb since 5-6 days  h/o trauma to left lower limb 3 days back  Past history: nil  No H/o: chest pain, SOB  General examination: -PR: 82/mins -RR:20/mins -Bp: 130/90mmhg -Sp02: 98% on RA  Systemic examination: -RS: bilateral air entry -CVS: s1+, s2+ -P/A: soft. BS+ L/E: swelling of left lower limb foot to thigh, tenderness +, movements+, peripheral pulses+
  3. 3.  CBP: normal,  TLC: 17,000  Bleeding time and clotting time : normal  2D-echo: -no RWMA, -good LV function , -IVC collapsing  Color Doppler of venous system of left lower limb performed -Impression: intramural echogenic contents with absent color flow uptake in distal SFV and popliteal vein s/o DVT
  4. 4.  A 45 years old male patient presented with complaints of right lower limb painful swelling since 4 days. - Sudden onset, - Increasing gradually - Sever cramping pain in calf and thigh - increased on walking and movement of the limb  h/o left sided nephrectomy 5 days back for left side renal cell carcinoma (RCC)  h/o chronic tobacco chewing  No h/o of chest pan , SOB , abdomen pain  No family history of VTE
  5. 5.  General examination: -PR: 92/mins -Bp: 140/90mmhg -RR:20/mins -Sp02: 98% on RA  Systemic examination: -RS: bilateral air entry -CVS: s1+, s2+ -P/A: soft. BS+, scar of nephrectomy is seen over left lumbar L/E: Swelling and redness over right lower limb from foot to thigh, no dilated , engorged veins , skin is stretched and shiny
  6. 6.  Duplex ultrasound: Impression: Common femoral ,deep femoral, popliteal and posterior tibial vein show echogenic thrombus and absent flow . s/o DVT  2D-echo: -no RWMA, -good LV function , -IVC collapsing
  7. 7.  Surgical Management: - Debridment of wound + IVC filter placement done  Medical management : -Tab ciplox (ciprofloxacin) 500 mg bd -Tab ultracet (paracetamol+ tramadol) 1 tab bd -Tab bevon tab od -Tab pradaxa (dabigatran)150mg bd x 1month -Tab dolo (paracetamol) 650 tid  Advise: -Left lower limb elevation -High protein diet
  8. 8.  Introduction  Etiology  Risk factors  Clinical features  Complications  Diagnostic procedures  Management  Prevention  Differentials  References
  9. 9.  Deep vein thrombosis (DVT) is the formation of a blood clot in a deep vein most commonly seen n the legs or in the arms
  10. 10.  Provoked DVT: DVT where there is an identifiable risk factor that likely caused the DVT.  Unprovoked DVT: DVT where there is no identifiable risk factor that likely caused the DVT
  11. 11.  DVT usually originates in the lower extremity venous system, starting at the calf and progressing proximally to involve popliteal, femoral or iliac system  80-90% pulmonary emboli originates here
  12. 12.  An intimal defect often works as nidus for clot formation  Initially a platelet aggregate develops, subsequently clotting factors through intrinsic and extrinsic pathway fibrin and red cells form a mesh until the lumen clot occludes the vein wall.
  13. 13.  Age: incidence increase with advancing age  Obesity: > BMI > is DVT  Prolonged bed rest ( 4days or more)  Lower limb fracture: a cast on the leg  limb paralysis  Extended travel (>4 hours)
  14. 14.  Acquired: - Surgery and trauma are responsible for upto 40% of all thromboembolic disease - Malignancy - Hormonal therapy, OCP - Pregnancy - Nephrotic syndrome - Antiphospholipid antibody syndrome - SLE, IBD
  15. 15.  Inherited : - Factor V Leiden mutation - Antithrombin deficiency - Protein C, S deficiency - Prothrombin 20210 gene variant - Homocysteinemia
  16. 16.  Trauma  Surgery  Peripheral and central lines
  17. 17.  Calf pain or tenderness or both  Swelling wit pitting edema  Increase in local temperature  Redness or discoloration  Dilatation of superficial veins
  18. 18.  Less frequent manifestations of DVT includes  Phlegmasia cerulea dolens  Phlegmasia alba dolens  Venous gangrene
  19. 19.  Extensive DVT of the major axial deep venous channels of the lower extremity with relative sparing if collateral veins  The leg becomes blue in color, swollen and painful  Which may result in venous gangrene.
  20. 20.  When the thrombosis extends to the collateral veins, massive fluid sequestration and significant edema  a/k/a Milk leg or white leg  The leg is pale and cold, secondary to arterial insufficiency,  Extremely tender
  21. 21.  Homan’s sign: - Pain in the calf region or knee with forced dorsiflexion
  22. 22.  Moses / Bancroft’s sign: - Gentle squeezing of the lower part of the calf from - side to side causes sever pain  Lowenberg sign: - Pain is elicited rapidly when a blood pressure cuff is placed and around the calf and inflated to 80mmhg
  23. 23.  Clinical examination alone is able to confirm only 20-30%cases of DVT  Blood test : - D-Dimer test - Coagulation profile - Routine hematological investigation  Imaging studies  ECG and 2D echo
  24. 24.  D-dimer: - D- dimer is a degradation product of fibrin cross-linking - And elevated D- dimer level can occur when blood clots are being formed. It can also be elevated in other conditions unrelated to DVT (cancer, pregnancy, recent surgery) - The cutoff value for normal D-dimer is <500mcg/L
  25. 25.  Non invasive: - Duplex ultrasound - Plethysmography - MRI techniques
  26. 26. Invasive: - Venography - Radio labeled fibrinogen
  27. 27.  Indications:  When anticoagulant therapy is ineffective  Unsafe  Contraindicated  The major surgical procedures for DVT are clot removal and partial interruption of the inferior vena cava to prevent pulmonary embolism.
  28. 28.  Inferior vena cave filter: it’s a type of vascular filter into inferior vena cava to prevent life-thraetening pulmonary embolism.  Indication:  Pulmonary embolism with contraindication to anticoagulation.  Recurrent pulmonary embolism despite adequate anticoagulation.
  29. 29.  Pulmonary embolism (PE): PE is a potentially life-threatening complication associated with DVT. Sudden shortness of breath, chest pain while inhaling and coughing up blood may occur with PE.  Post-phlebitic syndrome:  which manifest as leg pain and swelling, skin discoloration and skin sores.  Treatment complication: Bleeding ( hemorrhages).  Recurrent DVT  Chronic venous insufficiency  Paradoxic emboli
  30. 30.  Do regular walking  Limiting the amount of time you spend sitting  Exercising daily, mainly walking, swimming or other activities that promote good blood circulation.  Avoid wearing tight- fitting clothes for extended periods.  Drinking lots of fluids
  31. 31.  Consuming foods that acts as natural blood thinners to reduce the risk of developing blood clots, such as vitamin–E, ginger, cayenne pepper, garlic, turmeric and cinnamon  Wearing Elastic compression stockings  Lower your blood pressure with dietary changes, like reducing your salt and sugar intake.  Lose weight if overweight  Quit smoking
  32. 32.  Muscular tear  Rupture of a Baker’s cyst  Cellulites or other infection  Thrombophlebitis  Tumors  Connective tissue disorders
  33. 33.  Tintinallis emergency medicine  Rosens emergency medicine  Dutton. Orthopedic examination, evaluation and intervention  Belly and love surery  Medscape
  34. 34. Thank you