関: venous thrombosis

WordNet

phlebitis in conjunction with the formation of a blood clot (thrombus)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/03/03 14:00:44」(JST)

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Thrombophlebitis is phlebitis (vein inflammation) related to a thrombus (blood clot).^[1] When it occurs repeatedly in different locations, it is known as "Thrombophlebitis migrans" or "migrating thrombophlebitis".

Signs and symptoms[edit]

The following symptoms are often (but not always) associated with thrombophlebitis:^[2]

pain in the part of the body affected
skin redness or inflammation (not always present)
swelling (edema) of the extremities (ankle and foot)
palpable cord-like veins

Causes[edit]

Thrombophlebitis (another medical term is "White Leg") is related to a thrombus in a superficial vein. Risk factors include disorders related to increased tendency for blood clotting, injury to vein wall and reduced speed of blood in the veins such as varices and prolonged immobility. Prolonged traveling by car or airplane may promote a blood clot leading to thrombophlebitis but this occurs relatively rarely. Specific disorders associated with thrombophlebitis include superficial thrombophlebitis (affects veins near the skin surface) and deep venous thrombosis (affects deeper, larger veins). Thrombophlebitis can be found in people with Behcet's disease. Thrombophlebitis migrans can be a non-metastatic manifestation of malignancies such as pancreatic carcinoma (Trousseau sign of malignancy).

Diagnosis[edit]

The health care provider makes the diagnosis primarily based on the appearance of the affected area. Frequent checks of the pulse, blood pressure, temperature, skin condition, and circulation may be required.

If the cause is not readily identifiable, tests may be performed to determine the cause, including the following:

Doppler ultrasound
Extremity arteriography
Blood coagulation studies (Blood clotting tests)

Prevention[edit]

Routine changing of intravenous (IV) lines helps to prevent phlebitis related to IV lines. See the specific disorders associated with thrombophlebitis for other preventive measures.

Treatment[edit]

For more specific recommendations, see the particular condition. In general, treatment may include the following:

Medications
- analgesics (pain medications)
- anticoagulants e.g. warfarin or heparin to prevent new clot formation
- thrombolytics to dissolve an existing clot such as intravenous streptokinase.
- nonsteroidal anti-inflammatory medications (NSAIDS) such as ibuprofen to reduce pain and inflammation
- Support stockings and wraps to reduce discomfort

The patient may be advised to do the following:

Elevate the affected area to reduce swelling.
Keep pressure off of the area to reduce pain and decrease the risk of further damage.
Surgical removal, stripping, or bypass of the vein is rarely needed but may be recommended in some situations.

Prognosis[edit]

Thrombophlebitis and other forms of phlebitis usually respond to prompt medical treatment.

Complications[edit]

Not all superficial thrombophlebitis is benign ^[3] Complications are rare, but when they occur they can be serious. The most serious complication occurs when the superficial blood clot is associated with a deeper venous thrombosis; this can then dislodge, traveling through the heart and occluding the dense capillary network of the lungs; this is a pulmonary embolism which can be potentially life threatening.

References[edit]

^ Torpy JM, Burke AE, Glass RM (July 2006). "JAMA patient page. Thrombophlebitis". JAMA 296 (4): 468. doi:10.1001/jama.296.4.468. PMID 16868304.
^ Thrombophlebitis. MedlinePlus Medical Encyclopedia. Public domain text. Update Date: 4/19/2004. Updated by: Brian F. Burke M.D., Department of Internal Medicine, Munson Medical Center, Traverse City, MI. Review provided by VeriMed Healthcare Network.
^ Venous Review The Official Journal of Center for Vein Restoration

UpToDate Contents

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1. 下肢の表在性血栓性静脈炎 superficial thrombophlebitis of the lower extremity
2. 化膿性（敗血症性）血栓性静脈炎 suppurative septic thrombophlebitis
3. カテーテル関連の上肢静脈血栓症 catheter related upper extremity venous thrombosis
4. 敗血症性骨盤血栓性静脈炎 septic pelvic thrombophlebitis
5. 下肢慢性静脈疾患の概要およびマネージメント overview and management of lower extremity chronic venous disease

English Journal

Postpartum thrombotic complication in a patient with paroxysmal nocturnal hemoglobinuria.

Gessoni G1, Canistro R, Bergamini L, Valverde S, Gessoni F, Nani G, Beggio S, Spillare P, Tregnaghi A.
Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis.Blood Coagul Fibrinolysis.2015 Jun;26(4):458-63. doi: 10.1097/MBC.0000000000000250.
Paroxysmal nocturnal hemoglobinuria (PNH) is a clonal nonneoplastic hematopoietic stem cell disease characterized by an acquired mutation of the PIG-A gene with reduction or absence of CD55 and CD59. The absence of these proteins renders PNH erythrocytes susceptible to complement-mediated hemolysis.
PMID 25688459

Behcet colitis.

Chin AB1, Kumar AS2.
Clinics in colon and rectal surgery.Clin Colon Rectal Surg.2015 Jun;28(2):99-102. doi: 10.1055/s-0035-1547336.
Behcet disease (BD) is a chronic, multisystem, inflammatory disease characterized by variable clinical manifestations involving systemic vasculitis of both the small and large blood vessels. The majority of BD patients present with recurrent oral ulcers in combination with other manifestations of th
PMID 26034406

Evaluation and Treatment of Penile Thrombophlebitis (Mondor's Disease).

Manimala NJ1, Parker J.
Current urology reports.Curr Urol Rep.2015 Jun;16(6):512. doi: 10.1007/s11934-015-0512-z.
Superficial penile thrombophlebitis or penile Mondor's disease (PMD) is an underreported condition that causes anxiety and embarrassment in affected men. Patients usually present with a smooth, cord-like induration on the dorsal penile shaft 1-7 days after prolonged or intensive sexual intercourse,
PMID 25962547

Japanese Journal

Lemierre's Syndrome Associated with Periodontal Injury-derived Odontogenic Infection that Did Not Respond to Meropenem

Internal Medicine 54(14), 1803-1808, 2015
NAID 130005088264

静脈穿刺からカテーテル先端位置確認までエコーを利用したベッドサイド PICC挿入法の成績

日本静脈経腸栄養学会雑誌 30(3), 804-809, 2015
NAID 130005083302

斜台骨髄炎と海綿静脈洞部腫瘤性病変を呈しステロイドが奏功したLemierre症候群の1例

臨床神経学 55(5), 327-332, 2015
NAID 130005073099

Related Pictures

★リンクテーブル★

リンク元	「バンコマイシン」「有痛性白股症」「静脈血栓症」「血栓性静脈炎」
拡張検索	「lateral sinus thrombophlebitis」「venous thrombophlebitis」「intracranial suppurative thrombophlebitis」

「バンコマイシン」

Thrombophlebitis
	Classification and external resources
ICD-10	I80, I82.1
ICD-9	451
MedlinePlus	001108
MeSH	D013924

　　[★]

英: vancomycin, VCM
化: 塩酸バンコマイシン vancomycin hydrochloride
商: Vancocin, Luphocin、バンマイシン
関: 抗菌薬一覧、テイコプラニン、メトロニダゾール

first aid step1 2006 p.140,165,166,169,173,207

抗菌薬

グリコペプチド系抗生物質

特徴

Streptomyces orientalisから分離
経腸管的に吸収されないため骨髄移植時の消化管内消毒に用いられる。

構造

作用機序

細胞壁合成阻害作用(block peptidoglycan synthesis)
細胞内で作られたmurein monomerの重合を妨げる？

薬理作用

抗菌スペクトル

MRSAを含むほとんどのグラム陽性菌と一部の嫌気性菌に抗菌作用を示す
殺菌的に作用(bactericidal antibiotics)

動態

腸管からほとんど吸収されない→腸管殺菌のための経口投与、点滴静注による全身投与で用いられる

適応

感染性腸炎
骨髄移植時の消化管内殺菌

[US?]MRSA(methicillin-resistant Staphylococcus aureus), penicillin-resistant Sreptococcus pneumoniae

適応菌種

メチシリン耐性黄色ブドウ球菌、クロストリジウム・ディフィシル

注意

禁忌

副作用

nephrotoxicity, ototoxicity, thrombophlebitis, diffuse flushing(red man syndrome) (first aid step1 2006 p.169)

重大な副作用

添付文書

1)ショック：0.1%未満(血圧低下、不快感、口内異常感、喘鳴、眩暈、便意、耳鳴り、発汗等)
2)注射用塩酸バンコマイシン製剤：アナフィラキシー様症状、急性腎不全、間質性腎炎、汎血球減少、無顆粒球症、血小板減少、皮膚粘膜眼症候群(Stevens-Johnson症候群)、中毒性表皮壊死症(Lyell症候群)、剥脱性皮膚炎、第8脳神経障害、偽膜性大腸炎、肝機能障害、黄疸