A 45yo man underwent an emergency splenectomy following a fall from his bicycle. He smokes
5 cigarettes/day. Post-op, despite mobile, he develops swinging pyrexia and a swollen painful
left calf. His CXR shows lung atelectasis and abdominal U demonstrates a small sub-phrenic
collection. What is the single most likely risk factor for DVT in this pt?
a. Immobility
b. Intraperitoneal hemorrhage
c. Smoking
d. Splenectomy
e. Sub-phrenic collection
answer B : since it occured post operatively and there is evidence of an intra-peritoneal bleed, this means there was endothelial damage (e.g. leaking vessel), that would have been the biggest risk factor.
RF of DVT : virchow triad
• stasis
immobilization: paralysis, stroke, bed rest, prolonged sitting during travel, immobilization of an extremity after fracture
obesity, CHF
chronic venous insufficiency
• endothelial cell damage
post-operative injury, trauma
• hypercoagulable states
underlying malignancy (particularly adenocarcinoma)
cancer treatment (chemotherapy, hormonal)
exogenous estrogen administration (OCP, HRT)
pregnancy, post-partum
prior history of DVT/PE, family history
nephrotic syndrome
coagulopathies: Factor V Leiden, Prothrombin 20210A variant, inherited deficiencies of
antithrombin/protein C/protein S, antiphospholipid antibody, hyperhomocysteinemia, increased Factor VIII levels, and myeloproliferative disease
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ReplyDeleteIt's the surgery itself (splenectomy) that is the most likely risk factor for developing DVT and not the intraperitoneal haemorrhage ( because there is no history of that in the question )
ReplyDeleteIt's the surgery itself (splenectomy) that is the most likely risk factor for developing DVT and not the intraperitoneal haemorrhage ( because there is no history of that in the question )
ReplyDelete