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Deep vein thrombosis of the lower extremities, symptoms and treatment

Feet constantly withstand a tremendous load. When thousands of years ago a man rose from four limbs to two, he freed his hands for productive labor, providing his family with evolutionary progress. But the load on the legs has increased many times.

With the usual quiet walking, each leg rhythmically takes with each step pressure, one and a half times greater than our weight. While running, the pressure when pushing against the ground is 4 times the weight of a person. When transferring in the hands of heavy luggage, we complain that "the hands fall off," and after all, at the same time, the venous system of the legs passes the test of strength.

Half of the able-bodied population of our country can boast overweight, it also affects the condition of the veins. And then there is a walk up the stairs. And some of the work a person has adapted to squat, while it is hampered by the outflow of blood, veins expand and deform.

We can recall the flagrant case of ordinary Andrei S., whom his grandfather colleagues forced him to squat for several hours - this made him legless as a result of acute deep vein thrombosis.

Content

What is it in simple terms?

Deep vein thrombosis of the lower extremities

Thrombosis is a violation of the vascular permeability due to the formation of intravital blood clots in their lumen.

Arterial and venous vessels have a different structure. In the arteries, as in mountain rivers, the blood quickly spreads through the body as a result of heart contractions. Venous blood flows slowly like water in lowland rivers, except that, with the exception of the venous system of the head, the blood must also rise upwards. And this requires a large tension of the venous walls and the presence of valves in the vessels, which counteract the downward movement of blood.

In the middle of the 19th c. German pathologist R. Virkhov formulated the conditions for the occurrence of a thrombus:

  1. Violation of the inner layer of vessel walls.
  2. Decreased blood flow
  3. Increased blood viscosity

The mechanism of the formation of a dangerous blood clot contains a protective natural reaction of the body. When a vessel is damaged, special blood cells - platelets, gluing together, plug a hole in the vascular wall. Plasma protein fibrinogen and other blood cells are involved in this process.

In inflammatory vascular diseases, atherosclerosis, hypertension, intoxication and many painful conditions, the inner wall of the veins becomes rough. Platelets accumulate in this area, and a protective mechanism is activated.

If the blood has an increased viscosity ( diabetes , the consumption of animal fats, liver diseases, infectious diseases) - the risk of clot formation increases. And in the presence of varicose veins and weakening of the function of the venous valves, the speed of blood flow, especially in the parietal zone, slows down.

This is how the “Virchow Triad” (Virchow-Trias) takes shape, without treatment often leading to a sad outcome.

Types of blood clots

In the structure of a blood clot, there is a head with which it is attached to the vascular wall, a body and a tail, freely fluttering in the bloodstream ("floating").

They are classified by structure, mechanism of formation and in relation to the vessel lumen:

  • parietal,
  • occlusive (completely covering the vessel lumen).

Causes of venous thrombosis of the lower extremities

The list of reasons shows how great the possibility of this pathology:

  1. Age-related vascular sclerosis (compaction of the vascular wall and narrowing of the lumen of arteries and veins after 40 years).
  2. Varicose veins
  3. Heart diseases
  4. Excess weight increases the risk of thrombosis by 5 times.
  5. Pregnancy.
  6. Surgery, especially under general anesthesia, and the risk of thrombosis increases in proportion to the duration of the operation.
  7. Fractures of the legs and plaster immobilization of the extremities often provoke the development of thrombosis.
  8. Catheterization of veins.
  9. Damage to blood vessels as a result of injuries in the home and at work.
  10. Increased blood coagulability as a hereditary factor or acquired as a result of various pathological conditions.
  11. General hypothermia and dehydration.
  12. Bacterial and viral infectious diseases.
  13. New growths of the lungs, ovaries, gastrointestinal tract, brain.
  14. A sedentary lifestyle, causing a violation of blood circulation.
  15. Long bed rest.
  16. Standing or sitting work.
  17. Regular oral contraceptive use.
  18. Alcoholism.
  19. Smoking.

Symptoms of deep vein thrombosis of the lower extremities

Symptoms of deep vein thrombosis of the lower extremities

Deep vein thrombosis of the legs usually manifests itself with acute local inflammation:

  • acute painful arching pain appears in the calf muscles, radiating to the lower abdomen and to the sacral and lumbar spine;
  • any movement increases pain;
  • shin and foot swell, giving a noticeable increase in volume;
  • limb skin becomes bluish tint.

At the same time there are common signs of the inflammatory process:

  • general malaise,
  • limitation of motor activity.
  • temperature rise,
  • in the blood - increased levels of leukocytes and ESR.

Sometimes acute thrombosis is almost asymptomatic, which is even more dangerous - precious time is wasted (it goes into hours) to help before complications develop.

Complications of leg vein thrombosis

Complications of leg vein thrombosis

Complications of thrombosis

Without treatment, the acute process turns into chronic phlebothrombosis of deep and superficial veins. On the skin along the vessels can be formed abscesses and trophic ulcers.

A common acute phlebothrombosis causes a violation of tissue trophism in the affected area, the result will be cell necrosis and gangrene.

A thrombus slows down the blood flow, and the pressure in the affected vessel rises, which at some point causes the clot to come off.

A motile blood clot is called an embolus, if it is deposited in the pulmonary artery (50% of untreated cases) or the heart embolus can cause death, myocardial infarction, and if the brain is sedimented, it can cause a stroke.

Diagnostics

In addition to the characteristic signs of vein thrombosis, there are also specific symptoms:

  • Moses - when squeezing the leg, there is a sharp pain;
  • Lovenberg - squeezing of the shin tonometer cuff at values ​​from 80 mm Hg. Art. increases pain in the muscles of the leg;
  • Louvel - sneezing and coughing are given a sharp pain in the aching limb;
  • Homans - pain increases with flexion of the foot.

Ultrasound duplex scanning helps to distinguish thrombosis from other diseases of the venous and lymphatic systems, determines the location and extent of damage.

Phlebography - reveals mobile blood clots.

Treatment of deep vein thrombosis of the lower extremities

No home treatment can be!

Treatment (often inpatient) begins immediately after diagnosis. Compliance with strict bed rest for 5-10 days.

Conservative treatment aims to:

  1. To prevent the spread of thrombosis and the occurrence of thromboembolism.
  2. Prevent gangrene and organ amputation.
  3. Restore the venous lumen.
  • One-time intravenous heparin is administered, in the following days - drip.
  • Regular intake of venotonics (troksevazin, troxerutin).
  • Painkillers (diclofenac).
  • Introduction through the catheter thrombolytics to dissolve the clot.

Upon detection of a mobile thrombus, surgical treatment is performed.

Treatment of deep vein thrombosis of the lower extremities After the pain subsides and the swelling subsides, the patient returns, under the supervision of specialists, to a rolling lifestyle. Physical therapy is appointed, first in the supine position:

воспроизводить движения ног при велосипедной езде, до конца распрямляя ноги; 1. reproduce leg movements when cycling, straightening legs to the end;

привести согнутые ноги к груди, выпрямить их вертикально и вытянутыми опустить вниз; 2. bring the bent legs to the chest, straighten them vertically and pull them down;

выпрямленными ногами на весу имитировать движения ножниц. 3. straighten legs with weight to simulate the movement of scissors.

Compression stockings or elastic bandaging from the bottom up is prescribed to prevent thrombosis.

Nutrition for thrombosis of deep veins of the lower extremities provides for the exclusion of fried, smoked, spicy foods from food.

Prevention of deep vein thrombosis of the legs

To prevent the development of this dangerous disease requires:

  • maintain active mobility throughout life;
  • eat food that does not contribute to the production of cholesterol (fruits, vegetables);
  • regularly undergo medical examination;
  • during the day, change shoes with different heel height to improve venous outflow;
  • daily to do a contrast shower and foot massage;
  • do sport.

When sedentary lifestyle use any opportunity (sitting at a table in the office, in transport, in front of the TV) for the simplest gymnastics. Exercises for the calf muscles are carried out on the exhale with a contraction of the abdomen:

  • fix heels on the floor, and raise and lower toes,
  • fix your toes on the floor, raise your heels,
  • move your feet from left to right by moving the heel to toe stop,
  • bend your toes down and relax.

Some of these exercises can be performed in a standing position.

It is useful at home to sit on the floor with your legs extended forward, bring your feet towards you, and bend your breasts to your legs, keeping your back straight. Repeat several times.

After exercise 5 minutes to keep the legs elevated to improve venous outflow.

With varicose veins, in order not to cause a blood clot, you cannot engage in strength sports, limit squats and sharp bends in the body. Useful walking, swimming and cycling.

Deep vein thrombosis of the lower extremities in ICD 10

In the ICD 10 deep vein thrombosis of the legs is in the section:

Class IX - Diseases of the circulatory system (I00 — I99)

I80-I89 - Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified

I80 - Phlebitis and thrombophlebitis

  • I80.1 - Phlebitis and thrombophlebitis of the femoral vein
  • I80.2 - Phlebitis and thrombophlebitis of other deep vessels of the lower extremities
  • I80.3 - Phlebitis and thrombophlebitis of the lower extremities, unspecified
Interesting
Ekaterina Volkova
2017-05-29 14:09:43
It is necessary to start taking something so that there is no thrombosis, something to thin the blood.

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