blood vessel conditions

1. 1

2. DEFINITION:
 Phlebothrombosis is the
term applied when
thrombosis occurs in the
deep veins in the absence
of any inflammatory
reaction in the veins. It is
commonly referred to as
Deep Venous
Thrombosis.
2

3. DEFINITION:
 Thrombophlebitis is the term
applied when thrombosis
occurs in veins with
inflammatory reaction in the
vein, the thrombosis being
secondary to that inflammation.
Such thrombosis usually
occurs in close time-
relationship to infection of the
surrounding tissues or,
occasionally, trauma to the vein 3

4. AETIOLOGY of
PHLEBOTHROMBOSIS:
 In 1856, Virchow identified three
predisposing factors –
1. Slowing of the bloodstream
2. Changes in the vessel wall
3. Changes in the blood itself
 Phlebothrombosis is more likely to occur in
those who suffer from congestive cardiac
failure
4

5. Cont.
 those who are immobile following
surgery (especially abdominal surgery)
 those who are obese
 those who have varicose veins
 those who are taking a contraceptive pill
5

6. AETIOLOGY of
THROMBOPHLEBITIS:
 Conditions which may be associated
with thrombophlebitis are:
 Trauma to the vein concerned.
 Thrombophlebitis Migrans in which
multiple venous thromboses occur,
usually in superficial veins although
deeper ones may be involved.
6

7. Cont.
 Frequently, the cause is unclear but
often there is an association with
carcinoma, particularly of the pancreas,
breast or stomach
 Tropical thrombophlebitis. Outbreaks
have been reported in Africans. The
cause is unknown and thrombosis is
widespread, often with involvement of
the visceral veins.
7

8. Cont.
 Infective thrombophlebitis. This may be
secondary to middle ear sepsis,
suppurative osteomyelitis and
bronchiectasis. In such lesions, the
thrombi themselves become infected
and detached fragments cause
pyaemia.
8

9. Cont.
 Conditions in which there is
bacteraemia, notably typhoid fever. It is
thought that circulating organisms settle
in the intima of the veins and produce an
acute endophlebitis with secondary
thrombosis.
9

10. Cont.
 Any condition which causes irritation
and inflammation of the vein wall may
produce secondary thrombosis.
10

11. PATHOLOGY OF
PHLEBOTHROMBOSIS:
11

12. PATHOLOGY OF
THROMBOPHLEBITIS:
12

13. CLINICAL
MANIFESTATIONS of
PHLEBOTHROMBOSIS:
 The deep veins of the calf are those
most frequently affected.
 In a typical case, the leg is swollen and
oedematous and is usually warmer than
the opposite leg. The calf is tender and
painful on dorsiflexion of the foot
(Homan’s sign). The superficial veins
may be prominent.
13

14. Cont:
 Aching or cramp like pain at site of
thrombus.
 Tenderness on deep palpation.
 May be symptomless.
 Unexplained features like:
a) Pyrexia
b) Pleuritic pain
c) Tachycardia
14

15. CLINICAL
MANIFESTATIONS of
THROMBOPHLEBITIS:
 Localized, reddened, warm area with hard,
cord like swelling along course of affected
vein.
 Pain at rest and inc during movement.
 As condition resolves the skin become
pigmented along the course of the vein.
15

16. of PHLEBOTHROMBOSIS:
PREVENTION:
 Early postoperative mobilisation is most
imp factor in prophylaxis.
 General breathing exercises.
 Active movements of hip, knees and
ankle.
 Anticoagulant therapy.
16

17. TREATMENT:
 Treatment with i.v. heparin infusion
produces immediate anticoagulation.
 The affected limb is firmly bandaged.
 Oral anticoagulants like warfarin are
started. These are continued till 6
months to reduce risk of subsequent
DVT or phlebothrombosis.
17

18. of THROMBOPHLEBITIS:
 Firm elastic bandaging or stockings from
the toes to beyond the upper limit of
affected area.
 DRUG THERAPY:
i. Antibiotics in case of infection.
ii. Analgesics to relieve pain.
iii. Anti-inflammatory like indomethacin.
18

19.  EXERCISE: patient should encouraged
to
 Carry out foot exercises with legs
elevated.
 To remain ambulant.
19

20. 20