Cardiovascular- PNS (general and disease) Flashcards
Function of arteries and the exceptions
Transport blood from areas of high pressure to lower pressures in the body tissues.
The only exceptions are the umbilical vein (in utero) and the pulmonary veins.
What 3 things affect arterial circulation?
1- heart pump
2- influenced by elasticity and extensiblity of vessel walls
3- peripheral resistance, amount of blood in body
Arterioles are the primary site for _____ ______
vascular resistance
5 points about the anatomy of veins
1- larger capacity 2- thinner walls than arteries 3-greater number 4- one way valves to prevent back flow 5- superficial and deep veins. Deep veins accompany arteries.
What is venous circulation influenced by?
1-muscle contraction
2- gravity
3- respiration (increased return with inspiration)
4- compliancy of R heart
What makes up the lymph system?
1- lymphatics (superficial, intermediate, and deep)
2- lymph fluid
3- lymph tissue and organs: lymph nodes, tonsils, spleen, thymus, and thoracic duct
Lymphatic contraction occurs by what?
1- parasympathetic, sympathetic, and sensory nerve stimulation
2- contraction of adjacent mscles
3- abdominal and thoracic cavity pressure changes during normal breathing
4- mechanical stimulation of dermal tissues
5- volume changes within each lymphatic vessel.
Where are major lymph nodes located?
1- submaximally 2- cervical 3- axillary 4- mesenteric 5- iliac 6- inguinal 7- popliteal 8- cubital
Function of lymph nodes
contributes to the immune system- collect cellular debris and bacteria, remove excess fluid/blood waster/bacteria, produce antibodies
List arterial diseases
Occlusive Peripheral Arterial Disease (PAD)
Thromboangiitis Obliterans (Buerger’s Disease)
Diabetic Angiopathy
Raynaud’s disease or phenomenon
List venous diseases
Varicose veins
Superficial vein thrombophlebitis
Deep vein thrombophlebitis (DVT)
Chronic venous stasis/incompetence
List lymphatic diseases
lymphadenopathy
lymphedema
What areas and vessels does PAD affect?
- Its a chronic occlusive disease that affects medium and large sized vessels due to peripheral artherosclerosis
- primarily affects lower extremities
What other pathologies is PAD associated with?
hypertension, hyperlipedemia, CAD, cerebrovascular disease, diabetes, metabolic syndrome (and a Hx of smoking)
Early stage and general symptoms of PAD
General: diminshed or absent pulses, skin is pale on elevation and dusky red on dependency
Early: intermittent claudication- pain is burning/searing/aching/tight/crampy and occurs with walking but relieved with rest.
Late stage of PAD
pain at rest, muscle atrophy, trophic changes (hair loss, skin and nail changes)
Critical stenosis PAD
resting or nocturnal pain, skin ulcers, gangrene
What is Thromboangiitis Obliterans (Buerger’s Disease)?
Chronic, inflammatory vascular occlusive disease of small arteries and also veins
Begins distally and progresses proximally in both upper and lower extremities.
Who gets Thromboangiitis Obliterans (Buerger’s Disease) and what are the symptoms?
Young adults, largely males, who smoke
Symptoms: paresthesias or pain, cyanotic cold extremity, diminished temp senstations, fatigue, risk of ulceration, gangrene
Diabetic angiopathy. Go!
1- inappropriate elevation of blood glucose levels and accelerated atherosclerosis
2- Neuropathy is a major complication
3- Neurotrophic ulcers, may lead to gangrene and amputation
Everything you know about Raynaud’s Disease
1- Episodic spasm of small arteries and arterioles
2- Abnormal vasoconstrictor reflex exacerbated by exposure to cold or emotional stress, tips of fingers develop pallor, cyanosis, numbness and tingling
3- affects largely females
4- occlusive disease is not usually a factor
What are varicose veins?
- distended, swollen superficial veins; tortuous in appearance
- may lead to varicose ulcers
What is Superficial vein thrombophlebitis?
- clot formation and acute inflammation in the superficial vein
- localized pain; usually in the saphenous vein
What is Deep vein thrombophlebitis (DVT)?
- Clot formation and acute inflammation in a deep vein
- Usually occurs in LE, associated with venous stasis (bed rest, lack of leg exercise), hyperactivity of blood coagulation and vascular trauma; early ambulation is prophylactic
Signs and Symptoms of Deep vein thrombophlebitis (DVT)
- may be asymptomatic early
- progressive inflammation with tenderness to palpation
- dull ache, tightness, or pain in calf
- swelling
- warmth
- skin discoloration
- venous distention
Pulmonary emobolism
- DVT may precipitate PE
S/S- chest pain and dyspnea, diaphoresis, cough, apprehension - Go to ED, life threatning
Diagnose DVT
- Use Well’s criteria
- According to Therapy Ed do NOT use Homan’s (article cited in book)
Medical management of DVT
- anticoagulation therapy (ex: heparin)
- thrombolytic agents (ex: streptokinase)
-ambulation and mobility encouraged after 1 dose of low molecular weight heparin - ## compression stockings with pressure gradient of 30-40mm Hg can assist w/ pain and reduce risk of post-thrombolytic syndrome
What is Chronic venous stasis/incompetence
Venous valvular insufficiency: from fibroelastic degeneration of valve tissue, venous dilation
Grades for Chronic venous stasis/incompetence
Classification
Grade I: mild aching, minimal edema, dilated superficial veins
Grade II: increased edema, multiple dilated veins, changes in skin pigmentation
Grade III: venous claudication, severe edema, cutaneous ulceration
Differential Diagnosis- arterial vs.venous vs. lymph: Etiology
Arterial: artherosclerosis thrombosis, emboli, inflammatory process
Venous: thrombophlebitis, trauma, vein obstruction (clot), vein incompetence
Lymphatic: primary lymphedema, secondary lymphadema
Differential Diagnosis- arterial vs.venous vs. lymph: Pain
Arterial: severe muscle ischemia/intermittent claudication, rest pain indicates severe involvement, muscle fatigue/cramping/numbness, parathesias over time
Venous: min-mod steady pain, aching pain in LE w/ prolonged standing or sitting (dependent position), superficial pain along vein
Lymphatic: heaviness, tightness, aching, or discomfort
Differential Diagnosis- arterial vs.venous vs. lymph: Location of pain
Arterial: usually calf, lower leg, or dorsum of foot
Venous: muscle compartment tenderness
Lymphatic: edematous limb
Differential Diagnosis- arterial vs.venous vs. lymph: Vascular
Arterial: decreased or absent pulses, pallor of fore foot on elevation, dependent rubor
Venous: venous dilation or varicosity, edema- mod -sev especially after prolonged dependency
Lymphatic: rare complications unless severe and untreated edema
Differential Diagnosis- arterial vs.venous vs. lymph: Skin Changes
Arterial: pale, shiny, dry, loss of hair, nail changes, coolness of extremity
Venous: hemosiderin deposition-dark/cyanotic/thickened/brown skin, lipodermatosclerosis-fibrosing of subcutaneous tissue, may lead to stasis dermatitis , cellulitis
Lymphatic: cutaneous fibrosis, may lead to cellulitis, lymphangitis
Differential Diagnosis- arterial vs.venous vs. lymph: Acute
Arterial: distal pain, paresthetic, pale, pulseless, sudden onset
Venous: calf pain, aching, edema, muscle tenderness, 50% asymptomatic
Lymphatic: rarely acute, usually progressive over time except with changes in pressure to limb altering flow (repeated blood pressure measurements, airplane flights)
Differential Diagnosis- arterial vs.venous vs. lymph: Ulceration
Arterial: may develop in toes, feet, or areas of trauma, pale or yellow to black eschar, gangrene may develop, regular in shape and may appear punched out.
Venous: may develop at sides of ankles- especially medial malleolus along the course of veins, gangrene absent, painful, shallow, exudative, granulation tissue in the base, irregular borders.
Lymphatic: unusual
Differential Diagnosis: Risk factors for arterial
- over age 60
- smoking
- diabetes
- slightly more prevalent in men
- dyslipedemia
- hypertension
- hyperhomocysteinemia (abnormally high level of homocysteine in the blood)
- African American
Differential Diagnosis: Risk factors for venous
- venous hypertension
- varicose veins
- inheritated trait
- female
- age
- increased BMI
- sedentary lifestyle/prolonged sitting
- ligamentous laxity
Differential Diagnosis: Risk factors for lymphatic
- lymphadenectomy
- radiation treatment
- inflammatory arthritis
- obesity
What is lymphadenopathy?
enlargement of nodes, with or without tenderness
What is acute lymphangitis?
acute bacterial infection spreading throughout lymph system
usually streptococcal
What is lymphedema in general and the causes of it?
Chronic disorder w/ excessive accumulation of fluid due to obstruction of lymphatics or removal of lymph nodes.
Causes swelling of soft tissues in UE and LE.
Results from mechanical insufficiency of the lymphatic system.
What is primary lymphedema?
congenital condition with abnormal lymph node or lymph vessel formation (hypoplasia or hyperplasia)
What is secondary lymphedema?
acquired due to injury of one or more parts of the lymphatic system. Possible causes:
- surgery such as radical mastectomy, femoropopliteal bypass, lymph node removal
- tumors, trauma, or infection affecting the lymph vessels
- radiation therapy with fibrosis of tissues
- chronic venous insufficiency
- in tropical r subtropical areas, filariasis (nematode worm larvae in the lymphatic system)
