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TWO CASES WITH HEMOPTYSIS CASE 2 ,[object Object],[object Object]
Mr.Marimuthu,  35 years,lorry driver,admitted on 12.2.2009 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
GENERAL EXAMINATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PROVISONAL DIAGNOSIS ,[object Object],[object Object],[object Object]
 
INVESTIGATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ECG on admission
Chest X ray PA view
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ECG FINDINGS IN PULMONARY EMBOLISM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ECG FINDINGS IN PULMONARY EMBOLISM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
FURTHER INVESTIGATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
FINAL DIAGNOSIS ,[object Object],[object Object],[object Object],[object Object]
TREATMENT GIVEN ,[object Object],[object Object],[object Object],[object Object],[object Object]
VENOUS THROMBOEMBOLIC DISORDERS (DVT & PE) ,[object Object],[object Object],[object Object],[object Object],[object Object]
CLINICAL PRESENTATION   (Signs and symptoms of DVT & PE are neither sensitive nor specific) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ASSESSMENT OF SEVERITY OF PE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
LABORATORY STUDIES ,[object Object],[object Object],[object Object],[object Object]
LABORATORY ASSESSMENT OF INHERITED THROMBOPHILIC STATES Prothrombin gene mutation G20210A G20210A mutation  Partial protein C deficiency Partial protein S deficiency Protein C activity Protein S activity,  Free protein S antigen Factor V Leiden Activated protein C resistance, if positive confirm with Factor V Leiden PCR Hyperhomocystinemia Fasting plasma homocysteine levels
LABORATORY ASSESSMENT OF ACQUIRED THROMBOPHILIC STATES ANTIPHOSPHOLIPID ANTIBODY SYNDROME LUPUS ANTICOAGULANT, ANTICARDIOLIPIN ANTIBODY,  BETA 2 GLYCOPROTEIN 1 PNH RBC OR WBC FLOW CYTOMETRY FOR LOSS OF CD55,CD59 MYELOPROLIFERATIVE DISORDER JAK – 2 MUTATION
IMAGING - DVT SPECIFIC TESTING ,[object Object],[object Object],[object Object],[object Object],[object Object]
PE   SPECIFIC TESTING ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TREATMENT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
INVASIVE SPECIAL THERAPIES ,[object Object],[object Object],[object Object],[object Object],[object Object]
LONG TERM TREATMENT WITH VITAMIN K ANTAGONISTS FOR DVT AND PE First episode of DVT or PE secondary to a transient risk factors 3 mon Recommendation applies to both proximal and calf vein thrombosis First episode of idiopathic DVT or PE 6 – 12 mon Continuation of therapy after 6 -12 mon to be considered First episode of DVT or PE with a documented thrombophilic abnormality 6 – 12 mon Continuation of therapy after 6 -12 mon to be considered First episode of DVT or PE with documented antiphospholipid or >= 2 thrombophilic abnormality 12 mon Continuation of therapy after 12 mon to be considered
COURSE OF THE ILLNESS ,[object Object]
 
ACKNOWLEDGEMENTS ,[object Object],[object Object]
[object Object]

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Case 2: Pulmonary Thromboembolism

  • 1.
  • 2.
  • 3.
  • 4.
  • 5.
  • 6.
  • 7.
  • 8.  
  • 9.
  • 11. Chest X ray PA view
  • 12.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.  
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24. LABORATORY ASSESSMENT OF INHERITED THROMBOPHILIC STATES Prothrombin gene mutation G20210A G20210A mutation Partial protein C deficiency Partial protein S deficiency Protein C activity Protein S activity, Free protein S antigen Factor V Leiden Activated protein C resistance, if positive confirm with Factor V Leiden PCR Hyperhomocystinemia Fasting plasma homocysteine levels
  • 25. LABORATORY ASSESSMENT OF ACQUIRED THROMBOPHILIC STATES ANTIPHOSPHOLIPID ANTIBODY SYNDROME LUPUS ANTICOAGULANT, ANTICARDIOLIPIN ANTIBODY, BETA 2 GLYCOPROTEIN 1 PNH RBC OR WBC FLOW CYTOMETRY FOR LOSS OF CD55,CD59 MYELOPROLIFERATIVE DISORDER JAK – 2 MUTATION
  • 26.
  • 27.
  • 28.
  • 29.
  • 30.
  • 31.
  • 32. LONG TERM TREATMENT WITH VITAMIN K ANTAGONISTS FOR DVT AND PE First episode of DVT or PE secondary to a transient risk factors 3 mon Recommendation applies to both proximal and calf vein thrombosis First episode of idiopathic DVT or PE 6 – 12 mon Continuation of therapy after 6 -12 mon to be considered First episode of DVT or PE with a documented thrombophilic abnormality 6 – 12 mon Continuation of therapy after 6 -12 mon to be considered First episode of DVT or PE with documented antiphospholipid or >= 2 thrombophilic abnormality 12 mon Continuation of therapy after 12 mon to be considered
  • 33.
  • 34.  
  • 35.
  • 36.