Deep Vein Thrombosis

Deep vein thrombosis (DVT) is defined as the occurrence of blood clot (thrombosis) in the deep vein. The blood clot mostly develops in legs in case of DVT. It mostly affects people above 60 years of age, but it can develop at any age. Blood clots in the lower leg or thigh have a higher tendency of breaking loose and these clots may travel to artery or lungs causing the blockage of blood flow. When the blood clot breaks loose the condition is termed as pulmonary embolism, which is a serious and life threatening condition.

A blood clot may develop, if you are sitting still for a long time due to a long ride or a plane travel. Another major cause of DVT is blood clotting disorder. Some of the risk factors resposible for DVT include;

• Injury (fracture of legs) or surgery of the veins
• Prolonged bed rest
• Ulcerative colitis (infectious disease of large intestine )
• Birth control medicines  
• Family history of DVT
• Smoking and obesity
• Heart failure

Symptoms 

• Changed skin color (red, pale or blue)
• Pain in legs and thigh
• Swelling of the affected area (mostly leg, ankle and foot)
• Warm and tender skin 

 Diagnosis 

The diagnosis of DVT involves physical examination by the doctor along with D-dimer blood test and dopler ultrasound test of the legs. Other blood tests may conducted to check the blood clotting disorders.CT or MRI scans may be used for visual images of the affected veins.

Treatment

Blood thinners (anti-coagulation therapy) dissolve the existing clots and stop the development of new blood clots.Heparin (usually through injections) and warfarin are the drugs usually given as an initial treatment for DVT. Wearing compression stocking is recommended by the doctor after anti-coagulation therapy. These stockings improve the flow of blood in the legs.Surgery is required, if there is a danger of pulmonary embolism or in case of large blood clot. Vena cava filters are also used to prevent pulmonary embolism, if blood thinners are not suitable for a patient.

DVT may disappear without causing any symptoms or complications, but the there are chances of recurrence. To prevent this condition doctors recommend diet which is rich in vitamin K. Moreover, during long journeys on a car or plane take some time to move the legs (a little walk or other movements). People at high risk of developing this condition may take a dose of heparin before traveling for long hours. Exercise on regular basis is recommended as obesity is considered as a risk factor of DVT. Controlling body weight and blood pressure reduces the risk. 

 

Jugular Vein Thrombosis

The veins in the neck that drain blood from the brain, head, face and neck to the heart are known as jugular veins. External jugular veins drain blood from the skull and deep parts of the face, whereas internal jugular veins collect blood from brain, face and neck. A blood clot may develop in the internal or external jugular vein and the condition is termed as jugular vein thrombosis.

Internal Jugular Vein Thrombosis (IJV Thrombosis)

The internal jugular vein thrombosis (IJV thrombosis) is a rare and life-threatening condition, which is very hard to diagnose. The symptoms may include pain and swelling in the head and neck area. Fever and increased number of white blood cells also indicate the presence of this condition.Due to increased intracranial pressure a patient may experience headache and visual problems.  IJV thrombosis may occur, because of the following factors;

• Neck massage
• Head and neck infections
• Head or neck injury
• Surgery
• Polycythemia (bone marrow disorder due to excessive production of  red blood cells)
• Hyperhomocysteinemia (blood clot disorder)
• Intravenous drug abuse
• Head or neck cancer
• Spontaneous occurrence

 Complications

• Sepsis (systemic)
• Chylothorax (obstruction of the thoracic duct, fluid buildup in pleural cavity)
• Papilledema (optic disc swelling that increases intracranial pressure)
• Airway edema (thickening of the airway wall)
• Pulmonary embolism (blockage of the main artery of the lung or one of its branches)

 

External jugular vein thrombosis (EJV Thrombosis)

EJV thrombosis is an extremely uncommon condition related with catheter insertion, intravenous drug abuse and head and neck infections. Other factors factors contributing in the development of this thrombosis include age, obesity and upper abdomen and pelvic surgery.

CT scan, MRI and ultrasonography are some of the effective screening tests for detecting this type of thrombosis.

Treatment of jugular vein thrombosis

Most common method for treating jugular vein thrombosis for both internal and external type is through anti-coagulation (blood thinning medications). Antibiotics are given to treat the infections causing this condition. The duration of anti-coagulation therapy and antibiotics treatment is about 4 to 6 weeks. Surgery is required in severe cases of infections for the drainage of fluids and for the removal of the infected cells. A surgery may also be required on emergency basis in case of airway complications. Particular treatment methods are used to treat the underlying conditions of jugular vein thrombosis.

The prognosis of this condition is dependent on the early diagnosis, which can prevent numerous complications.

 

Renal Vein Thrombosis

What is renal vein thrombosis?

The formation of a thrombus (blood clot) in the vein that that trenches blood from the kidney is known as renal vein thrombosis.This type of thrombosis mostly occurs in patients with nephrotic syndrome (urinary protein loss, low blood proteins, high cholesterol, swelling etc). Other underlying causes of this disease in adults include renal cell cancer, glomerulonephritis (kidney disease), collagen vascular disease, clotting disorders and other severe infections. Abdomen or back injury can also be resposible for the development of this condition. In children this condition develops mainly because of dehydration and sepsis (systemic disease).

Symptoms

This condition exhibits fewer symptoms like thrombus to the lungs(which causes shortness of breath), less urination, blood in urine and sudden back pain.

Complications 

Pulmonary embolism (blockage of artery in the lung), renal atrophy (a kidney disease in which the size of kidney is reduced) and renal papillary necrosis (kidney disorder) are major complications of RVT.

Diagnosis

To diagnose renal vein thrombosis a doctor may prescribe certain tests to diagnose the underlying conditions. Abdominal CT scan, MRI and ultrasound tests are required. Other tests include duplex doppler exam of the renal veins, urinary analysis and venography of kidney veins.

Treatment

The main objective of the treatment is to keep the blood clots from developing and minimizing thromboembolism (the probability of the blood clots to travel to the other locations). The treatment also focuses on the underlying conditions for RVT. A patient has to take antibiotics (anti-coagulation therapy) to stop the formation of blood clots. For the treatment of nephrotic syndrome immune suppression therapy is used along with the dosage of steroids. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) can be given individually or in combination to prevent the protein loss in case of nephrotic syndrome. Surgical treatment is required in case of renal cell tumor. In case of kidney diseases a blood thinner known as warfarin is usually prescribed by the doctors and in case of a kidney transplant aspirin is recommended to prevent this condition.

Normal protein diet is recommended for the patients of RVT and the doctor may limit the physical activities for some time. Renal vein thrombosis gets better with the passage of time without causing a permanent injury to the kidneys. The prognosis of RVT is dependent on the underlying causes and complications. The chances of death, because of RVT are rare.

Cerebral Venous Sinus Thrombosis

 What is cerebral venous sinus thrombosis (CVST)?

The development of a blood clot in brain's cerebral venous, dural sinuses and cortical veins resulting in  blockage of the blood drainage out of brain is termed as cerebral venous sinus thrombosis (CVST). It is also known as cerebral sinovenous thrombosis. This condition can cause blood cells to break or leak resulting in a brain hemorrhage. It is a rare and challenging neurological disorder, because of it's adverse symptoms. It occurs in the initial years of life in almost 50% of the childhood cases. CVST is an uncommon stroke, which can affect can the babies during pregnancy, newborns and adults. However, it is uncommon and affects only 5 in a million individuals.

Symptoms Of CVST

• Headache/migraines
• Vision problems (blur vision )
• Unconsciousness, seizures or coma
• Loss of control over movements
• Speech disorders (impaired speech)
• Fluid pressure in skull and pressure on nerves

 Causes And Risk Factors

• Systemic diseases (diseases which affect tissues and organs, mostly due to sepsis (a condition which the body has severe response to bacteria)
• Neoplasm (a new or abnormal tissue growth)
• Pregnancy
• Puerperium (six weeks period after child birth)
• Dehydration
• Head injury
• Iron deficiency
• Sickle cell anemia
• Intracranial tumors (Brain tumors)
• Oral contraceptives (Birth control pills)
• Coagulopathies (Bleeding or clotting disorder)
• Arteriovenous malformations
•  Thyroid infection (fibrous thyroiditis)
• IBD (Inflammatory bowel disease ) and other infections
• Auto immune diseases

Diagnosis

CVST is hard to diagnose, but with new imaging techniques the early diagnosis and treatment of this condition has become possible. Before the screening tests the doctor examines the medical history and has a physical analysis of the patient. MR imaging (megnatic resonance imaging), unenhanced CT (computer tomography),  MR  and CT venography, angiography and blood tests are some specific tests for screening CVST.

Treatment

A patient of CVST requires immediate treatment and the  treatment may involve the following;

• Heparin (A compound that inhibits blood coagulation)
• Endovascular thrombolysis (Invasive therapy to break blood clots)
• Decompressive hemicraniectomy (Invasive surgical procedure in severe cases of CVST to relieve intracranial pressure)
• Antibiotics in case of infections and medications to stop blood from clotting

Treatment of underlying conditions of CVST and lifestyle changes (low fats diet, exercise and avoiding smoking) can prevent the development of this disorder.  Healthy diet and regular exercise also helps in recovering after this stroke. Moreover, rehabilitation and physical therapy may be required during the recovery process.

Portal Vein Thrombosis

What is the portal vein?

It is a large abdominal vein. The portal vein supplies blood to the liver by importing blood from the parts of intestines (bowel) and other abdominal organs.      


Portal vein thrombosis (PVT)

A thrombus mostly obstructs the portal vein. When this vein is completely obstructed, it causes blood to move back in the vein that leads to high blood pressure in other veins below it. The condition is called portal vein thrombosis (PVT). Sometimes the body tries to pass this obstructed vein by establishing thin walled veins  called collaterals. These thin walled veins are large and emerge like varicose veins also called varicosities. The majority of  varicosities are found at the esophagus lower end. They may emerge anywhere in the abdominal region.

How common is PVT?

It is a rare condition in U.S. PVT is detected in  5/10,000 person. The highest rate of PVT is in Africa and India due to;

1.          Liver infections
2.          Parasites and
3.          Liver cancer

Conditions associated with PVT

There are some underlying conditions associated with PVT are;

                   

•           Heart failure
•      Budd chiari
•      Constrictive pericarditis
•      Live cirrhosis
•      Scarring
•      Liver cancer
•      Pancreas cancer
•      Stomach and bile ducts cancer
•      Liver pus
•      Pancreatitis
•      Umbilical cord infection in babies
•      Trauma
•      Disorders related to blood clotting
•      Dehydration
•      Pills related to birth control

In most cases, no cause is found. Mostly young children are affected by PVT and in adults PVT leads to cancer

Life expectancy after PVT 

There is low risk of death if there is absence of liver disease and liver failure. There is a high risk of death (30% or more deaths within 2 years) within 1 or 2 year, If a patient is experiencing a liver failure and severe bleeding at a same time. The prognosis in children experiencing PVT is much better.

Symptoms of PVT

The PVT symptoms depends on the gradual of sudden formation of blood clots. In case of acute thrombus the symptoms are not very clear. The symptoms include;  

• Fever
• Unexpected pain in right upper quadrant
• Nausea/vomiting
• Accumulation  of fluid in abdomen
•  Intestinal ischemia
•  Blood during vomit

In cases of chronic thrombus the symptoms are very clear and alarming which include;

• Bright red blood during vomiting. The bleeding amount is high and frightening for both patient and the physician. This condition occurs after 3 or 4 years of the initial diagnosis
• Accumulation of fluid in the abdomen
• Confusion
• Brain memory loss
• Coma

Can PVT dissappear suddenly?

Acute thrombus may resolve spontaneously and the signs and symptoms may improve. In some caese, the body strat making collaterals to pass the obstructions and the signs may not occue. The chronic thrombus never resolves and need treatment.

Diagnosis of PVT

The diagnosis and physical exam include;

Ultrasound, MRI  (Computed tomography scans may detect the obstructions).

Angiography ( The disease is completely detected by angiography by obtaining x rays of the infected areas)

Liver biopsy  (A tiny needle is inserted in the skin to get a tiny piece of the liver. This test is also required to confirm the diagnosis)

Treatment

Sclerotherapy or variceal banding: (This treatment require several sessions to stop the bleeding).

Octreotide: (A chemical used to stops the bleeding but risk of recurrence is high in  this approach)

Blood thinners: Sometimes blood thinners are used to dissolve the clot. It is risky treatment because if blood vomiting occurr at the same time, then these medictions make situation worse. The majority of doctors don’t recommend these medication because of the bleeding related complications.

Surgery: The aim of surgical procedures is to help preventing the thin walled varicosities from bursting and bleeding. PVT surgries needs a multidisciplinary approach and involve a high risk and many. A patient having surgery  with a liver failure, the risks of death and other complications are very high.

Radiological techniques: Throug this treatment approach a link between the liver and shunt (pressure veins) is built. This results in varices decompression and decreases symptoms. This treatment is done in the presence of a radiology suite and x rays.  Some complications related to radiological techniques include:

• Bleeding  may start in the abdomen
• Failure of high pressure veins
• Dead liver
• Re-occurrence of the shunt blockage 

Transplantation

Liver transplant is a best option and most effective treatment recommended for the patients with liver damage. Transplantation is limited to few individuals because of unavailability of donars and expenses. The surviva rate is high. The quality of patient life omprove after this surgery.

• Untreated PVT causes many complications
• Coma
• Persistent blood vomiting
•  Fluid collection in the abdominal region
• Death of different parts of intestine 
• Liver condition become worse
• Brain confusion
• Loss of life

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