DVT.pptx

Lecture notes for medical students

1. Tips on using my ppt. You can freely download, edit, modify and put your name etc. Don’t be concerned about number of slides. Half the slides are blanks except for the title. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. At the end rerun the show – show blank> ask questions > show next slide. This will be an ACTIVE LEARNING SESSION x three revisions. Good for self study also. See notes for bibliography.

2. Learning Objectives

3. Learning Objectives Introduction & History Relevant Anatomy, Physiology Aetiology Pathophysiology Pathology Classification Clinical Features Investigations Management Prevention Guidelines Take home messages

4. Introduction & History.

5. Introduction What is DVT ?

6. Introduction Deep vein thrombosis is the formation of a blood clot in one of the deep veins of the body, usually in the leg.

7. What is clot / thrombus/ embolus

8. Introduction Thrombus is a  clot  that forms inside blood vessel or heart. A  thrombus  that breaks loose and travels from one location in the body to another is called an  embolus .

9. Aetiology

10. Aetiology Idiopathic Congenital/ Genetic Nutritional Deficiency/excess Traumatic Infections /Infestation Autoimmune Neoplastic (Benign/Malignant) Degenerative / lifestyle Iatrogenic Psychosomatic Poisoning/ Toxins/ Drug induced

11. Etiology Idiopathic Congenital Traumatic Infections /Infestation Autoimmune Neoplastic (Benign/Malignant) Degenerative

12. Etiology Virchows Triad Venous Stasis Hypercoaguability of blood Endothelial damage

13. Etiology Venous stasis prolonged bed rest (4 days or more) A cast on the leg Limb paralysis from stroke spinal cord injury extended travel in a vehicle

14. Hypercoagulability Surgery and trauma - Malignancy increased estrogen Inherited disorders of coagulation - Acquired disorders of coagulation- Nephrotic syndrome, Anti- phospholipid antibodies

15. Endothelial Injury Trauma Surgery Invasive procedure Iatrogenic causes – central venous catheters Subclavian Internal jugular lines These lines cause of upper extremity DVT.

16. Aetiology of Aetiology

17. Aetiology of Aetiology Idiopathic Congenital/ Genetic Nutritional Deficiency/excess Traumatic Infections /Infestation Autoimmune Neoplastic (Benign/Malignant) Degenerative / lifestyle Iatrogenic Psychosomatic Poisoning/ Toxins/ Drug induced

18. Pathophysiology

19. Pathophysiology Vessel trauma stimulates the clotting cascade. Platelets aggregate at the site particularly when venous stasis present Platelets and fibrin form the initial clot RBC are trapped in the fibrin meshwork

20. Pathophysiology The thrombus propagates in the direction of the blood flow. Inflammation is triggered, causing tenderness, swelling, and erythema . Pieces of thrombus may break loose and travel through circulation- emboli. Fibroblasts eventually invade the thrombus, scarring vein wall and destroying valves. Patency may be restored valve damage is permanent, affecting directional flow.

21. Clinical Features

22. Clinical features Phlegmasia cerulea dolens leg is cyanotic from massive ileofemoral venous obstruction. The leg is usually markedly edematous, painful, and cyanotic. Petechiae are often present . Phlegmasia alba dolens Painful white inflammation was originally used to describe massive ileofemoral venous thrombosis and associated arterial spasm. The affected extremity is often pale with poor or even absent distal pulses

23. Clinical Features Demography Symptoms Signs Prognosis Complications

24. Demography

25. Demography DVTs occur in about 1 per 1000 persons per year. 300,000 deaths may be directly or indirectly related to these diseases in us. In pregnant women, it has an incidence of 0.5 to 7 per 1,000 pregnancies, and is the second most common cause of maternal death in developed countries after bleeding Less common in asians Slightly more in males

26. Symptoms

27. Symptoms Asymptomatic Edema - Most specific symptom Leg pain - Occurs in 50% of patients but is nonspecific Tenderness - Occurs in 75% of patients Warmth or erythema of the skin over the area of thrombosis Clinical symptoms of pulmonary embolism (PE) as the primary manifestation

28. Signs

29. Signs Calf pain on dorsiflexion of the foot ( Homans sign) A palpable, indurated , cordlike, tender subcutaneous venous segment Variable discoloration of the lower extremity Blanched appearance of the leg because of edema (relatively rare)

30. Complications

31. Complications As many as 40% of patients have silent PE when symptomatic DVT is diagnosed  . Paradoxic emboli (rare) Recurrent DVT Postthrombotic syndrome (PTS)

32. Investigations

33. Investigations Laboratory Studies Routine Special Imaging Studies Tissue diagnosis Cytology FNAC Histology Germ line Testing and Molecular Analysis Diagnostic Laparotomy.

34. Investigations Laboratory Studies Routine Special Imaging Studies Tissue diagnosis Cytology FNAC Histlogy

35. Laboratory Studies D- dimer testing Coagulation studies ( eg , prothrombin time and activated partial thromboplastin time) to evaluate for a hypercoagulable state

36. Diagnostic Studies Imaging Studies

37. Diagnostic Studies Imaging Studies X-Ray – Venography USG Duplex CT / CT venogram Angiography MRI Endoscopy Venoscopy Nuclear scan Radiolabeled fibrinogen

38. Differential Diagnosis

39. Differential Diagnosis Cellulitis , lymphangitis Lymphedema Postphlebitic syndrome Ruptured Baker cyst Varicose veins Superfical thrombophlibitis CCF

40. Management

41. Management Anticoagulation (mainstay of therapy) - Heparins, warfarin , factor Xa inhibitors, and various emerging anticoagulants Pharmacologic thrombolysis Endovascular and surgical interventions Physical measures ( eg , elastic compression stockings and ambulation)

42. Minimally invasive Therapy

43. Minimally invasive Therapy Endovascular therapy Thrombus removal with catheter-directed thrombolysis Mechanical thrombectomy Stenting of venous obstructions

44. Prevention

45. Prevention Screening Risk reduction

46. Prevention Prophylaxis Mechanical / Pharmacological Mechanical Graded compression stockings Intermittent pneumatic leg compression Early mobilisation Pharmacological Heparin

47. Get this ppt in mobile Download Microsoft PowerPoint from play store. Open Google assistant Open Google lens. Scan qr code from next slide.

48. Get this ppt in mobile

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