Medicine Notes General and Vascular Surgery Notes
Dvtpe Notes
Updated Dvtpe Notes
General and Vascular Surgery
Complete set of notes covering the most common general and vascular surgical conditions. Includes pathophysiology, presentation, investigation and management. Clinically orientated with examination tips and colour-coded by topic. A great overview - ideal for written and clinical finals....
The following is a more accessible plain text extract of the PDF sample above, taken from our General and Vascular Surgery Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:
DVT
Occurs in 25-50% of surgical patients
Risk factors
Age (increases with age)
Pregnancy
Synthetic oestrogen (HRT/COCP)
Surgery
Previous DVT
Malignancy
Obesity
Immobility
Thrombophilia
Wells Score (Test of clinical probability of DVT)
| Active Cancer | 1 |
|---|---|
| Paralysis/paresis/recent immobilisation | 1 |
| Major surgery/bedridden for >3 days in last 4 weeks | 1 |
| Local tenderness along distribution of venous system | 1 |
| Entire leg swollen | 1 |
| Calf swelling >3cm compared with other leg | 1 |
| Pitting oedema | 1 |
| Collateral superficial veins (non-varicose) | 1 |
| Alternative diagnosis as or more likely than DVT | -2 |
Pathogenesis
Virchow’s Triad
Clinical features
-
Calf is
Swollen
Tender
Warm
Red
May be mild fever and pitting oedema
Management
LMWH e.g enoxaparin 1.5mg/kg/24hours subcut
Start warfarin simultaneously
Stop LMWH when INR = 2-3
Treat for 3 months if post-op (6 months if no cause found)
IVC filters can be used
Prevention
Stop OCP/HRT 4 weeks pre-op
Mobilise early
LMWH while immobile (start pre-op) 5000 units dalteparin subcut
TED stockings
Intermittent pneumatic pressure during op (boots)
PE (Pulmonary Embolism)
Risk factors
Same as for DVT
Pathogenesis
Usually arise from thrombus in pelvis or legs
Clots break off – IVC – rt heart – lungs
-
Other rarer causes include
Right ventricular thrombus post MI
Septic emboli (rt side endocarditis)
Fat/air/amniotic fluid embolism
Clinical features
Depends on size, number and distribution of emboli
Small emboli can be asymptomatic, whereas larger are often fatal
-
Symptoms include
Acute breathlessness
Pleuritic...
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Dvtpe
Complete set of notes covering the most common general and vascular surgical conditions. Includes pathophysiology, presentation, investigation and management. Clinically orientated with examination tips and colour-coded by topic. A great overview - ideal for written and clinical finals....
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