Venous History and Physical

How many cases a year for DVT?

>2.5 million cases a year

How many DVTs result in pulmonary embolus?

600,000 cases

How many deaths are from PE?

200,000 deaths

What are the risk factors for DVTs?

• age 

• surgery or trauma

• immobilization

• past hx of DVT

• coagulation disorders

• malignancy 

• oral contraceptives

• hormone replacement therapy

• pregnancy

• obesity 

• stroke

• CHF

• long distance travel

• varicose veins

What does DVT stand for?

deep venous thrombosis

What is virchow’s triad?

causes of clot formation within the intact venous system

What are the three things in virchows triad?

What is stabilize?

adhere to wall without changing location or propagating

What is propagate?

grows in size and location

What is embolize?

portion breaks free and travels elsewhere within vascular system

What is stasis?

blood that remains stagnant for any period of time will clot with minimal stimulus

What are the risk factors of stasis?

• immobilization

• surgery

• acute stroke

• acute paraplegic

• prolonged bedrest

• obesity

Stasis Obstruction:

• extrinsic compression

• tumors

• late trimester pregnancy 

• hematomas

• trauma

• paget-schroetter syndrome

• may-thurner syndrome

• nutcracker syndrome

• previous DVT

• CHF

What is Paget-Schroetter Disease?

compression of the subclavian vein that causes a blood clot

What is this image showing?

Paget-Schroter Disease 

What is another name for Paget-Schrotter Disease?

effort thrombosis

What is May-Thurner Syndrome?

compression of the LCIV by the RCIA

What is nutcracker syndrome?

refers to the compression of the left renal vein between the superior mesenteric artery (SMA) and aorta 

What is nutcracker syndrome associated with?

-renal venous hypertension

-ruptured wall resulting in a hematoma

What is this image showing?

nutcracker syndrome 

What is vein wall injury?

luminal surface of these cells contains various substances in their membrane to prevent adhesion of platelets and clotting factors

injury to the wall and the platelets attach to the wall and then the RBCs still to the wall

What can vein wall injury result from?

from catheters, stretching or twisting injuries, trauma, chemical injuries

Hypercoagulability is?

sudden and significant increase in clotting factors and platelets

Congenital Hypercoagulability:

• decrease antithrombin III

• MTHFR (methylenetetrahydrofolate reductase)

• protein c deficiency

• protein s deficiency

Acquired Hypercoaguability:

• adenocarcinoma (cancer)

• estrogen replacements

• oral contraceptives

• pregnancy and postpartum 

• liver disease

• smoking 

• nephrotic syndrome