Bates-PeripheralVascSystem Flashcards
common signs and symptoms of peripheral vascular disease?
EPICN - In extermeties, Edema, Pain, Intermittent claudication, Color change in cold weather, Numbness
intermittent claudication can be caused by atherosclerosis. What is another disease that can cause ischemia with exertion, BUT is reduced by leaning forward, (instead of just resting)
spinal stenosis, leaning forward stretches spinal cord out reducing pain, and is relieved less by rest.
hair loss is an indication of what?
loss of arterial perfusion, gangrene with dry or brown/black ulcers may ensue
fatigue, aching, pain, or numbness in the buttocks or hips suggest ischemia stemming from what artery?
aortoilliac
erectile dysfunction suggests ischemia stemming from what artery?
iliacpudendal
fatigue, aching, pain, or numbness in the thigh suggests ischemia stemming from what artery?
common femoral or aortoiliac
fatigue, aching, pain, or numbness in the upper calf suggests ischemia stemming from what artery?
superficial femoral
fatigue, aching, pain, or numbness in the lower calf suggests ischemia stemming from what artery?
popliteal
fatigue, aching, pain, or numbness in the foot suggests ischemia stemming from what artery?
tibial or peroneal
abdominal pain after meals and subsequent “food fear” and weight loss indicate
intestinal ischemia of the celiac or superior or inferior mesenteric arteries
what are the risk factors for Lower Extremity Peripheral Arterial Disease (LEPAD)
-50 (with smoking, diabetes, dyslipidemia, hypertension, or hyprhomocysteinemia) | 50-70- smoking or diabetes | 70+ just cause | pulse abnormal | exertion pain | known disease of arteries
What are the risk factors for Renal Artery Disease?
-30 and hypertensive | 55+ with SEVERE hypertension | accelerated hypertension | worsening renal function | small kidney | unexplained pulmonary edema
what are the risk factors for Abdominal Aortic Aneurysm?
excess infrarenal aortic diameter (over 3.0 cm) | smoking | 65+ | family hist. | arterial disease | hypertension | high Cholesterol
IRONY
an unexpected outcome, or the use of a word that is the opposite of its literal meaning
lymphadema in the arm or hand may follow what surgery?
axillary node dissection and radiation therapy
prominent veins in an edematous arm suggest what?
venous obstruction
what is Raynaud’s disease?
wrist pulses normal, but more distal arteries are induce sharply demarcated pallor in the fingers
what is a description for a widely dilated artery?
aneurysmal
bounding carotid, radial, and femoral pulses are seen in aortic ___.
insufficiency, (lack of elasticity produces an abnormally powerful pulse in regions downstream)
asymmetric diminished pulses are seen in arterial ____ from atherosclerosis or embolism.
occlusion
Lymphadenopathy refers to what? What are two classifications of this that should be distinguished in an exam?
lymphadenopathy is simply swollen lymph nodes, independent of tenderness. The physician should distinguish between a local or general version of this, by either finding a local lesion near the swelling, or by identifying large nodes in 2 other nonadjacent nodes.
occasionally you must search more ___ to find what would be the dorsalis pedis artery.
laterally, it may be congenitally absent in some people.
diabetes mellitus patients are often missing what pulse?
dorsalis pedis arterial pulse
A missing pulse mixed with pain and tingling, cold and paleness, is known as what and requires what?
sudden arterial occlusion, (ie. embolism or thrombosis), and reuiqres emergency treatment. (keep in mind that if collateral circulation is good, only numbness and coolness may result).
edema causes swelling that may do what?
obscure veins, tendons, and bony prominences
besides edema, what else can cause different circumferences in the legs?
muscular atrophy
a painful pale swollen leg together with tenderness in the groin over the femoral vein suggests deep _____ thrombosis.
iliofemoral. (except in the calf) pg. 488
local swelling, redness, warmth, and a subcutaneous cord suggest a ____ thrombophlebitis.
superficial
brownish discoloration or ulcers just above the malleolus suggest what?
chronic venous insufficiency
While arterial occlusive disease is much less common in the arms than in the legs, absent or diminished pulses at the wrist are found in acute embolic occlusion and in what disease?
Brueger’s disease (thromboangiitis obliterans) - an inflammatory and obliterative disease of the blood vessels of the extremities, primarily the lower extremities, occurring chiefly in young men and leading to ischemia of the tissues and gangrene
arterial occlusion involves what coloration, or lack of coloration, in the feet after the feet are lowered?
persisting rubor. This replaces the quick refill that would be normal, and may take up to a minute to appear. This is NOT a good test for VENOUS insufficiency.
what is the trendelburg test?
closing the saphenous vein after having the leg drain of venous blood. Then having patient stand up and noting the first sign 1) whether venous blood quickly comes back to saphenous vein (indicating communicating branches have failed venous valves. And then releasing the great saphenous vein and noting 2) whether filling of lower extremities happens quickly, indicated failed venous valves in the saphenous.
Injury to ___ ___ cells can provoke thrombus formation, atheromas, and the vascular lesions of hypertension
vascular endothelial
An ____ begins in the intima as lipid-filled foam cells, then fatty streaks
atheroma
What is the ankle-brachial formula and index?
ABI = ankle systolic BP/brachial systolic BP = say 110/120 or a fraction close to 1. LOW values indicate Peripheral Arterial Disease (PAD). 0.90 is low of normal. 0.60 to 0.90 is mild PAD, moderate is 0.60 to 0.40, and severe is 0.40 and below.
What is the cause: Edema is soft, with pitting on pressure, and occasionally bilateral. Look for brawny changes and skin thickening, especially near the ankle. Ulceration, brownish pigmentation, and edema in the feet are common.
chronic venous insufficiency
What is the cause: Edema is soft in the early stages, then becomes indurated, hard, and nonpitting. Skin is markedly thickened; ulceration is rare. There is no pigmentation. Edema is found in the feet and toes, often bilaterally.
Lymphedema. develops when lymph channels are obstructed by tumor, fibrosis, or inflammation, and in cases of axillary node dissection and radiation.
Chronic ARTERIAL OR VENOUS Insufficiency?: Pain - Intermittent claudication, progressing to pain at rest
chronic ARTERIAL Insufficiency
Chronic ARTERIAL OR VENOUS Insufficiency?: Mechanism - Tissue Ischemia
chronic ARTERIAL Insufficiency
Chronic ARTERIAL OR VENOUS Insufficiency?: Pulses - Decreased or Absent
chronic ARTERIAL Insufficiency
Chronic ARTERIAL OR VENOUS Insufficiency?: Color - Pale - especially on elevation, dusky red on dependency
chronic ARTERIAL Insufficiency
Chronic ARTERIAL OR VENOUS Insufficiency?: Temp - Cool
chronic ARTERIAL Insufficiency
Chronic ARTERIAL OR VENOUS Insufficiency?: Edema - Absent or mild; may develop as the patient tries to relieve rest pain by lowering the leg
chronic ARTERIAL Insufficiency
Chronic ARTERIAL OR VENOUS Insufficiency?: Skin changes - Trophic changes: thin, shiny, atrophic skin; loss of hair over the foot and toes; nails thickened and ridged
chronic ARTERIAL Insufficiency
Chronic ARTERIAL OR VENOUS Insufficiency?: Ulcers - If present, involves toes or points of trauma on feet
chronic ARTERIAL Insufficiency
Chronic ARTERIAL OR VENOUS Insufficiency?: Gangrene may develop
chronic ARTERIAL Insufficiency
Chronic ARTERIAL OR VENOUS Insufficiency?: Often painful
chronic VENOUS Insufficiency
Chronic ARTERIAL OR VENOUS Insufficiency?: Mechanism - ____ hypertension
chronic VENOUS Insufficiency
Chronic ARTERIAL OR VENOUS Insufficiency?: Pulses - Normal, though may be difficult to feel through edema
chronic VENOUS Insufficiency
Chronic ARTERIAL OR VENOUS Insufficiency?: Color - Normal, or cyanotic on dependency. Petechiae and then brown pigmentation appear with chronicity.
chronic VENOUS Insufficiency
Chronic ARTERIAL OR VENOUS Insufficiency?: Temp - Normal
chronic VENOUS Insufficiency
Chronic ARTERIAL OR VENOUS Insufficiency?: Edema - present, often markedly
chronic VENOUS Insufficiency
Chronic ARTERIAL OR VENOUS Insufficiency?: Skin changes - Often brown pigmentation around the ankle, stasis dermatitis, and possible thickening of the skin and narrowing of the leg as scarring develops
chronic VENOUS Insufficiency
Chronic ARTERIAL OR VENOUS Insufficiency?: Ulcers - If present, develops at sides of ankle, especially medially
chronic VENOUS Insufficiency
Chronic ARTERIAL OR VENOUS Insufficiency?: Gangrene does NOT develop
chronic VENOUS Insufficiency
What is the process for acute cellulitis?
Acute bacterial infection of the skin and subcutaneous tissues
What is the process for acute lymphangitis?
Acute bacterial infection (usually streptococcal) spreading up the lymphatic channels from a portal of entry such as an injured area or an ulcer
What is the process for Arterial Disorders > Acute Arterial Occlusion?
Embolism or thrombosis, possibly superimposed on arteriosclerosis obliterans
What is the process for Arterial Disorders > Atherosclerosis (obliterans) > Intermittent claudication pain?
Episodic muscular ischemia induced by exercise, due to atherosclerosis of large or medium-sized arteries
What is the process for Arterial Disorders > Atherosclerosis (obliterans) > pain at rest?
Ischemia even at rest
What is the process for Arterial Disorders > Raynaud’s Disease?
Raynaud’s disease: Episodic spasm of the small arteries and arterioles; no vascular occlusion
What is the process for Arterial Disorders > Raynaud’s Phenomenon?
Raynaud’s phenomenon: Syndrome secondary to other conditions such as collagen vascular disease, arterial occlusion, trauma, drugs
What is the process for Compartment syndrome?
Pressure builds from trauma or bleeding into one of the four major muscle compartments between the knee and ankle. Each compartment is enclosed by fascia and thus cannot expand to accommodate increasing pressure.
What is the process for Erythema Nodosu?
Raised tender bilateral subcutaneous lesions seen in systemic conditions such as pregnancy, sarcoidosis, tuberculosis, streptococcal infections, inflammatory bowel disease
What is the process for Thromboangiitis Obliterans (Buerger’s disease)?
Inflammatory and thrombotic occlusions of small arteries and also of veins, occurring in smokers
What is the process for Venous Disorders > Chronic Venous Insufficiency (deep)?
Chronic venous engorgement secondary to venous occlusion or incompetency of venous valves
What is the process for Venous Disorders > Deep Venous Thrombosis (DVT)?
Clot formation in a deep vein
What is the process for Venous Disorders > Superficial Thrombophlebitis?
Clot formation and acute inflammation in a superficial vein
What are some associated symptoms of Acute Cellulitis?
A local area of diffuse swelling, redness, and tenderness with enlarged, tender lymph nodes and fever; no palpable cord
What are some associated symptoms of Erythema Nodosum?
Lesions recur in crops; often malaise, joint pains, and fever
What are some characterizations of Acute Lymphangitis?
An arm or a leg, lasting days or longer, red streaks on the skin with tenderness, enlarged TENDER lymph nodes, and FEVER
What are some characterizations of compartment syndrome?
Tight, bursting pain in calf muscles, usually in the anterior tibial compartment, sometimes with overlying dusky red skin. TIMING: Several hours if acute (pressure must be relieved to overt necrosis). During exercise if chronic. AGGRAVATORS: Acute: anabolic steroids; surgical complication; crush injury. Chronic: occurs with exercise. Relief: Acute: surgical incision to relieve pressure. Chronic: avoiding exercise; ice elevation. Tingling, burning sensations in calf; muscles may feel tight, full, numbness, paralysis if unrelieved
What are the associated manifestations in the Arterial Disorder > Atherosclerosis > with Intermittent Claudication?
Local fatigue, numbness, diminished pulses, often signs of arterial insufficiency (see p. 498)
What are the associated manifestations in the Arterial Disorder > Atherosclerosis > withOUT Intermittent Claudication?
Numbness, tingling, trophic signs and color changes of arterial insufficiency (see p. 498)
Where is the pain, what is the timing, Aggravators and Relievers, in the Arterial Disorder > Atherosclerosis > with Intermittent Claudication?
Where: Usually calf muscles, but also may be in the buttock, hip, thigh, or foot, depending on the level of obstruction. Timing: Fairly brief; pain usually forces the patient to rest. Aggravator: Exercise such as walking. Reliever: Rest usually stops the pain in 1-3 min.
Where is the pain, what is the timing, Aggravators and Relievers, in the Arterial Disorder > Atherosclerosis > withOUT Intermittent Claudication?
Distal pain, in the toes or forefoot. Persistent, worse at night sometimes. Aggravated by elevated feet, relieved with legs dependent - lowered.
Where is the pain, what is the timing, Aggravators and Relievers, in the Thromboangiitis Obliterans (buerger’s disease) > with Intermittent Claudication in arch of foot?
Intermittent claudication, particularly in the arch of the foot. Fairly brief but recurrent. Exercise aggravates, and rest relieves. Distal coldness, sweating, numbness, and cyanosis; ulceration and gangrene at the tips of fingers or toes; migratory thrombophlebitis. Permanent cessation of smoking helps both kinds of pain (but patients seldom stop)
Where is the pain, what is the timing, Aggravators and Relievers, in the Thromboangiitis Obliterans (buerger’s disease) > with pain even at rest?
Rest pain in the fingers or toes. Chronic, persistent, may be worse at night. Permanent cessation of smoking helps both kinds of pain (but patients seldom stop).
Where is the pain, what is the timing, Aggravators, Relivers, and what are some associated symptoms, in the Arterial Disorder > Raynaud’s Disease and Phenomenon?
Distal portions of one or more fingers. Pain is usually not prominent unless fingertip ulcers develop. Numbness and tingling are common. Relatively brief (minutes) but recurrent. Exposure to cold, emotional upset. Relief in warmth. Color changes in the distal fingers: severe pallor (essential for the diagnosis) followed by cyanosis and then redness
Where is the pain, what is the timing, Aggravators, Relivers, and what are some associated symptoms, in the Venous Disorder > Chronic Venous Insufficiency (deep)?
Diffuse aching of the leg(s). Timing is Chronic, increasing as the day wears on. Standing aggravates. Elevation brings relief. Chronic edema, pigmentation, possibly ulceration (see p. 498)
Where is the pain, what is the timing, Aggravators, Relivers, and what are some associated symptoms, in the Venous Disorder > Deep Venous Thrombosis (DVT)?
Tight, bursting pain, if present, usually in the calf; may be painless. Timing: Often hard to determine because of lack of symptoms. Aggravated by walking, and relieved by not walking. Elevation speeds relief. Possible swelling of the foot and calf, local calf tenderness. Prior history of DVT
Where is the pain, what is the timing, and what are some associated symptoms, in the Arterial Disorder > Acute Arterial Occlusion?
Distal pain, usually involving the foot and leg. Sudden onset; associated symptoms may occur without pain. Coldness, numbness, weakness, absent distal pulses
Where is the pain, what is the timing, and what are some associated symptoms, in the Venous Disorder > Superficial Thrombophlebitis?
Pain in a local area along the course of a superficial vein, most often in the saphenous system. Timing:An acute episode lasting days or longer. Local redness, swelling, tenderness, a palpable cord, possibly fever
