Questions and Answers
What percentage of blood is carried by the superficial veins in the lower limb?
Which of the following is NOT a risk factor for developing lower limb DVT?
What complication is associated with lower limb deep vein thrombosis?
Which of the following factors is part of Virchow's Triad related to DVT?
Signup and view all the answers
Which patient factor most directly contributes to stasis in lower limb thrombosis?
Signup and view all the answers
What is the score range associated with low probability of DVT according to Wells' Criteria?
Signup and view all the answers
Which investigation is considered the gold standard for diagnosing pulmonary embolism?
Signup and view all the answers
What is the preferred method to reduce INR in patients on warfarin?
Signup and view all the answers
For how long should the first episode of DVT be treated with anticoagulants?
Signup and view all the answers
Which of the following factors adds the most points to the Wells' criteria score?
Signup and view all the answers
What INR range is desired for patients on warfarin to ensure delayed clotting of blood?
Signup and view all the answers
What condition is indicated by an alternative diagnosis that is more likely than DVT in the Wells' scoring?
Signup and view all the answers
What is the management strategy for anticoagulation during the first 5 days of treatment for DVT?
Signup and view all the answers
Which condition is most commonly associated with venous thrombosis?
Signup and view all the answers
What is a characteristic sign of phlegmasia cerulea dolens?
Signup and view all the answers
Which patient population is most likely to experience phlegmasia alba dolens?
Signup and view all the answers
What is Homan's sign used to indicate?
Signup and view all the answers
Which of the following is NOT a risk factor for the development of venous thrombosis?
Signup and view all the answers
Which veins are primarily involved in pulmonary embolism?
Signup and view all the answers
What is the primary cause of upper limb DVT associated with repetitive arm movements?
Signup and view all the answers
Which of the following is a feature of a post-thrombotic limb?
Signup and view all the answers
Which diagnostic method is used for primary upper limb DVT?
Signup and view all the answers
What is a common risk factor for developing post-thrombotic syndrome?
Signup and view all the answers
What is the most common cause of superficial thrombophlebitis?
Signup and view all the answers
Which type of prophylaxis is considered superior for DVT prevention?
Signup and view all the answers
Which symptom is NOT typically associated with superficial thrombophlebitis?
Signup and view all the answers
What is the primary management strategy for Paget schroetter disease?
Signup and view all the answers
Which group of patients is considered high risk for DVT?
Signup and view all the answers
Which of the following treatments is indicated for post-thrombotic limb?
Signup and view all the answers
Which intervention is part of mechanical prophylaxis for DVT?
Signup and view all the answers
Which agents are used for direct thrombolysis?
Signup and view all the answers
What is NOT a benefit of catheter-induced thrombolysis?
Signup and view all the answers
Which condition indicates the use of an IVC filter?
Signup and view all the answers
What complication is associated with IVC filters?
Signup and view all the answers
What distinguishes novel anticoagulants from traditional ones?
Signup and view all the answers
Which of the following is a reason for using a retrievable IVC filter?
Signup and view all the answers
Study Notes
Anatomy of Lower Limb Deep Veins
- Superficial veins carry 80% of blood: Peroneal, Anterior Tibial, and Posterior Tibial veins.
- These superficial veins unite to form the Femoral Vein.
Lower Limb Deep Vein Thrombosis (DVT)
- Semi-solid coagulum formation occurs in deep veins.
- Major complications include Pulmonary Embolism and Post Thrombotic Limb.
- Risk factors are categorized as stasis, hypercoagulability, and endothelial injury.
Patient Factors
- Age and Obesity increase risk.
- Immobility, Varicose veins, Pregnancy, and postpartum period are significant contributing factors.
- High-dose estrogen therapy also elevates risk.
Other Risk Factors
- Past experiences of DVT and pulmonary embolism.
- Conditions causing thrombophilia and presence of tumors.
Post Thrombotic Limb
- Affects about two-thirds of DVT patients.
- Characterized by varicosities in superficial veins and presence of clot in deep veins.
- Clinical features include varicose veins, skin pigmentation, and lipodermatosclerosis (inverted champagne bottle appearance).
- Higher risk with proximal DVT, inadequate anticoagulation, and recurrent DVT.
DVT Risk Groups & Prophylaxis
High-Risk Groups
- Major orthopedic surgery or pelvis/hip/lower limb fractures.
- Major abdominal/pelvic surgeries for cancer or in patients with prior thrombotic events.
- Significant trauma or immobilization leading to lower limb paralysis.
- Mechanical and pharmacological prophylaxis recommended.
Prophylaxis Types
- Pharmacological: Low Molecular Weight Heparin (LMWH) administered pre-surgery.
- Mechanical: Early ambulation and pneumatic compression stockings to reduce risk.
Wells' Criteria for DVT Prediction
- Scoring system ranges from 0 to over 2, indicating low (5%), moderate (17%), to high (17-53%) DVT probability.
- Various clinical signs including leg trauma, swelling, and presence of previous DVT contribute to scoring.
Investigations for DVT
- Doppler/Duplex scan is the first diagnostic tool.
- MRI is utilized if Doppler results are inconclusive for proximal veins.
Pulmonary Embolism
- Most frequent vein associated is the ilio-femoral vein.
- Clinical features include chest pain, dyspnea, increased jugular venous pressure, and decreased blood pressure.
- D-dimer test assists in ruling out DVT with high negative predictive value.
Management of DVT
- Anticoagulants are the main treatment to prevent clot propagation.
- Initial treatment includes LMWH combined with warfarin for the first five days, transitioning to warfarin alone afterward.
Duration of Anticoagulant Treatment
- First episode of DVT treated for 3 months, while recurrent DVT requires lifelong treatment.
- INR monitoring ensures desired anticoagulation levels are achieved.
Special Cases in Pregnancy
- LMWH is preferred for pregnant patients due to teratogenic risks associated with oral anticoagulants.
Upper Limb DVT
- Primary DVT may arise from repetitive arm movements (Paget-Schroetter disease).
- Secondary DVT is linked with thoracic outlet obstruction or cannula insertion.
Superficial Thrombophlebitis
- Mainly caused by IV line insertion leading to inflammation in superficial veins.
- Tenderness and cord-like swelling are typical features.
Prothrombotic States
- Various conditions can lead to increased thrombosis risk: trauma, malignancies, heart failure, recent myocardial infarction, paralysis, and certain syndromes.
Clinical Features of Venous Thrombosis
- Often asymptomatic, with unilateral presentation in majority of cases.
- Commonly affects calf and soleal veins.
Complications of Anticoagulation
- Indications for IVC filter include recurrent thromboembolism, DVT with contraindications to anticoagulation, and chronic pulmonary embolism.
Direct Thrombolysis
- This method dissolves clots with agents like streptokinase and urokinase, particularly beneficial in proximal DVT cases.
Novel Anticoagulants
- Newer anticoagulants such as Rivaroxaban and Apixaban require no monitoring.
Complications of IVC Filter
- Risks include migration, bleeding, and potential blockage of IVC by a clot.
- Management of IV fluids may be necessary for IVC blockage.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Explore the anatomy of lower limb deep veins and understand the condition known as Deep Vein Thrombosis (DVT). This quiz covers definitions, complications, and risk factors related to DVT, including Virchow's Triad. Test your knowledge about the blood circulation in the legs and associated medical concerns.
