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Anatomy of the abdominal viscera: Kidneys, ureters and suprarenal glands
Renal system anatomy and physiology
Renal failure: Pathology review
Anatomy clinical correlates: Anterior and posterior abdominal wall
Anatomy clinical correlates: Inguinal region
Anatomy clinical correlates: Peritoneum and diaphragm
Anatomy clinical correlates: Viscera of the gastrointestinal tract
Anatomy clinical correlates: Other abdominal organs
Appendicitis: Pathology review
Complications during pregnancy: Pathology review
Diverticular disease: Pathology review
Gallbladder disorders: Pathology review
GERD, peptic ulcers, gastritis, and stomach cancer: Pathology review
Inflammatory bowel disease: Pathology review
Mood disorders: Pathology review
Pancreatitis: Pathology review
Anatomy clinical correlates: Female pelvis and perineum
Cervical cancer: Pathology review
Uterine disorders: Pathology review
Extrinsic hemolytic normocytic anemia: Pathology review
Intrinsic hemolytic normocytic anemia: Pathology review
Macrocytic anemia: Pathology review
Microcytic anemia: Pathology review
Non-hemolytic normocytic anemia: Pathology review
Anatomy clinical correlates: Heart
Anatomy clinical correlates: Mediastinum
Anatomy clinical correlates: Pleura and lungs
Anatomy clinical correlates: Thoracic wall
Aortic dissections and aneurysms: Pathology review
Coronary artery disease: Pathology review
Deep vein thrombosis and pulmonary embolism: Pathology review
Pleural effusion, pneumothorax, hemothorax and atelectasis: Pathology review
ECG cardiac infarction and ischemia
Pigmentation skin disorders: Pathology review
Skin cancer: Pathology review
Papulosquamous and inflammatory skin disorders: Pathology review
Anatomy of the abdominal viscera: Esophagus and stomach
Anatomy of the abdominal viscera: Large intestine
Anatomy of the abdominal viscera: Small intestine
Anatomy of the gastrointestinal organs of the pelvis and perineum
Gastrointestinal system anatomy and physiology
Enteric nervous system
Colorectal polyps and cancer: Pathology review
Laxatives and cathartics
Lung cancer and mesothelioma: Pathology review
Nasal, oral and pharyngeal diseases: Pathology review
Obstructive lung diseases: Pathology review
Pneumonia: Pathology review
Tuberculosis: Pathology review
Amnesia, dissociative disorders and delirium: Pathology review
Cerebral vascular disease: Pathology review
Dementia: Pathology review
Electrolyte disturbances: Pathology review
Hypothyroidism: Pathology review
Bile secretion and enterohepatic circulation
Malabsorption syndromes: Pathology review
Bacillus cereus (Food poisoning)
Clostridium difficile (Pseudomembranous colitis)
Vibrio cholerae (Cholera)
Anatomy clinical correlates: Facial (CN VII) and vestibulocochlear (CN VIII) nerves
Cardiomyopathies: Pathology review
Heart blocks: Pathology review
Supraventricular arrhythmias: Pathology review
Valvular heart disease: Pathology review
Ventricular arrhythmias: Pathology review
Vertigo: Pathology review
ECG cardiac hypertrophy and enlargement
ECG normal sinus rhythm
ECG QRS transition
ECG rate and rhythm
Kidney stones: Pathology review
Sexually transmitted infections: Vaginitis and cervicitis: Pathology review
Sexually transmitted infections: Warts and ulcers: Pathology review
Urinary tract infections: Pathology review
Central nervous system infections: Pathology review
Shock: Pathology review
Anatomy clinical correlates: Anterior blood supply to the brain
Anatomy clinical correlates: Temporal regions, oral cavity and nose
Headaches: Pathology review
Traumatic brain injury: Pathology review
Vasculitis: Pathology review
Anatomy clinical correlates: Arm, elbow and forearm
Anatomy clinical correlates: Axilla
Anatomy clinical correlates: Bones, fascia and muscles of the neck
Anatomy clinical correlates: Bones, joints and muscles of the back
Anatomy clinical correlates: Clavicle and shoulder
Anatomy clinical correlates: Foot
Anatomy clinical correlates: Hip, gluteal region and thigh
Anatomy clinical correlates: Knee
Anatomy clinical correlates: Leg and ankle
Anatomy clinical correlates: Median, ulnar and radial nerves
Anatomy clinical correlates: Wrist and hand
Seronegative and septic arthritis: Pathology review
Apnea, hypoventilation and pulmonary hypertension: Pathology review
Heart failure: Pathology review
Nephrotic syndromes: Pathology review
Anatomy clinical correlates: Vertebral canal
Back pain: Pathology review
Anatomy clinical correlates: Male pelvis and perineum
Penile conditions: Pathology review
Prostate disorders and cancer: Pathology review
Testicular and scrotal conditions: Pathology review
Testicular tumors: Pathology review
Anatomy clinical correlates: Eye
Eye conditions: Inflammation, infections and trauma: Pathology review
Eye conditions: Refractive errors, lens disorders and glaucoma: Pathology review
Eye conditions: Retinal disorders: Pathology review
Bronchodilators: Beta 2-agonists and muscarinic antagonists
Bronchodilators: Leukotriene antagonists and methylxanthines
Pulmonary corticosteroids and mast cell inhibitors
Anatomy clinical correlates: Ear
Vaginal and vulvar disorders: Pathology review
Anxiety disorders, phobias and stress-related disorders: Pathology Review
Atherosclerosis and arteriosclerosis: Pathology review
Bone disorders: Pathology review
Diabetes mellitus: Pathology review
Drug misuse, intoxication and withdrawal: Alcohol: Pathology review
Drug misuse, intoxication and withdrawal: Hallucinogens: Pathology review
Drug misuse, intoxication and withdrawal: Other depressants: Pathology review
Drug misuse, intoxication and withdrawal: Stimulants: Pathology review
Dyslipidemias: Pathology review
Hypertension: Pathology review
Movement disorders: Pathology review
Peripheral artery disease: Pathology review
Psychological sleep disorders: Pathology review
Rheumatoid arthritis and osteoarthritis: Pathology review
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Deep Vein Thrombosis (DVT) Characteristics
Deep Vein Thrombosis (DVT) Management
Pulmonary Embolism Causes
Pulmonary Embolism Presentation and Diagnosis
Hannah is a 42 year old woman who came to the emergency department due to pain in her right calf.
She reports flying from Japan back to the United States 2 days ago.
She denies fever, chills, or history of trauma to the leg.
She reports a 25 pack year smoking history for 20 years, and she takes oral contraceptive pills.
On physical examination, she is stable, and her BMI is 32.
Her right leg is shown in this image.
On laboratory investigation, her D-dimer levels are elevated.
Deep vein thrombosis, or DVT and pulmonary embolism, or PE are a spectrum of clinical manifestations that result from venous thromboembolism.
The pathogenesis and risk factors of both DVT and PE centers around Virchow’s triad, that is; stasis of blood flow, hypercoagulability, and endothelial injury.
Board exams like to test your ability to identify a PE by using scenarios that promote venous stasis such as paralysis after a stroke, the postoperative period, as well as long drives or flights.
People with varicose veins are also at risk of DVT, because incompetent venous valves prevent proper venous outflow, causing stasis.
An interesting risk factor is pregnancy, where the enlarged uterus may compress the iliac veins, causing stasis of venous outflow.
Another similar cause is May-Thurner syndrome where the left iliac vein gets sandwiched between the right iliac artery anteriorly and the lumbar vertebrae posteriorly, which also leads to venous stasis.
Now, the coagulation system is normally balancing clot formation and clot lysis.
Hypercoagulability occurs is when the scale is tipped towards clot formation.
This may be genetic, such as factor V Leiden, or antithrombin III deficiency.
Or it may be acquired, like when there’s high estrogen during pregnancy or when using estrogen-containing oral contraceptive pills.
Also, nephrotic syndrome causes loss of antithrombin III in the urine, resulting in hypercoagulability.
This is especially prominent in membranous glomerulonephropathy.
Other acquired causes of hypercoagulability include malignancies, sepsis, and autoimmune diseases like lupus or antiphospholipid syndrome.
Finally, endothelial damage, like when there’s truma, can expose the underlying collagen, which initiates the coagulation cascade.
Alright, now DVTs typically affect the deep veins of the lower extremity, such as the popliteal, iliac and femoral veins.
The popliteal veins of the calf are most commonly affected, however, it’s important to remember that the more proximal iliofemoral DVTs that commonly embolize and cause PE. DVTs present with unilateral, painful swelling and redness of the affected extremity.
However, it’s important to know that there are other differential diagnoses, like cellulitis or a popliteal Baker cyst that can present similarly.
So, when it comes to diagnosis, the best choice on an exam is a compression ultrasound with Doppler.
Normally, veins are easily compressible using the ultrasound probe, but when there’s a clot, the affected vein becomes incompressible.
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