Clinical approch to patient with swollen and painful leg

Leg swelling caused by the retention of fluid in leg tissues is known as peripheral edema. It can be caused by a problem with the circulatory system, the lymphatic system or the kidneys

 Leg swelling problem isn't directly related with heart problem it is also signs of chronic kidney disease.
Now some common cause of a swollen leg:-

  • Deep venous thrombosis(DVT)
  • Acute rupture knee joint / Baker's cyst
  • Trauma, eg- rupture of tendon / muscle
  • Infection; eg- cellulitis(Staphylococcus), osteomyelitis. 

CASE HISTORY

A 38 years old woman on the OCP developed pain in the left calf 4 days ago; it had oedema of the lower led without any change.Examination revealed oedema of the lower lrg without any prominence of the veins; there was tenderness along the line of the deep veins. Doppler study showed early thrombus in the popliteal veins. She use anticogulated with haparin and warfarin for 6 month and given alternative contraceptive advice.


INVESTIGATION OF DVT

  • D-dimer assay;-
  1. Has a high negative predictive value
  2. Near patient tests: SimpliRED (agglutination test) Simplify (immunochromatography test)
  3. Laboratory tests: Enzyme linked immunosorbent assay (ELISA) Latex agglutination
  • B mode venous compression ultrasonography
  • venography
  • Plethysmography

  1. Digital photoplethysmography
  2. Strain gauge plethysmography
  3. Impedance plethysmography.

TREATMENT


The patient is start with sc LMWH and continued until formal anti-coagulation with warfarin is at target level; current recommendation for warfarin are:

DABIGATRAN a direct thrombin inhibitior is now being used as it does not require therapeutic monitoring.
                                               

Image result for deep vein thrombosis
Image result for deep vein thrombosis
Normal and DVT
                               

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