ENAL VEIN ROMBOSIS WHAT WAS IT? DR.JANANI SANKAR UNIT DR. KEDARI NAGARJUNA, DNB P KKCTH

Size: px
Start display at page:

Download "ENAL VEIN ROMBOSIS WHAT WAS IT? DR.JANANI SANKAR UNIT DR. KEDARI NAGARJUNA, DNB P KKCTH"

Transcription

1 ENAL VEIN ROMBOSIS WHAT WAS IT? DR.JANANI SANKAR UNIT DR. KEDARI NAGARJUNA, DNB P KKCTH

2 RESENTING COMPLAINTS: u 9 ¾ yrs, boy u Fever, Loose stools 10 days back u Right sided Abdominal pain+

3 NVESTIGATIONS u Urea, creatinine - normal u USG Abdomen - right hydronephrosis u CT Abdomen with contrastt -?RIGHT RENAL VEIN THROMBUS EXTENDING INTO IVC u REFERRED FOR FURTHER EVALUATION

4 n examination u Bilateral pedal edema u Free fluid in abdomen u BP - normal

5 elook into history: u Abdominal distension & Progressive leg swelling for 4 days u?oliguria u No hematuria

6 amily history u Father had Bilateral renal calculi - underwent stenting

7 nvestigations: u Creatinine normal (0.5) u Hypoalbuminemia (1.1gm/dl) u Hypercholesterolemia (417mg/dl) u Albuminuria (3+, Spot P/C 24) u Microscopic hematuria (25-30 RBC s/hpf) u C u P u P u M u C u H Counts Normal PCV 36% PT, PTT Normal Mantoux test negative Chest x-ray normal HBsAg negative

8 SG ABDOMEN u Mild bilateral nephromegaly u A clot 4 x 4 x 1.1 cm in the retro hepatic segment of the IVC, extending cranially from the origin of the right renal vein

9 Nephrotic syndrome with thrombotic complication u Low molecular weight Heparin 1mg/kg/dose BD u Prednisolone 2mg/kg/day

10 4hrs later Doppler study normal!!?dislodgement of thrombus (no symptoms)??resolution

11 ourse: u Urine output increased u Edema decreased u Hemodynamically stable u Parents counselled u Discharged on LMWH and Prednisolone u Plan to change to warfarin as outpatient

12 fter 72hrs u Readmitted u Severe epigastric pain and cough u Documented fever u Dyspneic, hypoxic u BP-normal u Anasarca u Diffuse abdominal tenderness

13 ifferential diagnosis: Pulmonary embolism Spontaneous Bacterial peritonitis Pneumonia

14 Shifted to PICU Non invasive ventilation Ceftriaxone Albumin infusion LMWH/steroid continued

15 u Repeat Doppler study no thrombus u USG Abdomen mild b/l nephromegaly, free fluid, dilated bowel loops, no thrombus u ECHO LV dysfunction

16 ultures u Blood culture penicillin resistant Pneumococcus u Changed to Vancomycin u Peritoneal fluid gram stain no organism, culture sterile

17 CT PULMONARY ANGIOGRAPHY Evidence of thrombus in tertiary branch of right pulmonary venules

18 radual improvement: u Started on warfarin (INR 2.19) u Later LMWH stopped u Off oxygen, Hemodynamically stable u Discharged after 2 weeks of vancomycin

19 Follow up: Work up for connective tissue disease ANA negative C3 elevated C4 normal HIV ELISA non eactive Ig profile normal

20 u Persistent proteinuria after completion of 6 weeks of daily steroid steroid resistant u Renal biopsy later u Planned to start on cyclosporine

21 DISCUSSION

22 Hypercoagulable state in Nephrotic syndrome u Vascular stasis u Increase in hepatic production of fibrinogen & other clotting factors u Decreased serum levels of anticoagulation factors u Increased plasma platelet production u Increased platelet aggregation u Increased urinary loss of antithrombin III, protein C, protein S

23 ISK FACTORS: u Risk of VTE is high in patients with membranous nephropathy u HYPOALBUMINEMIA most factor for VTE independent risk u Ratio of proteinuria to serum albumin - risk factor

24 iterature review: u Pulmonary Embolism and Renal Vein Thrombosis in Patients with Nephrotic Syndrome: Prospective Evaluation of Prevalence and Risk Factors with CT Zhang LJ, Zhang Z, Li SJ, Meinel FG, Nance JW Jr, Zhou CS, Zhao YE, Schoepf UJ, Lu GM. Radiology Jul 28: u PE and/or RVT was found in 15 (19%) of 80 children with nephrotic syndrome, while 165 (38%) of 432 adult patients with nephrotic syndrome had PE and/or RVT (P =.001).

25 hy this presentation? u Unusual presentation the child presented with Thrombotic complication and nephrotic syndrome was diagnosed retrospectively u High risk nephrotic syndrome thrombotic complication & penicillin resistant pneumococcal sepsis u Diagnostic dilemma & challenges faced during management

26 cknowledgements: u Dr. Sairam V.K - Consultant Nephrologist u Dr. Muralinath.S - Consultant Radiologist u Dr. Gopinath Consultant Radiologist u Dr. Ramkumar Consultant Dermatologist u Dr. R.Varadarajan Consultantt Hematologist u Dr. Balaji Consultant Vascular surgeon u PICU TEAM

Dr. Venkateswari. R. Dr. Janani Sankar s unit Kanchi Kamakoti CHILDS Trust Hospital

Dr. Venkateswari. R. Dr. Janani Sankar s unit Kanchi Kamakoti CHILDS Trust Hospital Dr. Venkateswari. R. Dr. Janani Sankar s unit Kanchi Kamakoti CHILDS Trust Hospital Acknowledgements: KKCTH Dr. Ramkumar Consultant Dermatologist Dr. Ramprakash Consultant Ophthalmologist Dr. Prasad Manne

More information

PE and DVT. Dr Anzo William Adiga WatsApp or Call Medical Officer/RHEMA MEDICAL GROUP

PE and DVT. Dr Anzo William Adiga WatsApp or Call Medical Officer/RHEMA MEDICAL GROUP PE and DVT Dr Anzo William Adiga WatsApp or Call +256777363201 Medical Officer/RHEMA MEDICAL GROUP OBJECTIVES DEFINE DVT AND P.E PATHOPHYSIOLOGY OF DVT CLINICAL PRESENTATION OF DVT/PE INVESTIGATE DVT MANAGEMENT

More information

Clots and Foamy Urine: Thrombotic Complications of Nephrotic Syndrome. Prayus Tailor, MD October 5, 2013 Renal and Hypertension Symposium

Clots and Foamy Urine: Thrombotic Complications of Nephrotic Syndrome. Prayus Tailor, MD October 5, 2013 Renal and Hypertension Symposium Clots and Foamy Urine: Thrombotic Complications of Nephrotic Syndrome Prayus Tailor, MD October 5, 2013 Renal and Hypertension Symposium Objectives Discuss the pathophysiology of thrombosis in nephrotic

More information

Nephrotic syndrome in children. Bashir Admani KPA Nephrology Precongress 24/4/2018

Nephrotic syndrome in children. Bashir Admani KPA Nephrology Precongress 24/4/2018 Nephrotic syndrome in children Bashir Admani KPA Nephrology Precongress 24/4/2018 What is Nephrotic syndrome?? Nephrotic syndrome is caused by renal diseases that increase the permeability across the glomerular

More information

RAPIDLY FAILING KIDNEYS. Dr Paul Johny 2 nd yr DNB Medicine Resident

RAPIDLY FAILING KIDNEYS. Dr Paul Johny 2 nd yr DNB Medicine Resident RAPIDLY FAILING KIDNEYS Dr Paul Johny 2 nd yr DNB Medicine Resident Mr Z 67yrs old Occupation : Retired officer from electricity board Chief complaints : Fever : 5 days Right lower limb swelling and pain

More information

Risk Factor Evaluation for Thrombosis and Bleeding in Pediatric Patients with Heart Disease

Risk Factor Evaluation for Thrombosis and Bleeding in Pediatric Patients with Heart Disease Risk Factor Evaluation for Thrombosis and Bleeding in Pediatric Patients with Heart Disease Kristen Nelson, MD Johns Hopkins University Director, Pediatric Cardiac Critical Care Why Does it Matter? Pediatric

More information

Fever in Lupus. 21 st April 2014

Fever in Lupus. 21 st April 2014 Fever in Lupus 21 st April 2014 Fever in lupus Cause of fever N= 487 % SLE fever 206 42 Infection in SLE 265 54.5 Active SLE and infection 8 1.6 Tumor fever 4 0.8 Miscellaneous 4 0.8 Crucial Question Infection

More information

Disorders of the kidney. Urine analysis. Nephrotic and nephritic syndrome.

Disorders of the kidney. Urine analysis. Nephrotic and nephritic syndrome. Disorders of the kidney. Urine analysis. Nephrotic and nephritic syndrome. Azotemia and Urinary Abnormalities Disturbances in urine volume oliguria, anuria, polyuria Abnormalities of urine sediment red

More information

Management of Nephrotic Syndrome

Management of Nephrotic Syndrome Management of Nephrotic Syndrome 1. Introduction Incidence 2-4/100,000. Boys > girls 3:2; age of onset 2-6 years 80% of cases in children is due to minimal change (MCD) of which 80% will respond to steroid

More information

THE URINARY SYSTEM. The cases we will cover are:

THE URINARY SYSTEM. The cases we will cover are: THE URINARY SYSTEM The focus of this week s lab will be pathology of the urinary system. Diseases of the kidney can be broken down into diseases that affect the glomeruli, tubules, interstitium, and blood

More information

THE URINARY SYSTEM. The cases we will cover are:

THE URINARY SYSTEM. The cases we will cover are: THE URINARY SYSTEM The focus of this week s lab will be pathology of the urinary system. Diseases of the kidney can be broken down into diseases that affect the glomeruli, tubules, interstitium, and blood

More information

Risk factors for DVT. Venous thrombosis & pulmonary embolism. Anticoagulation (cont d) Diagnosis 1/5/2018. Ahmed Mahmoud, MD

Risk factors for DVT. Venous thrombosis & pulmonary embolism. Anticoagulation (cont d) Diagnosis 1/5/2018. Ahmed Mahmoud, MD Risk factors for DVT Venous thrombosis & pulmonary embolism Ahmed Mahmoud, MD Surgery ; post op especially for long cases, pelvic operations (THR), Trauma ; long bone fractures, pelvic fractures (posterior

More information

Venous thrombosis & pulmonary embolism. Ahmed Mahmoud, MD

Venous thrombosis & pulmonary embolism. Ahmed Mahmoud, MD Venous thrombosis & pulmonary embolism Ahmed Mahmoud, MD Risk factors for DVT Surgery ; post op especially for long cases, pelvic operations (THR), Trauma ; long bone fractures, pelvic fractures (posterior

More information

Types Pathophysiology Clinical manifestations D.Dx. Investigations. Treatment. Complications.

Types Pathophysiology Clinical manifestations D.Dx. Investigations. Treatment. Complications. Types Pathophysiology Clinical manifestations D.Dx. Investigations. Treatment. Complications. Nephrotic syndrome affects 1-3 per 100,000 children

More information

CURRENT & FUTURE THERAPEUTIC MANAGEMENT OF VENOUS THROMBOEMBOLISM. Gordon Lowe Professor of Vascular Medicine University of Glasgow

CURRENT & FUTURE THERAPEUTIC MANAGEMENT OF VENOUS THROMBOEMBOLISM. Gordon Lowe Professor of Vascular Medicine University of Glasgow CURRENT & FUTURE THERAPEUTIC MANAGEMENT OF VENOUS THROMBOEMBOLISM Gordon Lowe Professor of Vascular Medicine University of Glasgow VENOUS THROMBOEMBOLISM Common cause of death and disability 50% hospital-acquired

More information

Nephrotic Syndrome. Sara Alsharhan PharmD candidate, KSU 2014

Nephrotic Syndrome. Sara Alsharhan PharmD candidate, KSU 2014 Nephrotic Syndrome Sara Alsharhan PharmD candidate, KSU 2014 Outline Introduction Nephrotic syndrome classifications Signs and symptoms Diagnoses Management Complications Monitoring Case presentation Introduction

More information

Mabel Labrada, MD Miami VA Medical Center

Mabel Labrada, MD Miami VA Medical Center Mabel Labrada, MD Miami VA Medical Center *1-Treatment for acute DVT with underlying malignancy is for 3 months. *2-Treatment of provoked acute proximal DVT can be stopped after 3months of treatment and

More information

CRRT Fundamentals Pre-Test. AKI & CRRT 2017 Practice Based Learning in CRRT

CRRT Fundamentals Pre-Test. AKI & CRRT 2017 Practice Based Learning in CRRT CRRT Fundamentals Pre-Test AKI & CRRT 2017 Practice Based Learning in CRRT Question 1 A 72-year-old man with HTN presents to the ED with slurred speech, headache and weakness after falling at home. He

More information

Successful Treatment of Bilateral Renal Vein Thrombosis in a Patient with Nephrotic Syndrome: A Case Report Z Li,J Li, F Liu ABSTRACT

Successful Treatment of Bilateral Renal Vein Thrombosis in a Patient with Nephrotic Syndrome: A Case Report Z Li,J Li, F Liu ABSTRACT Successful Treatment of Bilateral Renal Vein Thrombosis in a Patient with Nephrotic Syndrome: A Case Report Z Li,J Li, F Liu ABSTRACT Renal vein thrombosis is a well-known complication of nephrotic syndrome,

More information

Nephrotic syndrome Dr.Basma Adel FIFTH GRADE

Nephrotic syndrome Dr.Basma Adel FIFTH GRADE Nephrotic syndrome Dr.Basma Adel FIFTH GRADE 2017-2018 At the end of this lecture you should know: Types Pathophysiology Clinical manifestations D.Dx. Investigations. Treatment. Complications. 12/3/2017

More information

Renal Vein Thrombosis secondary to pyelonephritis: Case presentation

Renal Vein Thrombosis secondary to pyelonephritis: Case presentation RESEARCH ARTICLE Renal Vein Thrombosis secondary to pyelonephritis: Case presentation Anusha Skandini Ganeshan*, Angel Alberto Calderon Chongo Internal Medicine Department, Seychelles Hospital, Seychelles

More information

Disclosures. Anticoagulation in Kidney Disease: Considerations for Patients with Nephrotic Syndrome

Disclosures. Anticoagulation in Kidney Disease: Considerations for Patients with Nephrotic Syndrome Anticoagulation in Kidney Disease: Considerations for Patients with Nephrotic Syndrome Vimal K. Derebail Glomerular Disease Collaborative Network May 20 th, 2017 Disclosures Employer: University of North

More information

1 yr old girl presented with Fever on and off 3 months H/o frequent semisolid bulky stools 3 months Progressive abdominal distension 3 months Failure

1 yr old girl presented with Fever on and off 3 months H/o frequent semisolid bulky stools 3 months Progressive abdominal distension 3 months Failure Dr Rajasree S Dr Srinivas S, Dr Bagdi RK, Dr Satheesh C Apollo Childrens Hospital, Chennai 1 yr old girl presented with Fever on and off 3 months H/o frequent semisolid bulky stools 3 months Progressive

More information

Nephrotic Syndrome NS

Nephrotic Syndrome NS Nephrotic Syndrome NS By : Dr. Iman.M. Mudawi Pediatric Nephrology Unit Gaafar Ibn Auf Hospital Definitions: In children NS is applied to any condition with a triad of: Heavy proteinuria (UACR ratio >200

More information

Deep Vein Thrombosis and Pulmonary Embolism: Patient Information

Deep Vein Thrombosis and Pulmonary Embolism: Patient Information Deep Vein Thrombosis and Pulmonary Embolism: Patient Information A Deep Vein Thrombosis (DVT) and a Pulmonary Embolism (PE) are both disorders of unwanted blood clotting. Unwanted blood clots can occur

More information

Mr. I.K 58 years old

Mr. I.K 58 years old Mr. I.K 58 years old Hospitalized because of marked pitting peripheral edema (bilateral crural and perimalleolar edema) and uncontrolled blood pressure (BP 150/100 mmhg under treatment). since age 54 years

More information

Systemic examination

Systemic examination PROLONGED FEVER IN AN ADOLESCENT BOY Dr.Praveena Lionel, DNB PG, Dr.Kannan (HOD) Railway Hospital, Perambur History 11 yrs old adolescent boy was admitted with c/o Fever -1 wk Myalgia -1 wk Arthralgia

More information

Dr. Rami M. Adil Al-Hayali Assistant Professor in Medicine

Dr. Rami M. Adil Al-Hayali Assistant Professor in Medicine Dr. Rami M. Adil Al-Hayali Assistant Professor in Medicine Venous thromboembolism: pulmonary embolism (PE) deep vein thrombosis (DVT) 1% of all patients admitted to hospital 5% of in-hospital mortality

More information

Foamy Urine and Sickled Cells. Margaret Prat Huntwork, MD, MSEd Tulane / Ochsner Residency Program New Orleans, LA

Foamy Urine and Sickled Cells. Margaret Prat Huntwork, MD, MSEd Tulane / Ochsner Residency Program New Orleans, LA Foamy Urine and Sickled Cells Margaret Prat Huntwork, MD, MSEd Tulane / Ochsner Residency Program New Orleans, LA Foamy Urine and Sickled Cells Margaret Prat Huntwork, MD, MSEd Tulane University Health

More information

11/9/2015. Childhood Nephrotic Syndrome: The Clinical Pathway. Learning Objectives. Nephrotic Syndrome - Definition. Proteinuria.

11/9/2015. Childhood Nephrotic Syndrome: The Clinical Pathway. Learning Objectives. Nephrotic Syndrome - Definition. Proteinuria. Childhood Nephrotic Syndrome: The Clinical Pathway Cherry Mammen, MD, FRCPC, MHSc Douglas G. Matsell, MDCM, FRCPC Division of Nephrology, BC Children s Hospital Grand Rounds Nov 13th, 2015 Learning Objectives

More information

Childhood nephrotic syndrome practice guidelines

Childhood nephrotic syndrome practice guidelines Childhood nephrotic syndrome practice guidelines Dr Shuman Haq Consultant Paediatric Nephrologist Southampton Children s Hospital Definitions Nephrotic syndrome Proteinuria Urine protein : creatinine >200

More information

CASE 4 A RARE CASE OF INTRALUMINAL GLOMERULAR CAPILLARY DEPOSITS

CASE 4 A RARE CASE OF INTRALUMINAL GLOMERULAR CAPILLARY DEPOSITS CASE 4 A RARE CASE OF INTRALUMINAL GLOMERULAR CAPILLARY DEPOSITS DR ANNIE JOJO, Dr Seethalekshmy N V, Dr Nanda Kachare DEPARTMENT OF PATHOLOGY, AMRITA INSTITUTE OF MEDICAL SCIENCES, KOCHI. 54 yrs female,

More information

How long to continue anticoagulation after DVT?

How long to continue anticoagulation after DVT? How long to continue anticoagulation after DVT? Dr. Nihar Ranjan Pradhan M.S., DNB (Vascular Surgery), FVES(UK) Consultant Vascular Surgeon Apollo Hospital, Jubilee Hills, Hyderabad (Formerly Faculty in

More information

Jessica Bryan, Natalia Evans, Karlyn Henderson, & Whitney Parks

Jessica Bryan, Natalia Evans, Karlyn Henderson, & Whitney Parks Jessica Bryan, Natalia Evans, Karlyn Henderson, & Whitney Parks 1. What is the most common cause of death in hospitalized patients? 1. Hospital-acquired infection 2. Pulmonary embolism 3. Myocardial infarction

More information

Not all Leg DVT s are the Same: Which Patients Benefit from Interventional Therapy? Case 1:

Not all Leg DVT s are the Same: Which Patients Benefit from Interventional Therapy? Case 1: 12/16/2015 Not all Leg DVT s are the Same: Which Patients Benefit from Interventional Therapy? Constantino S.Peña, FSIR, FSCCT, FAHA Interventional Radiologist Medical Director, Vascular Imaging Miami

More information

Henoch Schonlein Purpura

Henoch Schonlein Purpura CHILDREN S SERVICES Henoch Schonlein Purpura Definition A vasculitic syndrome of small vessels classically characterised by a purpuric rash, abdominal pain, arthritis, and nephritis. Platelet count and

More information

Pulmonary Embolism. Pulmonary Embolism. Pulmonary Embolism. PE - Clinical

Pulmonary Embolism. Pulmonary Embolism. Pulmonary Embolism. PE - Clinical Pulmonary embolus - a practical approach to investigation and treatment Sam Janes Wellcome Senior Fellow and Respiratory Physician, University College London Background Diagnosis Treatment Common: 50 cases

More information

1. SCOPE of GUIDELINE:

1. SCOPE of GUIDELINE: Page 1 of 35 CLINICAL PRACTICE GUIDELINE: Venous Thromboembolism (VTE) Prevention Guideline: Thromboprophylaxis AUTHORIZATION: VP, Medicine Date Approved: May 17, 2012 Date Revised: Vancouver Coastal Health

More information

Pulmonary Embolism Pathway

Pulmonary Embolism Pathway Pulmonary Embolism Pathway Ambulatory Care Pathway Dr. A. Zafar, Dr. A. Rehman, Dr. T. Malik September, 2011. Patient Identification Label Pulmonary Embolism Pathway Clinical History Comments Hospital

More information

Focal Segmental Glomerulosclerosis and the Nephro6c Syndrome Dr. A. Gangji Dr. P. Marge>s. Part 1: Clinical

Focal Segmental Glomerulosclerosis and the Nephro6c Syndrome Dr. A. Gangji Dr. P. Marge>s. Part 1: Clinical Focal Segmental Glomerulosclerosis and the Nephro6c Syndrome Dr. A. Gangji Dr. P. Marge>s Part 1: Clinical Pa#ent DM 18 year old McMaster student Back pain, severe fa#gue Oct 2006 Leg swelling to ER Nov

More information

Venous thrombosis is common and often occurs spontaneously, but it also frequently accompanies medical and surgical conditions, both in the community

Venous thrombosis is common and often occurs spontaneously, but it also frequently accompanies medical and surgical conditions, both in the community Venous Thrombosis Venous Thrombosis It occurs mainly in the deep veins of the leg (deep vein thrombosis, DVT), from which parts of the clot frequently embolize to the lungs (pulmonary embolism, PE). Fewer

More information

Dhanalakshmi.R II yr MD Stanley medical college

Dhanalakshmi.R II yr MD Stanley medical college Dhanalakshmi.R II yr MD Stanley medical college 10 Yr old female child - abdominal pain & vomiting for 1 day. Diffuse in nature, moderate in intensity, not related to food intake & radiates to back. No

More information

Pathology of pulmonary vascular disease. Dr.Ashraf Abdelfatah Deyab. Assistant Professor of Pathology Faculty of Medicine Almajma ah University

Pathology of pulmonary vascular disease. Dr.Ashraf Abdelfatah Deyab. Assistant Professor of Pathology Faculty of Medicine Almajma ah University Pathology of pulmonary vascular disease Dr.Ashraf Abdelfatah Deyab Assistant Professor of Pathology Faculty of Medicine Almajma ah University Pulmonary vascular disease Type of pulmonary circulation: Types

More information

DIAGNOSIS AND MANAGEMENT OF DIURETIC RESISTANCE. Jules B. Puschett, M.D.

DIAGNOSIS AND MANAGEMENT OF DIURETIC RESISTANCE. Jules B. Puschett, M.D. DIAGNOSIS AND MANAGEMENT OF DIURETIC RESISTANCE Jules B. Puschett, M.D. Diuretic Resistance A clinical circumstance in which patients do not respond to a combination of salt restriction and even large

More information

Kerry Cooper M.D. Arizona Kidney Disease and Hypertension Center April 30, 2009

Kerry Cooper M.D. Arizona Kidney Disease and Hypertension Center April 30, 2009 Kerry Cooper M.D. Arizona Kidney Disease and Hypertension Center April 30, 2009 DR. KERRY COOPER IS ON THE SPEAKER BUREAU OF AMGEN, ABBOTT, GENZYME, SHIRE, AND BMS DR. COOPER IS ALSO INVOLVED IN CLINICAL

More information

Interventional Treatment VTE: Radiologic Approach

Interventional Treatment VTE: Radiologic Approach Interventional Treatment VTE: Radiologic Approach Hae Giu Lee, MD Professor, Dept of Radiology Seoul St. Mary s Hospital The Catholic University of Korea Introduction Incidence High incidence: 250,000-1,000,000/year

More information

Approach to Thrombosis

Approach to Thrombosis Approach to Thrombosis Theera Ruchutrakool, M.D. Division of Hematology Department of Medicine Siriraj Hospital Faculty of Medicine Mahidol University Approach to Thrombosis Thrombosis: thrombus formation

More information

Shock, Hemorrhage and Thrombosis

Shock, Hemorrhage and Thrombosis Shock, Hemorrhage and Thrombosis 1 Shock Systemic hypoperfusion due to: Reduction in cardiac output Reduction in effective circulating blood volume Hypotension Impaired tissue perfusion Cellular hypoxia

More information

Dr. E.SUDHA (Fellow in Pediatric Nephrology) DEPT OF PEDIATRIC NEPHROLOGY & DIALYSIS Dr.MEHTA CHILDRENS HOSPITAL

Dr. E.SUDHA (Fellow in Pediatric Nephrology) DEPT OF PEDIATRIC NEPHROLOGY & DIALYSIS Dr.MEHTA CHILDRENS HOSPITAL Dr. E.SUDHA (Fellow in Pediatric Nephrology) DEPT OF PEDIATRIC NEPHROLOGY & DIALYSIS Dr.MEHTA CHILDRENS HOSPITAL CASE HISTORY 4 yrs old previously well boy Born to 2 nd degree consanguinity Fever x 5 days

More information

ADULT TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) TELEMETRY BED TRANSFER ORDERS 1 of 4

ADULT TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) TELEMETRY BED TRANSFER ORDERS 1 of 4 TELEMETRY BED TRANSFER 1 of 4 9 Actual 9 Estimated Patient ID Area Weight kg 9 Actual 9 Estimated Height cm ALLERGIES: REFER TO ALLERGY PROFILE/ POWERCHART Transfer to: 10 South Attending Physician: Diagnosis:

More information

Jordan M. Garrison, MD FACS, FASMBS

Jordan M. Garrison, MD FACS, FASMBS Jordan M. Garrison, MD FACS, FASMBS Peripheral Arterial Disease (PAD) Near or Complete obstruction of > 1 Peripheral Artery Peripheral Venous reflux Disease Varicose Veins Chronic Venous Stasis Ulcer Disease

More information

CHAPTER 2 VENOUS THROMBOEMBOLISM

CHAPTER 2 VENOUS THROMBOEMBOLISM CHAPTER 2 VENOUS THROMBOEMBOLISM Objectives Venous Thromboembolism (VTE) Prevalence Patho-physiology Risk Factors Diagnosis Pulmonary Embolism (PE) Management of DVT/PE Prevention VTE Patho-physiology

More information

Venous Thrombo-Embolism (VTE)

Venous Thrombo-Embolism (VTE) Venous Thrombo-Embolism (VTE) Information for service users and carers RDaSH leading the way with care Older People s Mental Health Services Reducing risk of unwanted blood clots whilst in hospital About

More information

DVT Pathophysiology and Prophylaxis in Medically Hospitalized Patients. David Liff MD Oklahoma Heart Institute Vascular Center

DVT Pathophysiology and Prophylaxis in Medically Hospitalized Patients. David Liff MD Oklahoma Heart Institute Vascular Center DVT Pathophysiology and Prophylaxis in Medically Hospitalized Patients David Liff MD Oklahoma Heart Institute Vascular Center Overview Pathophysiology of DVT Epidemiology and risk factors for DVT in the

More information

Table 2: Outcomes measured. Table 1: Intrapleural alteplase instillation therapy protocol

Table 2: Outcomes measured. Table 1: Intrapleural alteplase instillation therapy protocol ORIGINAL RESEARCH ARTICLE Intrapleural F brinolytic Therapy with Alteplase in Empyema Thoracis in Children conducted in the Department of Pediatric critical care and Pulmonology unit at our institution

More information

Renal Transplant Surgery

Renal Transplant Surgery Renal Transplant Surgery Mr Somaiah Aroori MS MD EBS in HPB FRCS Consultant HPB & Renal Transplant Surgeon SWTC, Derriford Hospital, Plymouth Over next few minutes Aim to cover Details of Transplant procedure

More information

Disclosures. DVT: Diagnosis and Treatment. Questions To Ask. Dr. Susanna Shin - DVT: Diagnosis and Treatment. Acute Venous Thromboembolism (VTE) None

Disclosures. DVT: Diagnosis and Treatment. Questions To Ask. Dr. Susanna Shin - DVT: Diagnosis and Treatment. Acute Venous Thromboembolism (VTE) None Disclosures DVT: Diagnosis and Treatment None Susanna Shin, MD, FACS Assistant Professor University of Washington Acute Venous Thromboembolism (VTE) Deep Venous Thrombosis (DVT) Pulmonary Embolism (PE)

More information

H.Jalanko has documented that he has no relevant financial relationships to disclose or conflict of interest to resolve.

H.Jalanko has documented that he has no relevant financial relationships to disclose or conflict of interest to resolve. H.Jalanko has documented that he has no relevant financial relationships to disclose or conflict of interest to resolve. Management dilemmas in infants with congenital nephrotic syndrome (CNS) Hannu Jalanko

More information

CASE OF THE WEEK 1

CASE OF THE WEEK 1 www.nephro-pathology.com CASE OF THE WEEK 1 Clinical Presentation: A 17 year old Indian boy presented with anasarca, decreased urine output and episodes of nausea and vomiting over the last three weeks.

More information

DVT - initial management NSCCG

DVT - initial management NSCCG Background information Information resources for patients and carers Updates to this care map Synonyms Below knee DVT and bleeding risks Patient with confirmed DVT Scan confirms superficial thrombophlebitis

More information

Prostate Biopsy Alerts

Prostate Biopsy Alerts Prostate Biopsy Alerts Saskatchewan Prostate Assessment Pathway Guidelines for the Primary Care Provider for Patient Preparation and the Management of Medications and Complications September 2016 Table

More information

Pulmonary Embolism Is it the Greatest Danger in Deep Vein Thrombosis?

Pulmonary Embolism Is it the Greatest Danger in Deep Vein Thrombosis? Difficult issues in Deep Vein Thrombosis: Pulmonary Embolism Is it the Greatest Danger in Deep Vein Thrombosis? Raluca Dulgheru; C Gherghinescu; B Dorobat; H Muresan; R Darabont; M Cinteza; D Vinereanu

More information

13 year old, Saudi, girl known case of : uncontrolled IDDM for 7 years on 1 I.U/kg premix insulin Admitted electively from the clinic with history of

13 year old, Saudi, girl known case of : uncontrolled IDDM for 7 years on 1 I.U/kg premix insulin Admitted electively from the clinic with history of 13 year old, Saudi, girl known case of : uncontrolled IDDM for 7 years on 1 I.U/kg premix insulin Admitted electively from the clinic with history of increased weight (more than 5 kg ) lower limbs swelling

More information

Amanda Phillips, RVT

Amanda Phillips, RVT Amanda Phillips, RVT Cockett Syndrome Iliac vein compression syndrome http://www.ardms.org/volunteer-now/clearly-connected/pages/may-thurner-syndrome-what-sonographers-should-know.aspx Compression of Lt

More information

Treatment of deep vein thrombosis and pulmonary embolism with low molecular weight heparin

Treatment of deep vein thrombosis and pulmonary embolism with low molecular weight heparin Treatment of deep vein thrombosis and pulmonary embolism with low molecular weight heparin You have been given this leaflet because you have a blood clot. Normally blood flows freely around the body without

More information

Dr. Riaz JanMohamed Consultant Haematologist The Hillingdon Hospital Foundation Trust

Dr. Riaz JanMohamed Consultant Haematologist The Hillingdon Hospital Foundation Trust MANAGEMENT OF PATIENTS WITH DEEP VEIN THROMBOSIS (DVT) IN THE COMMUNITY SETTING & ANTICOAGULATION CLINICS THE PAST, PRESENT AND THE FUTURE Dr. Riaz JanMohamed Consultant Haematologist The Hillingdon Hospital

More information

COMPLICATED DKA SINDHU BHARATHI S STANLEY MEDICAL COLLEGE MD POST GRADUATE

COMPLICATED DKA SINDHU BHARATHI S STANLEY MEDICAL COLLEGE MD POST GRADUATE COMPLICATED DKA SINDHU BHARATHI S STANLEY MEDICAL COLLEGE MD POST GRADUATE Dr.Shanthi, Professor & Head, Dr. T.S. Ekambaranath Asst Professor, PICU, ISP, Stanley Medical College 9yrs male, previously normal

More information

62- year-old man presented with-

62- year-old man presented with- 62- year-old man presented with- High grade continued fever Extreme anorexia and vomiting 2 months BACKGROUND On 15 th March 2004, presented with- - severe pain, swelling, marked redness of ears, nose,

More information

Suspected Deep Vein Thrombosis (DVT) Assessment

Suspected Deep Vein Thrombosis (DVT) Assessment CHI no... First name... DOB... /... /... Last name... Sex: c M c F Address...... Telephone... or attach addressograph label here Hospital/Location: c Hairmyres c Monklands c Wishaw Other (specify)... Ward/Base...

More information

Nutcracker Syndrome. Dr Heena Kithany Specialty Registrar Dorset County Hospitals NHS Trust

Nutcracker Syndrome. Dr Heena Kithany Specialty Registrar Dorset County Hospitals NHS Trust Nutcracker Syndrome Dr Heena Kithany Specialty Registrar Dorset County Hospitals NHS Trust Case 1: JB Referred at 17.9yrs with intermittent abdominal pain and few episodes of painless frank haematuria

More information

STORMY DENGUE with bloody problems. Anand M.Patil PICU MED/SURG TEAM Apollo Childrens Hospitals Chennai

STORMY DENGUE with bloody problems. Anand M.Patil PICU MED/SURG TEAM Apollo Childrens Hospitals Chennai STORMY DENGUE with bloody problems Anand M.Patil PICU MED/SURG TEAM Apollo Childrens Hospitals Chennai 1 HISTORY 4 ½ years girl Day 1: Fever, Lethargy, Low urine output Hypotension, high PCV,low platelets

More information

Nephrotic Syndrome. Department of pediatrics The first affiliated hospital Sun Yat Sen University. Yue Zhihui ( 岳智慧 )

Nephrotic Syndrome. Department of pediatrics The first affiliated hospital Sun Yat Sen University. Yue Zhihui ( 岳智慧 ) Nephrotic Syndrome Department of pediatrics The first affiliated hospital Sun Yat Sen University Yue Zhihui ( 岳智慧 ) yuezhihui810@yahoo.com.cn Contents Definition Pathophysiology Clinical manifestation

More information

Heparin-Induced Thrombocytopenia causing Adrenal Insufficiency

Heparin-Induced Thrombocytopenia causing Adrenal Insufficiency Heparin-Induced Thrombocytopenia causing Adrenal Insufficiency NATASHA MALKANI, MD LAHEY CLINIC INTERNAL MEDICINE, PGY-2 TUFTS UNIVERSITY SCHOOL OF MEDICINE Objective Describe mechanism of HIT Describe

More information

An unusual cause of pneumatocoele

An unusual cause of pneumatocoele An unusual cause of pneumatocoele From Dr.N.C.Gowrishankar s Unit Pediatric Surgery and PICU Dr Shashi Ranjani DNB PG Mehta Children Hospital 13 year boy h/o RTA at 2.30 pm boy was under the rear wheel

More information

Frequently Asked Questions about Cancer Associated Thrombosis

Frequently Asked Questions about Cancer Associated Thrombosis + Frequently Asked Questions about Cancer Associated Thrombosis Atlantic Canada Oncology Group Annual Meeting June 13 th, 2015 Sudeep Shivakumar, Dalhousie University + Conflict of Interest Disclosures

More information

Immunotherapy. Immunotherapy Triage

Immunotherapy. Immunotherapy Triage Immunotherapy Immunotherapy Triage The most commonly used drug is Ipilimumab for Metastatic Melanoma, but use of immunotherapy is developing in lung cancer and in clinical trials. Drugs include Nivolumab

More information

Suspected Deep Vein Thrombosis (DVT) Pathway for Non Pregnant patients Updated November 2016, with new D-dimer reference range

Suspected Deep Vein Thrombosis (DVT) Pathway for Non Pregnant patients Updated November 2016, with new D-dimer reference range Suspected Deep Vein Thrombosis (DVT) Pathway for Non Pregnant patients Updated November 2016, with new D-dimer reference range Suspect a DVT? Complete a Two-level DVT Wells score on ICE system (see page

More information

Management of acute alcoholic hepatitis

Management of acute alcoholic hepatitis Management of acute alcoholic hepatitis Yesim ALAHDAB Marmara University Hospital, Istanbul/TURKEY 5 th European Young Hepatologists Workshop August, 27-29, 2015 Moulin de Vernègues, France 1.4L ALCOHOL

More information

The University of Arizona Pediatric Residency Program. Primary Goals for Rotation. Nephrology

The University of Arizona Pediatric Residency Program. Primary Goals for Rotation. Nephrology The University of Arizona Pediatric Residency Program Primary Goals for Rotation Nephrology 1. GOAL: Understand the general pediatrician's role in diagnosis and management of hypertension in children.

More information

Update on the Management of Cancer Associated VTE

Update on the Management of Cancer Associated VTE Update on the Management of Cancer Associated VTE Jean M. Connors, MD 2018 Master Class Course Anticoagulation Management Services BWH/DFCI Hemostatic Antithrombotic Stewardship BWH Associate Professor

More information

Clinical Case Presentation. Dana Assis, MD

Clinical Case Presentation. Dana Assis, MD Clinical Case Presentation Dana Assis, MD 4.12.2016 Clinical Presentation 63 year old male with medical history AIDS (CD4 11, VL 62K), Hep C cirrhosis (never treated), DM II c/b diabetic retinopathy, HTN,

More information

Portal Vein Thrombosis in Minimal Change Disease

Portal Vein Thrombosis in Minimal Change Disease Case Report Ewha Med J 2014;37(2):131-135 http://dx.doi.org/10.12771/emj.2014.37.2.131 pissn 2234-3180 eissn 2234-2591 Portal Vein Thrombosis in Minimal Change Disease Gyuri Kim, Jung Yeon Lee, Su Jin

More information

CASE OF STAPH. AUREUS PNEUMONIA DR.VINAY BHOMIA MD

CASE OF STAPH. AUREUS PNEUMONIA DR.VINAY BHOMIA MD CASE OF STAPH. AUREUS PNEUMONIA DR.VINAY BHOMIA MD PATIENT S HISTORY Ambalal Labana a male aged 40 yrs came with c/o -- High grade fever with rigors 7 days --cough with white expectoration 7 days --Breathlessness

More information

Looking Outside the Box: Incidental Extracardiac Finding in Echo

Looking Outside the Box: Incidental Extracardiac Finding in Echo Looking Outside the Box: Incidental Extracardiac Finding in Echo Dr. Aijaz Shah Head of Division, Adult Echocardiography Laboratory Prince Sultan Cardiac Centre Riyadh Case 1 17 year old boy presented

More information

Patient Case. Patient Case 6/1/2013. Treatment of Pulmonary Hypertension in a Community

Patient Case. Patient Case 6/1/2013. Treatment of Pulmonary Hypertension in a Community Treatment of Pulmonary Hypertension in a Community Hospital Serena Von Ruden, PharmD, RN, BSN St. Francis Hospital Federal Way, WA Franciscan Health System HPI: 66 year old male with advanced oxygendependent

More information

>4000 mg/dl (=20000/(500/100)) >615 mmol/l (=20000/(65*0.5))

>4000 mg/dl (=20000/(500/100)) >615 mmol/l (=20000/(65*0.5)) Supplemental Table 1 Thresholds to define outliers of lab values in screening test for proteinuria Type of screening test Unit Threshold for Outliers References 24 hour urine albumin mg/d >20000 experienced

More information

Acute Pulmonary Embolism and Deep Vein Thrombosis. Barbara LeVarge MD Beth Israel Deaconess Medical Center Pulmonary Hypertension Center COPYRIGHT

Acute Pulmonary Embolism and Deep Vein Thrombosis. Barbara LeVarge MD Beth Israel Deaconess Medical Center Pulmonary Hypertension Center COPYRIGHT Acute Pulmonary Embolism and Deep Vein Thrombosis Barbara LeVarge MD Beth Israel Deaconess Medical Center Pulmonary Hypertension Center Acute PE and DVT No disclosures. Acute PE and DVT Learning objectives

More information

Acute Management of Pulmonary Embolism

Acute Management of Pulmonary Embolism Acute Management of Pulmonary Embolism Dr Alex West Respiratory Consultant Guy s and St Thomas Hospital London Declarations - none Order of Play Up date in Diagnostic Imaging - CTPA and V:Q SPECT Sub-massive

More information

A 50-year-old woman with syncope

A 50-year-old woman with syncope Hira Shahzad 1, Ali Bin Sarwar Zubairi 2 1 Medical College, Aga Khan University Hospital, Karachi 2 Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan Ali Bin Sarwar Zubairi Associate

More information

Case report Fever in a patient with ANCA-associated vasculitis

Case report Fever in a patient with ANCA-associated vasculitis Case report Fever in a patient with ANCA-associated vasculitis 73 years-old white woman PRIOR MEDICAL HISTORY *Hypertension: Enalapril, Furosemide *Dyslipidemia: Pravastatin *Ischemic heart disease: 2008

More information

Anticoagulants. Pathological formation of a haemostatic plug Arterial associated with atherosclerosis Venous blood stasis e.g. DVT

Anticoagulants. Pathological formation of a haemostatic plug Arterial associated with atherosclerosis Venous blood stasis e.g. DVT Haemostasis Thrombosis Phases Endogenous anticoagulants Stopping blood loss Pathological formation of a haemostatic plug Arterial associated with atherosclerosis Venous blood stasis e.g. DVT Vascular Platelet

More information

The following content was supplied by the author as supporting material and has not been copy-edited or verified by JBJS.

The following content was supplied by the author as supporting material and has not been copy-edited or verified by JBJS. Page 1 The following content was supplied by the author as supporting material and has not been copy-edited or verified by JBJS. Appendix TABLE E-1 Care-Module Trigger Events That May Indicate an Adverse

More information

DEEP VEIN THROMBOSIS (DVT): TREATMENT

DEEP VEIN THROMBOSIS (DVT): TREATMENT DEEP VEIN THROMBOSIS (DVT): TREATMENT OBJECTIVE: To provide an evidence-based approach to treatment of patients presenting with deep vein thrombosis (DVT). BACKGROUND: An estimated 45,000 patients in Canada

More information

VTE in Children: Practical Issues

VTE in Children: Practical Issues VTE in Children: Practical Issues Wasil Jastaniah MBBS,FAAP,FRCPC Consultant Pediatric Hem/Onc/BMT May 2012 Top 10 Reasons Why Pediatric VTE is Different 1. Social, ethical, and legal implications. 2.

More information

A RARE NEUROLOGICAL PRESENTATION OF SLE. Dr Yoganand M N Dr Prithvi P Nayak

A RARE NEUROLOGICAL PRESENTATION OF SLE. Dr Yoganand M N Dr Prithvi P Nayak A RARE NEUROLOGICAL PRESENTATION OF SLE Dr Jayachandra Dr Yoganand M N Dr Prithvi P Nayak Presenter: Dr Shambhavi K R CHIEF COMPLAINTS A 30 year old lady hailing from Nepal presented to OPD with complaints

More information

New Oral Anticoagulants in treatment of VTE, PE DR.AMR HANAFY (LECTURER OF CARDIOLOGY ) ASWAN UNIVERSITY

New Oral Anticoagulants in treatment of VTE, PE DR.AMR HANAFY (LECTURER OF CARDIOLOGY ) ASWAN UNIVERSITY New Oral Anticoagulants in treatment of VTE, PE DR.AMR HANAFY (LECTURER OF CARDIOLOGY ) ASWAN UNIVERSITY Fact VTE is deadly! It nibbles after it bites! The 30-day mortality rates for first-time DVT or

More information

Paediatrics Dr. Bakr Lecture 3 Nephrotic Syndrome

Paediatrics Dr. Bakr Lecture 3 Nephrotic Syndrome P a g e 1 DEFINITION Paediatrics Dr. Bakr Lecture 3 Nephrotic Syndrome Definition: nephrotic syndrome is a disorder characterized by heavy proteinuria with hypoprpteinimia,hyper lipidemia and edema. It

More information

IVC FILTERS: A CASE REPORT REVIEWING THE INDICATIONS FOR PLACEMENT, RETRIEVAL AND ANTICOAGULATION

IVC FILTERS: A CASE REPORT REVIEWING THE INDICATIONS FOR PLACEMENT, RETRIEVAL AND ANTICOAGULATION IVC FILTERS: A CASE REPORT REVIEWING THE INDICATIONS FOR PLACEMENT, RETRIEVAL AND ANTICOAGULATION Resident(s): George Athanasatos Attending(s): Daniel Golwyn Program/Dept: Interventional Radiology CHIEF

More information

HIT in ECMO: a challenging complication

HIT in ECMO: a challenging complication HIT in ECMO: a challenging complication Blanca Martinez SOC Anestesia e Rianimazione 2 Direttore R. Muzzi Azienda Ospedaliero-Universitaria SM della Misericordia di Udine martinez.blanca@aoud.sanita.fvg.it

More information

Venous interventions in DVT

Venous interventions in DVT Venous interventions in DVT Sriram Narayanan Chief of Vascular and Endovascular Surgery, Tan Tock Seng Hospital A/Prof of Surgery, National University of Singapore ANTI-COAGULATION LMWH Warfarin x 6m Acute

More information