PBL - Day 1

1- Explore general causes of unilateral edema:

Unilateral edema: is a condition of abnormally accumulation of fluid in the interstitial
spaces in only one limb.
Some of the possible causes of Unilateral edema of the lower extremity:

Rupture of a Baker's cyst which presents in knee joint.

Venous insufficiency.
Deep vein thrombosis.
Cellulitis (which is infection of the skin and the underlying connective tissue).
Trauma.
Lymphatic obstruction.
Tumor of fibrosis obstructing the iliac vein.
Reflex sympathetic dystrophy (which is a chronic systemic disease characterized
by severe pain, swelling, and changes in the skin).

2- Describe the mechanisms of natural anticoagulant:

Anticoagulant are blood thinners, they prevent blood clots, which can stop blood flow to
the heart:

Natural flow of the blood is mainly caused by three main factors:

1. Movement of the blood.
2. Low viscosity of the blood.
3. Healthy endothelial layer.
Some food has anticoagulant properties, such as Garlic, vitamin E, willow bark,
fish oil, ginger, and chamomile.
Walking and moving limbs enhance blood circulation, thus help preventing
blood clotting.
Certain drugs , such as heparin and vitamin K antagonists.

3- Discuss complications of prolonged sitting:

Deep vein thrombosis (DVT) is a blood clot that develops in a vein deep in the
body. This clot can cause a backup in blood flow, causing pain and disability. If
part of the clot breaks off it can also TRAVEL up to the lungs causing a pulmonary
embolism (PE) which can be fatal. The clot can be formed because of slow blood
flow, pooling of blood, injury, or clotting problems. Muscle contractions in the
limbs help push blood through veins back to the heart. Long periods of
immobility, like sitting at a JOB, increase the chance that a clot will form.

Slowed Metabolism. When you sit for an extended period of time, your body
starts to slow and shut down on a metabolic level. Since you're not moving
around, your circulation slows and you're burning fewer calories and fewer fat
burning enzymes are moving through your body. All of this can lead to an overall
slowed metabolism that can affect your energy levels and cause you to gain
weight
Herniated Disk Sitting puts a lot of pressure on your hips and spine, and can lead
to some injuries in them over an extended period of time. One such injury may
be a herniated disk. Continued pressure on your spine may cause a disk to come
out of place, creating a painful condition that can require medication, physical
therapy or even surgery.
Obesity sitting can play a contributing role in obesity. While not burning enough
calories is part of the problem, studies have also shown that being overly
sedentary can slow your metabolism and change how your body functions,
further contributing to weight gain
Muscle Weakness moving less results in loss of muscle mass and muscle
weakness. One of the hardest hit muscles is the gluteus maximums, or the
buttocks. It is one of the largest muscles in the body and plays a big role in just
about any movement you could want to do, so it's essential that it stays strong.
Weak gluteus muscles can result in LOWER BACK PAIN and hip bursitis as well.
Raised Cholesterol Sitting causes enzyme activity in the body to drop by as
much as 90%, preventing those helpful enzymes from grabbing that fat and using
it for energy. In fact, after a few hours of sitting, healthy cholesterol plummets
by 20%.

4- Describe the anatomy of deep and superficial veins :

Superficial vein :
Great saphenous vein
The great saphenous vein drains the medial end of the dorsal venous arch of the
foot and passes upward directly in front of the medial malleolus It then ascends in
company with the saphenous nerve in the superficial fascia over the medial side of
the leg. The vein passes behind the knee and curves forward around the medial side
of the thigh. It passes through the lower part of the saphenous opening in the deep
fascia and joins the femoral.
The great saphenous vein possesses numerous valves and is connected to the small
saphenous vein by one or two branches that pass behind the knee. Several
perforating veins connect the great saphenous vein with the deep veins
along the medial side of the calf .
At the saphenous opening in the deep fascia, the great saphenous vein usually
receives three tributaries that are variable in size and arrangement the superficial
circumflex iliac vein, the superficial epigastric vein, and the superficial external

pudendal vein. These veins correspond with the three branches of the femoral
artery found in this region An additional vein, known as the accessory vein, usually
joins the main vein about the middle of the thigh or higher up at the saphenous
opening.
SMALL saphenous vein
The small saphenous vein arises from the lateral part of the dorsal venous arch of the
foot It ascends behind the lateral malleolus in company with the sural nerve. It follows
the lateral border of the tendo calcaneus and then runs up the middle of the back of the
leg. The vein pierces the deep fascia and passes between the two heads of the
gastrocnemius muscle in the lower part of the popliteal fossa it ends in the popliteal
vein.
The small saphenous vein has numerous valves along its course.
Tributaries:
Numerous small veins from the back of the leg
Communicating veins with the deep veins of the foot
Important anastomotic branches that run upward and
medially and join the great saphenous vein The mode of termination of the small
saphenous vein is subject to variation: It may join the popliteal vein; it may
join the great saphenous vein; or it may split in two, one division joining the popliteal
and the other joining the great saphenous vein.
Deep vein :
Femoral vein
The femoral vein enters the thigh by passing through the opening in the adductor
magnus as a continuation of the popliteal vein . It ascends through the thigh, lying at
first on the lateral side of the artery, then posterior to it, and finally on its medial side It
leaves the thigh in the intermediate compartment of the femoral sheath and passes
behind the inguinal ligament to
become the external iliac vein.
Tributaries:
The tributaries of the femoral vein are the great saphenous vein and veins that
correspond to the branches of the femoral artery . The superficial circumflex iliac vein,
the superficial epigastric vein, and the external pudendal veins drain into the great
saphenous vein.
Popliteal vein
The popliteal vein is formed by the junction of the venae comitantes of the anterior and
posterior tibial arteries at the lower border of the popliteus muscle on the medial side
of the popliteal artery. As it ascends through the fossa, it crosses behind the popliteal
artery so that it comes to lie on its lateral side. It passes through the opening in the
adductor magnus to become the femoral vein.
Tributaries:
The tributaries of the popliteal vein are as follows:
Veins that correspond to branches given off by the

popliteal artery.
Small saphenous vein, which perforates the deep fascia
and passes between the two heads of the gastrocnemius
muscle to end in the popliteal vein.
tibial vein

5- explore whats D Dimer and how its linked to leg swelling:

A d-dimer test is a blood test that measures a substance that is released when a blood
clot breaks up (D-dimer is the degradation product of crosslinked (by factor XIII) fibrin)
. Doctors order the d-dimer test, along with other lab tests and imaging scans, to help
check for blood-clotting problems. A d-dimer test can also be used to check how well a
treatment is working.
Why It Is Done?
Doctors use the d-dimer test when a person might have a dangerous blood-clotting
problem. These problems include:

Deep vein thrombosis, a condition in which a blood clot (thrombus) forms in the deep
veins of the legs, pelvis, or arms. To learn more, see the topic Deep Vein Thrombosis.
Pulmonary embolism, a condition in which blood flow in an artery in the lung is
suddenly blocked. To learn more, see the topic Pulmonary Embolism.
Disseminated intravascular coagulation (DIC), a condition that prevents a person's
blood from clotting normally.

Done by :
Ahmad Abdulrahman Hajer Halawani