3. Peripheral Vascular Disease Flashcards
This system is mainly for transportation of O2, nutrients, & proteins
Peripheral vascular system
3 systems included in the peripheral vascualr system
arterial system
venous system
lymphatic system
The framework of the peripheral vascular system
Blood vessel
Layers of the blood vessel
- Tunica intima/ tunica interna
2.Tunica Media - Tunica Adventitia/tunica externa
This is the innermost layer of the blood vessel
Tunica intima
Layers of the tunica intima
Connective tissue
Basement membrane
endothelium
Thi sis the only layer present in all blood vessel
endothelium
This is the middle layer of the blood vessel
Tunica media
this is composed of a smooth muscle
tunica media
The bulk of the tunica media is seen in what structure?
artery
Can the artery contract? what kind of muscle is it?
yes, the artery is a smooth muscle
This is the outermost layer of the blood vessel
Tunica adventitia
This is composed of an elastic and a collagenous fiber
Tunica adventitia
The bulk of the tunica adventitia is seen in what structure?
tunica adventitia
Blood vessel that carries oxygenated blood
Artery
This blood vessel is a muscular, elastic, & tubular extension of the heart
Artery
characteristic of arteries proximal & distal to the heart
Proximal: increase in pressure, elastic
Distal: decrease in pressure, muscular
blood vessels that are very thin in nature so the O2 can easily pass through
Capillaries
This is also known as the exchange vessel
Capillaries
Blood vessel that carries deoxygenated blood
Veins
Blood vessels with valves
Veins
How many percent of blood do the veins carry?
60-64%
another term for veins
Capacitance vessel
3 types of veins
- superficial vein
- perforating vein/ communicating vein
- deep vein
This vein is found underneath the skin
superficial vein
2 great superficial vein in the lower extremity
- Greater saphenous vein
- Lesser saphenous vein
Where does the greater saphenous vein run?
on the medial aspect of the leg & thigh to join the femoral vein
Where does the Lesser saphenous vein run?
On the lateral malleolus to the posterior leg to join the popliteal vein
this vein connect the superficial vein to the deep vein
perforating vein/ communicating vein
This type of vein is a large vein that already follows the structure of an artery
deep vein
This vessel carries fluids back to the bloodstream
Lymphatics
The lymphatics can be found everywhere inside the body except:
CNS & cornea
Where are lymph nodes found?
Cervical area, axillary area, inguinal area
What cells are found in the lymph nodes?
macrophages
This is the inflammation and occlusion affecting medium to large arteries
Atherosclerosis Obliterans (ASO)
What size arteries are affected in Atherosclerosis Obliterans (ASO)
medium to large arteries
early stage signs & symptoms of Atherosclerosis Obliterans (ASO)
(+) intermittent claudication
late stage signs & symptoms of Atherosclerosis Obliterans (ASO)
(+) gangrene
in a non-DM pt, the most affected artery in Atherosclerosis Obliterans (ASO) are:
abdominal aorta
common iliac artery
femoral artery
in a DM pt, the most affected artery in Atherosclerosis Obliterans (ASO) are:
Femoral artery
tibial artery
Most common artery affected in Atherosclerosis Obliterans (ASO)
Femoral artery
This is an inflammation & occlusion affect the small arteries
Thromboangiitis Obliterans (TAO)
other term for Thromboangiitis Obliterans (TAO)
buerger’s disease
Thromboangiitis Obliterans starts in what segment?
distal to the proximal segment (ascending pattern)
This an abnormal vasoconstriction reflex affecting the small arteries
Raynaud’s phenomenon
precipitating factors of Raynaud’s phenomenon
exposure to cold & emotional stress
the cyclic color pattern of Raynaud’s phenomenon, what sign is present?
pallor
cyanosis
rubor
French flag sign
What to do when a patient with Raynaud’s phenomenon experiences pallor?
place the hands in a warm body cavity area (ex, armpits/sit on the chair/rub pt’s hand with towel)
This is a distention, swollen, superficial vein
Varicosities
Affected structures in varicosities, what is the cause?
valves, increase pressure in the lower ex
Causes of varicosities
prolonged standing
obesity
pregnancy
cross legs
Sx/s of varicosities
Aching, heavy leg with appearance of spider vein
this is an inflammation & occlusion affecting superficial veins
Superficial Vein thrombosis (SVT)
vein affected in Superficial Vein thrombosis (SVT)
saphenous vein
This is the most serious complication of varicosities
Superficial Vein thrombosis (SVT)
what and where where is the sx/s of Superficial Vein thrombosis (SVT) felt?
pain along the course of the saphenous vein
This is an inflammation & occlusion affecting the deep vein
Deep Vein thrombosis (DVT)
Triad in Deep Vein thrombosis (DVT)
Virchow’s triad
Hypercoagulability
Intimal wall damage
Venous stasis
special test in Deep Vein thrombosis (DVT), how is it performed?
(+) homan’s test,
squeeze the calf then passive Dorsiflex ,pain is indicative of (+) results
medicine for Deep Vein thrombosis (DVT)
anticoagulants
heparin (given through IV)
warfarin (oral medication)
What to do when a patient takes anticoagulants?
immobilize the affected LE
What is the most serious complication of Deep Vein thrombosis (DVT)
Pulmonary embolism
what is the best prevention for Deep Vein thrombosis (DVT)
early mobilization
This is an increased pressure in the deep veins
Chronic venous insufficiency (CVI)
this is the most common form of venous diseases
Chronic venous insufficiency
stages of Chronic venous insufficiency
what is found in stage 1
edema + pigmentation
stages of Chronic venous insufficiency
what is found in stage 2
edema + pigmentation +varicosities + dermatitis
stages of Chronic venous insufficiency
what is found in stage 3
ulceration
this is the most common manifestation of CVI
ulceration
this is an enlargement of the lymph nodes with or without tenderness
Lymphadenopathy
this is an excessive accumulation of fluids in the tissue
Lymphedema
2 types of Lymphedema
- Primary Lymphedema
- Secondary Lymphedema
this lymphedema is genetic
primary lymphedema
this is a congenital edema after birth
Milroy’s disease
this is a congenital edema after birth
this is a primary edema present in < 35y/o
Praecox
this is a primary edema present >35y/o
Tarda
what is the genetic risk for primary edema
<25%
this is the best initial exercise for primary edema, can it be applied in all types of primary lymphedema?
brisk walking
this cannot be applied for Milroy’s disease
Causes of secondary lymphedema
infection
surgery
malignancy
tumor
Arterial insufficiency vs Venous Insufficiency
pulse
AI: decreased or absent
VI: normal
Arterial insufficiency vs Venous Insufficiency
temperature
AI: cold
VI: normal/warm
Arterial insufficiency vs Venous Insufficiency
ulceration location
AI: lateral malleolus, anterior tibia
VI: medial malleolus, medial leg & thigh
Arterial insufficiency vs Venous Insufficiency
pain
AI: painful (pain on elevation, dusky red on dependency)
VI: painless (pain relieved upon leg elevation)
Arterial insufficiency vs Venous Insufficiency
positive sx/s
AI: (+) gangrene; (+) rest pain
VI: (+) edema, (+) dermatitis, (+) pigmentation
how is claudication time done?
measure the time/distance where the pain is felt using a treadmill
this is where the duration of ambulation exercises is based. Exercise to the point of pain but not beyond the pain
Special test for arterial insufficiency
claudication time
Special test for lymphedema, how is it performed what indicates a positive test
stemmer’s test
pinch the skin at the base of the 2nd toe
(+) lift of skin= (-) edema= (-)Stemmer’s test
Special test for arterial insufficiency, how is it performed?
Ankle brachial index (ABI)
LE:
doppler US pointed to the dorsalis pedis pulse/ posterior tibial pulse
BP cuff is wrapped in the calf area
UE:
doppler US pointed to the brachial pulse/radial pulse
BP cuff is wrapped in the brachium
Results: LE BP/UE BP
How to interpret results for Ankle brachial index (ABI)
> 1.20 falsely elevated: DM
1.19-0.95: Normal
0.94-0.75: mild arterial disease; (+) intermittent claudication
0.74-0.50: moderate arterial diseases; (+) rest pain
<0.50: severe arterial disease
Ulceration on the sole of the foot is seen in what condition?
diabetic ulceration
