MANAGEMENT OF DVT  DR SANJAY H SHARMA    SPECIALIST A&E   KHOULA HOSPITAL
DEEP VEIN THROMBOSIS• PASSENGERS, WHO SIT IMMOBILE FOR    HOURS ON LONG DISTANCE FLIGHTS ARE    PRONE TO DEEP VEIN THROMBO...
VIRCHOWS TRIAD              ENDOTHELIAL INJURY              THROMBOSIS  ABNORMAL BLOOD FLOW                 HYPERCOAGULABI...
THROMBOSIS•   VIRCHOWS TRIAD•   1. ENDOTHELIAL INJURY•   INJURY TO ENDOTHELIUM CAN BE CAUSED    BY•   ATHEROSCLEROSIS•   H...
ALTERATION IN BLOOD FLOW• STASIS IS A MAJOR FACTOR IN    DEVELOPMENT OF VENOUS THROMBI.•   NORMAL BLOOD FLOW IS LAMINAR , ...
STASIS AND TURBULENCECONTRIBUTE TO THROMBOSIS•   CAUSES ARE•   ULCERATED ATHEROSCLEROSIS•   ANEURYSMS•   MYOCARDIAL INFARC...
HYPERCOAGULABILTY• PRIMARY CAUSES:• MUTATION IN THE FACTOR V GENE WHICH    CAUSES FUNCTIONAL DEFICENCY OF    PROTEIN C.•  ...
VENOUS THROMBOSIS• IS ALWAYS OCCLUSIVE• THE THROMBUS OFTEN CREATES A LONG    CAST OF THE VEIN LUMEN .•   VENOUS THROMBI FO...
FATE OF THROMBUS• IF A PATIENT SURVIVES , THROMBI   UNDERGO COMBINATION OF FOLLOWING   FOUR EVENTS:1. PROPAGATION : THE TH...
DEEP VENOUS THROMBI• DEEP THROMBI IN THE LARGER LEG VEINS    ARE MORE SERIOUS AS THEY CAN    EMBOLIZE.( POPLITEAL, FEMORAL...
DVT OCCURS IN VARIERTY OFCLINICAL SETTINGS• CARDIAC FAILURE:DUE TO VENOUS STASIS• TRAUMA , SURGERY, BURNS RESULTS IN    RE...
CLINICAL FEATURES OF DVT• VENOUS THROMBOSIS MAY OCCUR IN    WOMEN TAKING ORAL CONTRACEPTIVES.•   ENFORCED BED REST AFTER S...
CLINICAL FEATURES• FORCEFUL DORSIFLEXION OF THE FOOT    WILL CAUSE PAIN IN THE CALF MUSCLE    ( HOMAN SIGN)•   SOMETIMES E...
OPERATION FOR DEEP VEINTHROMBOSIS• ILIOFEMORAL VENOUS  THROMBECTOMY• CAVAL CLIPPING• INSERTION OF  UMBRELLA FILTER
OPERATION FOR POSTTHROMBOTIC SYNDROME• SAPHANEOUS TRANSPOSITION• PROFUNDA FEMORIS TRANSPOSITION• CAVAL AND ILIAC VEIN BYPA...
REFERENCES• ROSEN’S EMERGENCY MEDICINE 5TH  EDITION• DAVIDSON’S PRINCIPLE AND  PRACTICE OF MEDICINE 16TH EDITION• HUTCHISO...
REFERENCES• CLINICAL ANATOMY BY RICHARD S SNELL    7TH EDITION•   BASIC PATHOLOGY BY KUMAR AND    ROBBINS 6TH EDITION•   C...
Dvt
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Dvt

  1. 1. MANAGEMENT OF DVT DR SANJAY H SHARMA SPECIALIST A&E KHOULA HOSPITAL
  2. 2. DEEP VEIN THROMBOSIS• PASSENGERS, WHO SIT IMMOBILE FOR HOURS ON LONG DISTANCE FLIGHTS ARE PRONE TO DEEP VEIN THROMBOSIS IN THE LEG.• DVT MAY GIVE RISE TO MILD PAIN OR TIGHTNESS IN THE CALF MUSCLES.• DVT CAN BE ASYMPTOMATIC• THROMBUS DISLODGED CAUSES PULMONARY EMBOLISM.• PREVENTIVE MEASURE INCLUDES STRECHING OF LEGS EVERY HOUR.
  3. 3. VIRCHOWS TRIAD ENDOTHELIAL INJURY THROMBOSIS ABNORMAL BLOOD FLOW HYPERCOAGULABILITY
  4. 4. THROMBOSIS• VIRCHOWS TRIAD• 1. ENDOTHELIAL INJURY• INJURY TO ENDOTHELIUM CAN BE CAUSED BY• ATHEROSCLEROSIS• HYPERTENSION• HYPERCHOLESTEROLEMIA• RADIATION INJURY• SMOKING
  5. 5. ALTERATION IN BLOOD FLOW• STASIS IS A MAJOR FACTOR IN DEVELOPMENT OF VENOUS THROMBI.• NORMAL BLOOD FLOW IS LAMINAR , CELLULAR ELEMENTS FLOW CENTRALLY AND PLASMA IN PERIPHERY.• STASIS AND TURBULENCE DISRUPTS LAMINAR FLOW OF BLOOD• PREVENT DILUTION OF ACTIVATED CLOTTING FACTOR.
  6. 6. STASIS AND TURBULENCECONTRIBUTE TO THROMBOSIS• CAUSES ARE• ULCERATED ATHEROSCLEROSIS• ANEURYSMS• MYOCARDIAL INFARCTION “: DUE TO REGIONS OF NON CONTRACTILE MYOCARDIUM THERE IS STASIS OF BLOOD WHICH HELPS IN FORMATION OF MURAL THROMBUS.• MITRAL VALVE STENOSIS• ATRIAL FIBRILLATION
  7. 7. HYPERCOAGULABILTY• PRIMARY CAUSES:• MUTATION IN THE FACTOR V GENE WHICH CAUSES FUNCTIONAL DEFICENCY OF PROTEIN C.• SECONDARY CAUSES:• CCF• TRAUMA• ORAL CONTRACEPTIVES• SMOKING• OBESITY
  8. 8. VENOUS THROMBOSIS• IS ALWAYS OCCLUSIVE• THE THROMBUS OFTEN CREATES A LONG CAST OF THE VEIN LUMEN .• VENOUS THROMBI FORM IN SLOWLY MOVING VENOUS BLOOD , THEY TEND TO CONTAIN ERYTHROCYTES THEREFORE KNOWN AS RED OR STASIS THROMBI.• 90 % OF CASES AFFECTS THE VEINS OF LOWER LIMB.
  9. 9. FATE OF THROMBUS• IF A PATIENT SURVIVES , THROMBI UNDERGO COMBINATION OF FOLLOWING FOUR EVENTS:1. PROPAGATION : THE THROMBUS ACCUMULATE MORE PLATELET AND FIBRIN , OBSTRUCTING VESSEL.2. .EMBOLIZATION : THROMBI MAY DISLODGE AND BE TRANSPORTED TO OTHER SITES IN THE VASCULATURE.3. .DISSOLUTION: THROMBI MAY BE REMOVED BY FIBRINOLYTIC ACTIVITY.4. .ORGANIZATION AND RECANALIZATION : THROMBI MAY INDUCE INFLAMMATION AND FIBROSIS
  10. 10. DEEP VENOUS THROMBI• DEEP THROMBI IN THE LARGER LEG VEINS ARE MORE SERIOUS AS THEY CAN EMBOLIZE.( POPLITEAL, FEMORAL AND ILIAC VEINS)• DVT CAN CAUSE EDEMA OF FOOT AND ANKLE AND PRODUCE PAIN AND TENDERNESS• HALF OF CASES ARE ASYMPTOMATIC.• VENOUS OBSTRUCTION IS COMPENSATED BY OPENING COLLATERALS.•
  11. 11. DVT OCCURS IN VARIERTY OFCLINICAL SETTINGS• CARDIAC FAILURE:DUE TO VENOUS STASIS• TRAUMA , SURGERY, BURNS RESULTS IN REDUCED PHYSICAL ACTIVITY.• ADVANCED AGE, BED REST, IMMOBILIZATION INCREASES RISK OF DVT.• REDUCED PHYSICAL ACTIVITY DIMINISHES THE MILKING ACTION OF MUSCLES IN THE LOWER LEG AND SO SLOWS VENOUS RETURN.
  12. 12. CLINICAL FEATURES OF DVT• VENOUS THROMBOSIS MAY OCCUR IN WOMEN TAKING ORAL CONTRACEPTIVES.• ENFORCED BED REST AFTER SURGERY.• CARDIAC FAILURE ALSO LEADS TO VENOUS STASIS AND THROMOSIS.• AFFECTED LIMB IS SWOLLEN, TENDER , WARMER THEN NORMAL• DILATED SUPERFICIAL VEINS MAY BE SEEN WHICH DO NOT COLLAPSE AFTER ELEVATION.•
  13. 13. CLINICAL FEATURES• FORCEFUL DORSIFLEXION OF THE FOOT WILL CAUSE PAIN IN THE CALF MUSCLE ( HOMAN SIGN)• SOMETIMES EXTENSION OF DVT UPWARDS TO THIGH MAY LEAD TO TENDER , HARD . PALPABLE FEMORAL VEIN .• PULMONARY EMBOLISM MAY BE FIRST CLINICAL MANIFESTATION OF DVT
  14. 14. OPERATION FOR DEEP VEINTHROMBOSIS• ILIOFEMORAL VENOUS THROMBECTOMY• CAVAL CLIPPING• INSERTION OF UMBRELLA FILTER
  15. 15. OPERATION FOR POSTTHROMBOTIC SYNDROME• SAPHANEOUS TRANSPOSITION• PROFUNDA FEMORIS TRANSPOSITION• CAVAL AND ILIAC VEIN BYPASS GRAFTING• PLASTIC VENOCUFFS• AUTO GRAFT INSERTION
  16. 16. REFERENCES• ROSEN’S EMERGENCY MEDICINE 5TH EDITION• DAVIDSON’S PRINCIPLE AND PRACTICE OF MEDICINE 16TH EDITION• HUTCHISON’S CLINICAL METHODS 19TH EDITION
  17. 17. REFERENCES• CLINICAL ANATOMY BY RICHARD S SNELL 7TH EDITION• BASIC PATHOLOGY BY KUMAR AND ROBBINS 6TH EDITION• CUNNIGHAMS ANATOMY 15TH EDITION• GENERAL SURGICAL OPERATION BY RM KIRK 5TH EDITION• MEDICAL PHYSIOLOGY BY GUYTON 10 TH EDITION

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