Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Venous clots do not allow blood to return to the heart
and symptoms occur because of this damming effect. Most often occurring in the
legs or the arms,
symptoms include:
swelling,
warmth,
redness, and
pain.
Arterial clots do not allow blood get to the affected
area.
Body tissue that is deprived of blood and oxygen begins to die and becomes
ischemic (isch=to restrain + emia = blood)
Pain is the initial symptom of the ischemia, or oxygen deprivation due to
loss of blood supply.
Other symptoms depend upon the location of the clot, and
often the effect will be a loss of function. Heart attack and stroke are
self-explanatory.
In an arm or leg, in addition to pain, the limb may appear
white, and weakness, loss of sensation, or
paralysis may occur.
If
the blood supply is lost to an area of the bowel, in addition to intense pain,
there may be bloody diarrhea.
How are blood clots diagnosed?
The initial step in making the diagnosis of a blood clot is obtaining a
patient history. The blood clot itself does not cause a problem. It's the
location of the blood clot and its effect on blood flow that causes symptoms and
signs.
If a blood clot or thrombus is a consideration, the history may expand to
explore risk factors or situations that might put the patient at risk for forming a
clot.
Venous blood clots often develop slowly with a gradual
onset of swelling, pain, and discoloration. Symptoms of a venous thrombus will
often progress over hours.
Arterial thrombi occur as an
acute event. Tissues
need oxygen immediately, and the loss of blood supply creates a situation in
which symptoms begin immediately.
There may be symptoms that precede the acute artery blockage, that may be
warning signs of the potential future complete occlusion of the blood vessel.
Patients with an acute
heart attack (myocardial infarction) may experience
angina in the days and
weeks prior to the heart attack.
Patients with peripheral artery disease may have pain with walking (claudication),
and a TIA (transient
ischemia attack, mini-stroke) may precede a stroke.
Physical examination can assist in providing additional information that may
increase the suspicion for a blood clot.
Venous thrombi may cause swelling of an
extremity. It may be red, warm, and tender; sometimes the appearance is
difficult to distinguish from cellulitis or an infection of the extremity. If
there is concern about a pulmonary embolus, the clinician may examine the
lungs, listening for abnormal sounds caused by an area of inflamed lung tissue.
Arterial thrombus symptoms are much more dramatic. If a leg or arm is
involved, the tissue may be white because of the lack of blood supply. As well,
it may be cool to touch and there may be loss of sensation and movement. The
patient may be writhing in pain.
Arterial thrombus is also the cause of heart attack (myocardial infarction) and stroke
(cerebrovascular accident) and their associated symptoms.
Testing for venous blood clots
Venous blood clots may be detected in a variety of ways,
though ultrasound is
most commonly used. Occasionally, the patient's size and shape limit the ability
for ultrasound to provide a definitive answer.
Venography is an alternative test to look for a clot. In this test, a radiologist injects
contrast dye into a small vein in the hand or foot and using
fluoroscopy (video
X-ray), watches the dye fill the veins in the extremity as it travels back to the
heart. The area of clot or obstruction can thus be
visualized.
Sometimes, a blood test is used to screen for blood clots. D-Dimer is a
breakdown product of a blood clot, and its levels in the bloodstream may be
measured. Blood clots are not stagnant; the body tries to dissolve them at the
same time as new clot is being formed. D-Dimer is not specific for a blood clot
in a given area and cannot distinguish a "good” or needed blood clot, one that
forms after surgery or due to bruising from a fall, from one that is causing
medical problems. It is used as a screening test with hopes that the result will
be negative and show that there is no need to look further for blood clots.
The D-dimer blood test is usually ordered with the expectation that it will
be negative. It is a useful test in patients who have a low probability of
having a blood clot, and the health care practitioner usually counsels the
patient that a positive blood test will likely require additional tests being
ordered.
Should a blood clot embolize to the lung, this may be a
medical emergency. There are a variety of tests to look for pulmonary emboli. A
plain chest X-ray will not show blood clots, but it may be done to look for
other conditions that can cause chest pain and shortness of breath, which are
the symptoms of a pulmonary embolus. An electrocardiogram (EKG) may show
abnormalities suggestive of a pulmonary embolus and also may reveal other causes
of chest pain.
Computerized tomography (CT scan) is often the test of choice when suspicion of
pulmonary embolus is high. Contrast material is injected intravenously, and the
radiologist can determine whether a clot is present in the pulmonary vessels.
The contrast material injected into the body can be irritating to the kidney(s)
and should not be used in patients who have impaired kidney function. In older
patients, screening blood tests (serum
creatinine) to check kidney function may be required before a dye study is
considered.
On occasion, a ventilationperfusion
(V/Q) scan is performed to look for pulmonary emboli. This test uses labeled
chemicals to identify inhaled air into the lungs and match it with blood flow in
the arteries. If a mismatch occurs, meaning that there is lung tissue that has
good air entry but no blood flow, it may be indicative of a pulmonary embolus.
It is less accurate and more subjective than a CT scan, and requires the skill
and experience of a radiologist to interpret. Two radiologist may interpret a VQ
scan differently and come to different conclusions.
Testing for arterial blood clots
Arterial thrombosis is an emergency, since tissue cannot
survive long without blood supply before there is irreversible damage. When this
occurs in an arm or leg, often a surgeon is consulted on an emergency basis. Arteriography may be
considered, a test in which contrast material is injected into the artery in
question to look for blockage on imaging studies. Sometimes, if there is a large
artery that is occluded, this test is done in the operating room with the
presumption that a surgical procedure will be needed to open the vessel and
restore blood flow.
For a heart attack (acute myocardial infarction, MI), the EKG may
establish the diagnosis, although blood tests may be used to look for enzymes
(troponin, myoglobin, CPK)
that leak into the bloodstream from irritated heart muscle. In an acute heart
attack, the
diagnostic and therapeutic procedure of choice is a
heart catheterization.
For an acute stroke (cerebrovascular accident, CVA), the test of choice is a
computerized tomography (CT) scan of the head to look for bleeding or tumor as
the cause of stroke symptoms. If the symptoms resolve, the diagnosis is a
transient ischemic attack
(TIA, mini-stroke), and further tests may
include carotid ultrasound to look for blockages in the major arteries of the
neck and echocardiography to
look for blood clots in the heart that may embolize to the brain.
Urinary tract infection (UTI) is an infection of the kidney, ureter, bladder, and/or urethra. Not
everyone with a UTI has symptoms. Common symptoms include a frequent urge to
urinate and a painful, burning when urinating.
Rectal bleeding (hematochezia) refers to the passage of bright red blood from the anus. Rectal bleeding may be moderate to severe and most bleeding comes from the colon, rectum, or anus. Common causes include anal fissures, hemorrhoids, diverticulitis, and more.
High blood pressure, also known as hypertension, is a repeatedly
elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above
140 with a diastolic pressure above 90. There are two causes of high blood pressure, primary and secondary. Primary high blood pressure is much more common that secondary and its basic causes or underlying defects are not always known. It is known that a diet high in salt increases the risk for high blood pressure, as well as high cholesterol. Genetic factors are also a primary cause. Secondary high blood pressure is generally caused by another condition such as renal hypertension, tumors, and other conditions. Treatment for high blood pressure is generally lifestyle changes and if necessary, diet.
There are many symptoms involved in the 1st, 2nd and 3rd trimesters of pregnancy. The first early pregnancy symptom is typically a missed period, but others include breast swelling and tenderness, nausea and sometimes vomiting, fatigue and bloating. Second trimester symptoms include backache, weight gain, itching, and possible stretch marks. Third trimester symptoms are additional weight gain, heartburn, hemorrhoids, swelling of the ankles, fingers, and face, breast tenderness, and trouble sleeping. Read more to learn about recommended procedures and tests for each stage of a healthy pregnancy.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.
Deep vein thrombosis (DVT) is a blood clot in a vein located deep in the muscles of the legs, thighs, pelvis (lower torso), or arms. The most common symptoms of a deep vein thrombosis are swelling and pain in the leg that has the blood clot. A DVT is difficult to diagnose without specific tests in which the deep vein system can be examined.
Cholesterol is naturally produced by the body, and is a building block for cell membranes and hormones. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol, conversely, high-density lipoprotein (HDL) cholesterol is the "good" cholesterol. High cholesterol treatment includes lifestyle changes (diet and exercise), and medications such as statins, bile acid resins, and fibric acid derivatives.
Heart attack happens when a blood clot completely obstructs a coronary
artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical
instability of the heart.
A hematoma is a collection of blood that is outside a blood vessel. There are different areas where hematomas occur including the inside the skull, scalp, ear, septum, bones, finger and toenails, and intra-abdominal. Treatment for hematomas depend on the type and location of the hematoma.
Stool color is generally brown. When stool color changes, often, an individual becomes concerned. The presence of the bilirubin in bile is generally responsible for stool color. Bilirubin concentration can vary bile color from light yellow to almost black in color. Changes in bilirubin can cause stool to turn green, gray, or clay-like in color. Intestinal bleeding may turn stool black, tarry, red, maroon, or smelly stool. Medication and food may also affect stool color.
Normal vaginal bleeding (menorrhea) occurs through the process of menstruation. Abnormal vaginal bleeding in women who are ovulating regularly most commonly involves excessive, frequent, irregular, or decreased bleeding. Causes of abnormal may arise from a variety of conditions.
Celiac disease is a result of an immune reaction to gluten, a protein found in wheat or related grains and present in many foods that we eat. Celiac disease causes impaired absorption and digestion of nutrients through the small intestine. Signs and symptoms of celiac disease include malabsorbption (diarrhea, foul smelling gas, bloating, and increased amounts of fat in the stool) and malnutrition (weight loss, edema, anemia, bruising easily, neuropathy, and infertility). Treatment for celiac disease is a gluten free diet, and at times if necessary, medications
Internal bleeding occurs when an artery or vein is damaged and blood to escapes the circulatory system and collects inside the body. Internal bleeding can be caused by a variety of situations such as blunt trauma, deceleration trauma, medications, fractures, and spontaneous bleeding. Treatment of internal bleeding depends on the cause of the bleeding.
A peptic ulcer is an ulcer in the lining of the stomach, duodenum, or esophagus. Ulcer formation is related to Helicobacter pylori bacteria in the stomach, use of anti-inflammatory medications, and cigarette smoking.
Ascites, the accumulation of fluid in the abdominal cavity is most commonly caused by cirrhosis of the liver. Some of the other causes of ascites include portal hypertension, congestive heart failure, blood clots, and pancreatitis. The most common symptoms include increased abdominal girth and size, abdominal bloating, and abdominal pain. Treatment depends on the cause of ascites.
The spleen enlarges if it is asked to do excessive work in filtering or manufacturing blood cells, if there is abnormal blood flow to it, or if it is invaded with abnormal cells or deposits. Symptoms of an enlarged spleen may include weakness and fatigue, easy bleeding, and poor white blood cell function. Treatment of an enlarged spleen is focused toward the cause of the splenomegaly. Surgery may be required to remove the spleen.
Thrombocytopenia refers to a decreased number of platelets in the blood. There are many causes of thrombocytopenia such as decreased platelet production (viral infections for example rubella, mumps, chickenpox, hepatitis C, and HIV); increased platelet destruction or consumption (for example sulfonamide antibiotics, heparin, blood transfusions, and lupus); or increased splenic sequestration (enlarged spleen due to conditions for example liver disease, blood cancers, and more). Treatment of thrombocytopenia depends on the cause.
Heart disease (coronary artery disease) is caused by a buildup of cholesterol deposits in the coronary arteries. Risk factors for heart disease include smoking, high blood pressure, heredity, diabetes, peripheral artery disease, and obesity. Symptoms include chest pain and shortness of breath. There are a variety of tests used to diagnose coronary artery disease. Treatment includes life-style changes, medications, procedures, or surgery.
Peripheral vascular disease (PVD) refers to diseases of the blood vessels (arteries and veins) located outside the heart and brain. While there are many causes of peripheral vascular disease, doctors commonly use the term peripheral vascular disease to refer to peripheral artery disease (peripheral arterial disease, PAD), a condition that develops when the arteries that supply blood to the internal organs, arms, and legs become completely or partially blocked as a result of atherosclerosis. Peripheral artery disease symptoms include: intermittent claudication, rest pain, numbness in the extremities, and more. Treatment for peripheral artery disease include: lifestyle measures, medication, angioplasty, and surgery.
The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Treatment for type 1 diabetes is with insulin, exercise, and a diabetic diet. Treatment for type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered.
Wisdom teeth are the third set of molars that people get in their late teens or early twenties. Impacted wisdom teeth that only partially erupt allows for an opening for bacteria to enter around the tooth and cause an infection, which results in pain, swelling, jaw stiffness, and general illness. Before your wisdom teeth are pulled, the teeth and the surrounding tissue will be numbed with a local anesthetic. Recovery from wisdom tooth removal depends upon the difficulty of the extraction.
Hydronephrosis is a condition in which the kidney swells, due to a backup of urine. Hydronephrosis generally occurs with another disease.Symptoms of hydronephrosis include nausea, vomiting, urinary tract infection, fever, painful urination, increased urinary frequency and urgency, flank pain, and swelling of the abdomen. Treatment of hydronephrosis depends on the cause.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
When a portion of the brain loses blood supply, through a blood clot or embolus, a transient ischemic attack (TIA, mini-stroke) may occur. If the symptoms do not resolve, a stroke most likely has occurred. Symptoms of TIA include: confusion, weakness, lethargy, and loss of function to one side of the body. Risk factors for TIA include vascular disease, smoking, high blood pressure, high cholesterol, and diabetes. Treatment depends upon the severity of the TIA, and whether it resolves.
Phlebitis is the inflammation of a vein. Thrombophlebitis is when a blood clot causes the inflammation. Phlebitis can be superficial or deeper in the veins. A blood clot deep in a vein is deep vein thrombosis (DVT). Some of the common causes of phlebitis include prolonged inactivity, varicose veins, trauma to a vein, underlying cancers, clotting disorders, etc. Symptoms of phlebitis may be mild (pain, tenderness, redness, or bulging of a vein. Treatment of phlebitis depends on the cause.
In the United States, head injuries are one of the most common causes of death and disability. Head injuries due to bleeding are generally classified by the location of the blood within the scull, these include: epidural hematoma, subdural hematoma, subarachnoid bleed, intracranial bleed, sheer injury, edema, and skull fracture. Some common symptoms of a head injury include: vomiting, bleeding from the ear, speech difficulties, paralysis, difficulty swallowing, and body numbness. Treatment of a head injury depends on the type and severity of the injury.
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