1. Thandiwe Murape 2014

2.  Acts as a reservoir to hold blood.  Acts as a conduit to return blood to heart and lungs.  Is composed of single tissue layer but large veins have an internal elastic membrane.  Blood travels from end-capillary venules for eventual delivery to the heart & lungs (The Fundamental of Phlebology, 2014) http://www.vectorstock.com/royalty-free-vector/venous-system-vector- 826048 http://education-portal.com/academy/lesson/what-are-veins-functions-lesson- quiz.html#lesson

3. DVT is the formation of a blood clot in the deep leg veins. It is a very serious health condition that can proceed to pulmonary embolism which is life threatening. It commonly occurs in the lower-limb veins but can also occur in the upper limbs. Signs of DVT include pain, swelling and erythema (Rumack, 2011) DVT maybe caused by: - - Previous history of DVT - In-dwelling venous catheters/surgery - Injury to the vein wall - Malignancy +/- chemotherapy - Immobilisation - Pregnancy - Coagulation abnormalities (Thrush & Hartshorne, 2010) http://www.sirweb.org/patients/deep-vein-thrombosis/ http://www.lymphedemapeople.com/thesite/lymphedema_deep_venous_thromb osis.htm

4.  Duplex Ultrasound is the preferred method of imaging DVT because it is cheap and readily available.  Other diagnostic methods include: - - CT scan - MRI - Venography - Lung Ventilation perfusion scan (used for pulmonary embolism diagnosis) - Other test include the D-Dimer blood test (National Heart, Lung and Blood Institute)

5.  A 47 year old man presented with pain in the right calf  Previous history of varicose veins and DVT in his early 20s.  Strong family history of DVT and strokes  Clinical signs included pain in calf with very mild swelling and limping.  Not on blood thinners  A recent overseas holiday. http://thehealthscience.com/showthread.php?840181-Bedside-Ultrasonography- in-Deep-Vein-Thrombosis

6.  On examination, the CFV, LSV (upper thigh) and the FV compressed adequately but on Colour Doppler there was little flow even with augmentation.  Examination was extended to the IVC, CIV and EIV to rule out any possible thrombus.  An investigation of the LSV continued from the ankle and a heterogenous thrombus of moderate echogenicity was seen in the lower leg.

7.  Lower leg veins also involved; SSV, Med Gastrocs and Pop veins.  These veins were not compressible and there was partial to no blood flow on Colour Doppler.  Thrombosed varicose veins were also seen in the medial aspect of the lower leg.  Patient had a noticeable small lump in the medical aspect of the lower leg and he felt pain with probe pressure during compression. Thrombosis in LSV lower leg- no blood flow Varicose vein in the lower leg, med aspect

8.  Visualisation of thrombosis in the SSV prompted further investigation to the origin of the vessel, the pop vein.  Thrombosis was found in the distal pop vein and was partially compressible with little colour flow.  Examination was presented to radiologist for evaluation.  Given his history, an urgent report was written for patient to take to his GP for further discussion on treatment.

9.  Worksheet indicating thrombosed veins.

10.  Compression of ultrasound has potential to cause thrombus to break off the vein walls leading to pulmonary embolisation ( Zwiebel & Pellerito, 2005).  Obese patients – difficult to evaluate veins in the groin region and adductor canal region  Pregnant patients  Swollen /fat legs (Allan et al, 2006)  http://www.environmentalhealthnews.org/ehs/news/2012/ob-gyns-and-environmental-health

11.  If DVT is not treated, severe complication may occur which include Pulmonary Embolism and postphlebitic syndrome (Rumack,2011) - Thrombus may break off and travel to the heart then the lungs then block - A combination of DVT and PE is referred to as Venous Thromboembolism (VTE). http://www.medindia.net/patients/patientinfo/pulmonary-embolism-and-deep- vein-thrombosis.htm

12.  DVT treatment begins immediately after diagnosis to reduce the risk of the clot breaking off and extend further to the heart and lungs. Immediate treatment may reduce the risk of post thrombotic syndrome.  Depending on location or severity of DVT, treatments may be done at home or in hospital.  Anticoagulants are used as treatment of DVT such as heparin and warfarin.  Heparin is administered intravenously and acts immediately which warfarin is administered orally and take days to be effective.  Regular blood tests and ultrasound are important for monitoring effects of treatment.  Management of DVT include - elevation the affected leg whenever possible  Use of graduated compression stockings  Prevention of long periods of immobility. (http://www.phlebology.com.au/deep-vein-thrombosis)

13.  Carol M., Rumack., Stephanie R., Wilson., William J., Charboneau and Deborah Levine. 2011. Diagnostic Ultrasound. 4 th edition. USA. Elsevier Mosby.  Paul L., Allan., Paul A., Dubbins., Myron A., Pozniak and Norman W., McDicken. 2006. Clinical Doppler Ultrasound. 2 nd edition. China. Churchill Livingstone Elsevier.  Abigail Thrush and Tim Hartshorne. 2010. Vascular Ultrasound, How, Why and When. 3 rd edition. China. Churchill Livingstone Elsevier.  Ulrike M., Hamper and Robert M., DeJong, and Leslie M., Scoutt. 2007. Ultrasound Evaluation of the Lower Extremity Veins. Radiologic Clinics of North America 45 (3): 525-547.  The Australasian School of Phlebology. Deep Vein Thrombosis. Retrieved on 30 October 2014 from: http://www.phlebology.com.au/deep-vein-thrombosis http://www.phlebology.com.au/deep-vein-thrombosis  National Heart, Lung and Blood Institue. DVT Diagnosis. Retrieved on 30 October 2014 from http://www.nhlbi.nih.gov/health/health-topics/topics/dvt/diagnosis.html