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37yo F, previously health, left leg pain for 2 days. medications include OCPs and calcium supplementation. distal left lower extremity shows a subcutaneous, palpable, hard, cord-like structure within a 6X1-cm, warim erythematous area just proximal to the ankle. scattered varicose veins in the lower extremities, Next step?
A. application of warm compreses
B. Use of compression stockings
C. oral dicloxacilline therapy
D. oral predisone therapy
E. Subcultaneous enoxaparin therapy
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Superficial thrombophlebitis may occur spontaneously, as in pregnant or postpartum women or in individuals with varicose veins or thromboangiitis obliterans; or it may be associated with trauma, as in the case of a blow to the leg or following intravenous therapy with irritating solutions. It also may be a manifestation of systemic hypercoagulability secondary to abdominal cancer such as carcinoma of the pancreas and may be the earliest sign of these conditions. Superficial thrombophlebitis may be associated with occult deep venous thrombosis (DVT) in about *** 20% of cases ***.
Clinical Findings
The patient usually presents complaining of localized extremity pain and redness. Areas of induration, erythema, and tenderness correspond to dilated and often thrombosed superficial veins. Over time, a firm cord may develop. Generalized edema is absent unless the deep veins are involved.
Treatment
The primary treatment of superficial venous thrombophlebitis is the administration of nonsteroidal anti-inflammatory drugs, local heat, elevation, and support stockings or elastic wraps. Ambulation is encouraged. In most cases, symptoms will resolve within 7“10 days. Excision of the involved vein is recommended for symptoms that persist over 2 weeks despite treatment or for recurrent phlebitis in the same vein segment. If there is progressive proximal extension with involvement of the saphenofemoral junction or cephalic-subclavian junction, ligation and resection of the vein at the junction should be performed. Alternatively, full-dose anticoagulation can be utilized. Ligation and resection is most effective treating pain, while anticoagulation is most effective treating thrombus extension/embolization.
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# For the superficial, localized, mildly tender area of thrombophlebitis that occurs in a varicose vein, treatment with mild analgesics, such as aspirin, and the use of some type of elastic support usually are sufficient. Patients are encouraged to continue their usual daily activities. If extensive varicosities are present or if symptoms persist, phlebectomy of the involved segment may be indicated.
# More severe thrombophlebitis, as indicated by the degree of pain and redness and the extent of the abnormality, should be treated by bedrest with elevation of the extremity and the application of massive, hot, wet compresses. The latter measure seems to be more effective when a large, bulky dressing, including a blanket and plastic sheeting followed by hot water bottles, is used, taking care to avoid burning the patient. The immobilization is probably as beneficial as the moist heat. Long-leg heavy-gauge elastic stockings or multiple elastic (Ace) bandages are indicated when the patient becomes ambulatory.
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guys is it Aor B
based on the above explanation
