Thrombophlebitis By: BILAL AL-LAMI

Objectives Definition Risk factors Pathophysiology Signs and symptoms Diagnosis Deferential diagnosis Treatment Complications

Definition Thrombo means “clot” phlebitis means “inflammation of the vessel”. Thrombophlebitis occurs when a blood clot causes inflammation in a vein. Blood clots typically forms in the legs or pelvis. Formation of venous clot depends on the presence of virchow’s triad factors.

Risk factors

Trauma, travel Hypercoagulability, hormone replacement Iv drugs Old (more than 60) Malignancy Obesity, obstetrics Surgery, smoking Immobilization

Pathophysiology Most common cause of hereditary hemophilia is factor V Leiden Thrombi usually form at the venous cusps of deep veins where altered or static blood flow causes clot formation Alternatively, clots form from intimal defects Clots are composed from fibrin, red cells and platelets and cause partial/complete obstruction of vein Postphlebitic syndrome (PPS) may develop after the resolution of a DVT PPS is due valvular incompetence, persistent outflow obstruction and abnormal microcirculation.

Signs and symptoms Pain in the part of the body that is affected Warmth Tenderness Fever Skin redness and inflammation Swelling(edema)of the extremities

Diagnosis

Physical examination –doctor will look for any swelling, dis-colouration and soreness in the affected area. Ultrasound – This allows the doctor to watch and monitor the blood flow ensuring that there are no blood clots present and the overall flow of the blood is not being constrained or restricted. Blood tests –doctor will check for the presence of D-Dimer, a small protein fragment that is present in the blood of all DVT sufferers. Venography – An X-ray test that involves injecting dye into a vein to show how blood flows through the veins. This will allow the doctor to determine the condition of veins.  Computerized tomography (CT) or magnetic resonance imaging (MRI) scans – These are imaging techniques which portray high resolution images of the veins. doctor may use these techniques to show if there is a clot present.

Differential diagnosis Post traumatic(hematomas adjacent to the vein) venous puncture. intravenous drug abuse Allergic reaction to insect bite Lymphangitis Cellulitis Erythema nodosum erysipelas

Treatment

BE ACTIVE Elevate the legs Warm cloths Drugs Support socks NSAIDS Drink lots of water Salicylates (natural blood thinners)

Complications Extremely painful ulcers may form on the skin close to the varicose vein particularly near the ankles. If the blood clot dislodges this may leads to PE

References https://www.slideshare.net/innocentkingsleyasogwa/iliofemoral-thrombophlebitis-by-ai-kingsley https://www.thrombosisadviser.com/how-is-deep-vein-thrombosis-diagnosed/ http://lermagazine.com/article/vascular-viewpoint-improving-superficial-thrombophlebitis-care     Hingorani A, Ascher E. Superficial venous thrombophlebitis. In: Gloviczski P, ed. Handbook of Venous Disorders. 3rd ed. Oxford, England: Oxford University Press; 2009:314-319.

THANK YOU