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Clin Med II > arterial diseases, venous diseases, lymphedema > Flashcards

arterial diseases, venous diseases, lymphedema Flashcards

1
Q

PAD

A
  • atherosclerosis most common cause

- imbalance of supply and demand -> ischemia in peripheral arteries and sx

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2
Q

risk factors for PAD

A
  • smoking*
  • HTN*
  • diabetes*
  • hyperlipidemia*
  • metabolic syndrome*
  • age > 70
  • usually men > women
  • family hx
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3
Q

at risk population for PAD

A
  • age > 70
  • age 50-60 with hx of smoking or diabetes
  • age 40-49 with diabetes and at least one other risk factors for atherosclerosis
  • intermittent claudication or ischemic rest pain
  • abnormal LE pulse eam
  • known atherosclerosis
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4
Q

sx of PAD

A
  • may be asymptomatic
  • intermittent claudication*
  • nonhealing wounds or gangrene
  • extremity pain, atypical or diffuse extremity pain
  • erectile dysfunction*
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5
Q

common places for intermittent claudication

A
  • butt
  • hip
  • thigh
  • calf
  • foot
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6
Q

PE findings for PAD

A
  • smooth, shiney skin without hair
  • cool skin, pallor, cyanosis, mottling
  • ulcers, gangrene
  • dependent rubor
  • decreased or absent distal pulses
  • bruits
  • buerger test
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7
Q

diagnosis of PAD

A
  • ABI, exs ABI of <0.9
  • segmental pressures, toe pressures
  • arterial duplex
  • CTA, MRA, angiography
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8
Q

classification of PAD

A
  • wifi classification- risk of limb amputation at 1 year

- wound, ischemia, and foot infection

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9
Q

treatment for PAD

A
  • conservative care
  • medical management
  • surgery
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10
Q

conservative tx for PAD

A
  • risk factor modification
  • smoking cessation
  • consistent mod exercise routine
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11
Q

medical management for PAD

A
  • ASA
  • statins
  • cilostazole- increases exs tolerance
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12
Q

indications for surgery in PAD

A
  • disabling claudication
  • ischemic rest pain
  • ulcerations, gangrene
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13
Q

surgical options for PAD

A
  • stent placement and angiography
  • enarterectomy
  • open bypass procedures
  • amputation
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14
Q

what is the TASC classification

A
  • determines if PAD lesions are candidates for percutaneous revascularization
  • A lesions- short stenosis
  • D lesions- diffuse disease and chronic occlusions
  • A and B best for percutaneous revasc
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15
Q

when to refer PAD to vascular surgery

A
  • progressive sx
  • short distance claudication
  • rest pain
  • ulcers or nonhealing
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16
Q

subclavian steal syndrome

A
  • L subclavian steals blood flow from posterior circulation -> neurologic sx
  • unequal UE BP > 10-15 mmHg
  • arm claudication
  • arm or hand ischemia
  • neurologic sx
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17
Q

dx of subclavian steal syndrome

A
  • noninvasive eval of cerebrovascular and UE arterial circulation via doppler, duplex US, intracranial doppler
  • MRA, CTA or angiography
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18
Q

treatment of subclavian steal syndrome

A
  • intervention for sx or to maintain LIMA bypass
  • medical therapy
  • surgical therapy
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19
Q

etiology of acute limb ischemia/ occlusion

A
  • progressive PAD
  • arterial emboli
  • arterial thrombus- usually at site of plaque
  • aneurysm or thrombosis if bypass
  • trauma
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20
Q

risk factors of acute limb ischemia/ occlusion

A
  • a fib
  • recent MI
  • large vessel aneurysm
  • aortic dissection
  • arterial trauma
  • DVT
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21
Q

symptoms of acute limb ischemia/ occlusion

A
  • depends on time, location, and collateral vessels
  • six P’s
  • limb and life threatening ischemia d/t lactic acid build up and breakdown byproducts
  • irreversible damage after 6 hours
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22
Q

6 P’s of acute limb ischemia/ occlusion

A
  • pulselessness
  • pain**
  • poikilothemia
  • pallor
  • paresthesia
  • paralysis
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23
Q

classification of arterial occlusion

A
  • viable- no tissue damage
  • marginally threatened- emergency
  • immediately threatened- emergency
  • irreversible- non-emergent, requires amputation
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24
Q

treatment of acute arterial occlusion

A
  • anticoag- IV heparin
  • thrombectomy/ embolectomy
  • endovascular surgery
  • surgical intervention
  • thrombolytic therapy- catheter directed lysis
  • post revasc- assess for source of thrombus**
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25
blue toe syndrome
- small vessel occlusion - usually embolic - scattered petechiae, cyanosis of soles of feet or toes - need to ID and treat embolic source
26
anatomic risk factors for venous thrombosis
- mae thurner syndrome | - inferior vena cava abnormalities
27
acquired risk factors for VTE
- previous VTE - active malignancy - surgery, trauma - pregnancy - drugs- OCP, HRT - immobilization, recent hospitalization - antiphospholipid ab - CV risk factors
28
hereditary risk factors for VTE
- factor V leiden - prothrombin gene mutation - protein 5 or C deficiency - anti thrombin deficiency
29
complications of VTE
- PE - stroke or arterial embolism - death - phlebmasia cerulean dolens - thrombus extension - postphlebitic syndrome
30
si/sx of DVT
- pain esp in calf - swelling of entire extremity - erythema - palpable cord - superficial venous dilation - skin necrosis or livedo reticularis
31
phlemgasia cerulean dolens
- "severe" DVT - sudden severe leg pain and edema - cyanosis - venous gangrene - compartment syndrome - arterial compromise
32
what is the well's score used for
- DVT risk assessment
33
d dimer
- fibrin split product - nonspecific - used in low probability pts when ruling out DVT - elevated if elderly, pregnant, malignancy, or trauma
34
dx of DVT
- use well's score - compression US - venous duplex imaging - d dimer
35
treatment of DVT
- monitor progression - anticoagulation if proximal veins, +/- if calf veins - thrombolysis or thrombectomy - IVC filter placement- rare - compression stockings
36
anticoagulation tx for DVT
- IV heparin bridge to coumadin - subq LMWH or fondaparinux and bridge to coumadin - pradaxa, xarelto, eliquis - if provoked DVT with transient risk factors tx for 3-12 mo - if unprovoked or persistent risk factors tx indefinitely
37
DVTs requiring hypercoag work up
- unprovoked and < 50 y/o - unprovoked with family hx - recurrent DVT - thrombosis in unusual vascular bed i.e. portal, hepatic, mesenteric - hx of warfarin skin necrosis
38
monitoring and follow up of DVT
- may need serial duplex venous studies - periodic physical exams - edu pt on si/sx of complications and bleeding
39
prophylaxis of DVT
- early mobilization - compression socks - anticoagulation - IVC filter- rare
40
risk factors for superficial thrombophlebitis
- varicose veins - peripheral IV - same as DVT risk factors
41
si/sx of superficial thrombophlebitis
- pain at site if superficial vein - palpable and tender - local erythema and warmth
42
diagnosis of superficial thrombophlebitis
- history and pE | - venous duplex to r/o DVT
43
treatment of superficial thrombophlebitis
- local heat - elevate above heart level - NSAIDs - remove catheter if in place - if superficial v near proximal junction may require serial US imaging - inflammation decreases in 1-2 weeks, firm cord may remain for longer
44
upper extremity DVT
- not common - catheter related thrombosis - paget- schroetter syndrome - thoracic outlet syndrome - tumor - need to refer to vasc surgery if unprovoked
45
causes of venous diseases
- inadequate muscle pump function - incompetent valves - elevated venous pressure
46
risk factors for venous disorders
- prolonged standing* - smoking* - high BMI* - sedentary lifestyle* - advanced age - family hx - ligamentous laxity - LE trauma - prior venous thrombosis - pregnancy
47
telangiectasias
- dilated small superficial veins - aka spider veins - most prevalent chronic venous disorder - often present in absence of more significant abnormalities
48
varicose veins
- dilated tortuous superficial veins > 3 mm - greater saphenous v and tributaries most commonly involved - usually women > men - increased incidence with age
49
chronic venous insufficiency
- most commonly assoc with chronic venous reflux - blood pools in deep veins -> tissue congestion/ edema -> tissue ischemia and nutritional impairment - necrosis of subq . fat and skin atrophy
50
si/sx of chronic venous insufficiency
- sx worse at end of the day - leg pain, heaviness, swelling - skin irritation or itching - nonhealing wounds - skin discoloration and thickening - bleeding from varicosity or spider veins
51
PE findings of chronic venous insufficiency
- pitting edema - edema spares foot - venous dilations - lipodermatosclerosis - skin discoloration- brown woody apearance - ulcerations at or above ankle
52
diagnosis of chronic venous insufficiency
- venous duplex US - eval for DVT - physical exam and history
53
treatment for chronic venous insufficiency
- leg elevation - compression stockings - exercise - skin care - steroids for stasis dermatitis - abx for infections, high risk of cellulitis - surgery if failing tx, bleeding from varicose veins
54
surgical options for chronic venous insufficiency
- sclerotherapy - phlebectomy or ligation - thermal ablation
55
lymphedema
- interstitial collection of protein rich fluid d/t disruption of lymphatic flow
56
what is the most common cause of lymphedema world wide
- filarisis | - d/t infection from nematode wucherecia bancroft
57
what is the most common cause of lymphedema in developed world
- malignancy | - treatment for malignancy
58
congenital lymphedema
- birth- 2 years old
59
lymphedema praecox
- onset during puberty or pregnancy prior to 35
60
lymphedema tarda
- onset after 35
61
risk factors for lymphedema
- cancer and cancer tx** - hereditary syndromes like turner or noonan - older age - obesity, inflammatory disorders - infection
62
si/sx of lymphedema
- insidious onset swelling - dorsal pedal humps - nonpitting edema - aching, discomfort, heaviness, tightness - skin changes - restricted ROM
63
phyiscal exam findings of lymphedema
- hyperkeratinized skin - nonpitting edema - squaring of toes - dorsal pedal hump - exaggerated skin folds near ankles - if advanced- woody appearance, dermal thickening, acanthosis and verrucous overgrowth - stemmer sign
64
stemmer sign
- thickening of skin fold at base of 2nd toe or 2nd finger - inability to lift skin of affected limb - sign of lymphedema
65
dx of lymphedema
- measure limb circumference and volume - lymphoscintigraphy- measure flow of fluid from skin to LN - CT, MR (not usually needed) - US to r/o DVT or ID mass - genetic testing for primary cause - filarial testing in endemic regions
66
treatment of lyphedema
- compression - good hygiene- retinoids, emollients, keratolytics - weight loss - avoid restrictive clothing - leg elevation - lymph massage - exercise - drugs- coumarin and flavonoids - surgery- staged excision or LN transfer

Clin Med II (16 decks)

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