Chapter 12: Peripheral Vascular System

Question 1

Arterial layers of tissue

Answer 1

Tunica Intima: innermost layer-metabolic properties, synthesizes regulators of thrombosis, modulates blood flow and vascular reactivity through synthesis of vasoconstrictors like endothelin and ACE, immune and inflammatory reaction
Tunica media: medial layer: smooth muscle cells that mediate for BP
Tunica externa: outermost layer

Question 2

Injury to vascular endothelial cells

Answer 2

provoke thrombus formation, atheromas, vascular lesions of hypertension

Question 3

Great veins of legs

Answer 3

Greater saphenous-interior of leg-upper

small sapheonous-lower leg

Question 4

lymphatics arm

Answer 4

epitrochlear nodes-medial surface of arm 3cm above the elbow

Question 5

Grading of pulses

Answer 5

3+bounding
2+ brisk, expected (normal)
1+ diminished, weaker than expected
0: absent, unable to palpate

Question 6

Allen test

Answer 6

evaluates arterial supply to the hand

Question 7

Allen test procedure

Answer 7

Ask the patient to make a tight fist with one hand; then compress both radial and ulnar arteries firmly between your thumbs and fingers. Next ask the patient to open the hand into a relaxed, slightly flexed position. The palm is pale. Release youir pressure over the ulnar artery, if the ulnar artery ispatent, the palm flushes w/in 3-5 sec. Patency of the radial artery may be assessed doing the same

Question 8

Chronic arterial insufficiency

Answer 8

pain: intermittent claudication, progressing to pain at rest
mech: tissue ischemia
pulses: decreased or absent
color: pale, esp on elevation; dusky red on dependency
temp: cool
edema: absent or mild; may develop if patient tries to relive rest pain by lowering the leg
skin changes: trophic changes; thin, shiny, atrophic skin; loss of hair over the foot and toes; nails thickened and ridged
ulcerations: if present involves toes or points of trauma on feet
gangrene: may develop

Question 9

Chronic venous insuff

Answer 9

pain: often painful
mech: venous htn
pulses: normal, may be difficult to palpate through edema
color: normal or cyanotic on dependency. petechiae may develop
temp: normal
edema: present
skin changes: brown pigmentation around the ankle, stasis dermatitis, and possible thickening of the skin and narrowing of the legs as scarring develops
ulceration: if present, develops at sides of ankle, esp medially
gangrene: does not develop