thandiwe murape 2014. acts as a reservoir to hold blood. acts as a conduit to return blood to...
TRANSCRIPT
AN INVESTIGATION OF DEEP VEIN THROMBOSIS BASED ON CLINICAL AND SONOGRAPHIC EVIDENCE
Thandiwe Murape 2014
THE VENOUS SYSTEM
Acts as a reservoir to hold blood. Acts as a conduit to return blood to
heart and lungs. Is composed of single tissue layer but
large veins have an internal elastic membrane.
Blood travels from end-capillary venules for eventual delivery to the heart & lungs (The Fundamental of Phlebology, 2014)
http://www.vectorstock.com/royalty-free-vector/venous-system-vector-826048
http://education-portal.com/academy/lesson/what-are-veins-functions-lesson-quiz.html#lesson
WHAT IS DEEP VEIN THROMBOSIS (DVT)• DVT is the formation of a blood clot in the
deep leg veins. It is a very serious health condition that can proceed to pulmonary embolism which is life threatening.
• It commonly occurs in the lower-limb veins but can also occur in the upper limbs.
• Signs of DVT include pain, swelling and erythema (Rumack, 2011)
• DVT maybe caused by: -• - Previous history of DVT
- In-dwelling venous catheters/surgery- Injury to the vein wall - Malignancy +/- chemotherapy- Immobilisation - Pregnancy- Coagulation abnormalities (Thrush & Hartshorne, 2010)
http://www.sirweb.org/patients/deep-vein-thrombosis/
http://www.lymphedemapeople.com/thesite/lymphedema_deep_venous_thrombosis.htm
DIAGNOSTIC MODALITIES
Duplex Ultrasound is the preferred
method of imaging DVT because it is
cheap and readily available.
Other diagnostic methods include: -
- CT scan
- MRI
- Venography
- Lung Ventilation perfusion scan (used
for pulmonary embolism diagnosis)
- Other test include the D-Dimer blood
test
(National Heart, Lung and Blood
Institute)
CASE STUDY
A 47 year old man presented with pain
in the right calf
Previous history of varicose veins and
DVT in his early 20s.
Strong family history of DVT and strokes
Clinical signs included pain in calf with
very mild swelling and limping.
Not on blood thinners
A recent overseas holiday.
http://thehealthscience.com/showthread.php?840181-Bedside-Ultrasonography-in-Deep-Vein-Thrombosis
… PATHOLOGY
On examination, the CFV, LSV (upper
thigh) and the FV compressed adequately
but on Colour Doppler there was little flow
even with augmentation.
Examination was extended to the IVC, CIV
and EIV to rule out any possible thrombus.
An investigation of the LSV continued
from the ankle and a heterogenous
thrombus of moderate echogenicity was
seen in the lower leg.
… PATHOLOGY
Lower leg veins also involved; SSV, Med
Gastrocs and Pop veins.
These veins were not compressible and
there was partial to no blood flow on
Colour Doppler.
Thrombosed varicose veins were also seen
in the medial aspect of the lower leg.
Patient had a noticeable small lump in the
medical aspect of the lower leg and he felt
pain with probe pressure during
compression.
Thrombosis in LSV lower leg- no blood flow
Varicose vein in the lower leg, med aspect
…PATHOLOGY
Visualisation of thrombosis in the SSV prompted further investigation to the origin of the vessel, the pop vein.
Thrombosis was found in the distal pop vein and was partially compressible with little colour flow.
Examination was presented to radiologist for evaluation.
Given his history, an urgent report was written for patient to take to his GP for further discussion on treatment.
WORK SHEET FOR THE EXAMINATION
Worksheet indicating thrombosed veins.
PITFALLS AND LIMITATION OF ULTRASOUND
Compression of ultrasound has potential to cause thrombus to break off the vein walls
leading to pulmonary embolisation ( Zwiebel & Pellerito, 2005).
Obese patients – difficult to evaluate veins in the groin region and adductor canal
region
Pregnant patients
Swollen /fat legs
(Allan et al, 2006)
http://www.environmentalhealthnews.org/ehs/news/2012/ob-gyns-and-environmental-health
DISEASE PROCESS
If DVT is not treated, severe
complication may occur which include
Pulmonary Embolism and postphlebitic
syndrome (Rumack,2011)
- Thrombus may break off and travel to
the heart then the lungs then block
- A combination of DVT and PE is
referred to as Venous Thromboembolism
(VTE).
http://www.medindia.net/patients/patientinfo/pulmonary-embolism-and-deep-vein-thrombosis.htm
TREATMENT
DVT treatment begins immediately after diagnosis to reduce the risk of the clot breaking off and extend further to the heart and lungs. Immediate treatment may
reduce the risk of post thrombotic syndrome. Depending on location or severity of DVT, treatments may be done at home or in
hospital.
Anticoagulants are used as treatment of DVT such as heparin and warfarin.
Heparin is administered intravenously and acts immediately which warfarin is
administered orally and take days to be effective.
Regular blood tests and ultrasound are important for monitoring effects of treatment.
Management of DVT include
- elevation the affected leg whenever possible
• Use of graduated compression stockings
• Prevention of long periods of immobility.
(http://www.phlebology.com.au/deep-vein-thrombosis)
REFERENCE
Carol M., Rumack., Stephanie R., Wilson., William J., Charboneau and Deborah Levine. 2011. Diagnostic Ultrasound. 4th edition. USA. Elsevier Mosby.
Paul L., Allan., Paul A., Dubbins., Myron A., Pozniak and Norman W., McDicken. 2006. Clinical Doppler Ultrasound. 2nd edition. China. Churchill Livingstone Elsevier.
Abigail Thrush and Tim Hartshorne. 2010. Vascular Ultrasound, How, Why and When. 3rd edition. China. Churchill Livingstone Elsevier.
Ulrike M., Hamper and Robert M., DeJong, and Leslie M., Scoutt. 2007. Ultrasound Evaluation of the Lower Extremity Veins. Radiologic Clinics of North America 45 (3): 525-547.
The Australasian School of Phlebology. Deep Vein Thrombosis. Retrieved on 30 October 2014 from: http://www.phlebology.com.au/deep-vein-thrombosis
National Heart, Lung and Blood Institue. DVT Diagnosis. Retrieved on 30 October 2014 from
http://www.nhlbi.nih.gov/health/health-topics/topics/dvt/diagnosis.html