Chapter 24

Question 1

what are the most common findings of acute DVT?

Answer 1

swelling
pain
redness
warmth

Question 2

what are differential diagnoses for acute DVT?

Answer 2

muscle strain 
direct injury to the leg
muscle tear
Bakers cyst
cellulitis 
lymphangitiis
heart failure
extrinsic compression

Question 3

what are most common findings with chronic DVT?

Answer 3

swelling
heaviness
discoloration 
ulcers 
varicosities

Question 4

what is induration of skin /edema?

Answer 4

fluid accumulcation

body tissue contains excessive amount of fluid

Question 5

what is erythema?

Answer 5

redness
inflammatory process
e.g celluitis

Question 6

what is browish dicoloration from?

Answer 6

venous stasis usually in lower leg to ankle area (gaiter zone)

Question 7

where is the gaiter zone?

Answer 7

lower leg to ankle

Question 8

what is pallor?

Answer 8

whiteness

Question 9

what is pallor caused from?

Answer 9

arterial spasms secondary to extensive, acute iliofemoral thrombosis.
limb threatening

Question 10

what is phlegamsia alba dolens?

Answer 10

pallor/ whiteness

limb threatening

Question 11

what is cyanosis?

Answer 11

bluish discoloration

Question 12

what is cyanosis caused by?

Answer 12

severely reduced venous outflow from iliofemoral thrombosis markedly reduces arterial inflow
limb threatening

Question 13

what is phegmasia cerulea dolens?

Answer 13

cyanosis leading to venous gangrene

tissue hypoxia can develop

Question 14

what are locations of venous ulcers versus arterial?

Answer 14

venous: often near medial malleolus
arterial: tibial area, toes, bony prominences

Question 15

what are the appearance of venous ulcers versus arterial?

Answer 15

V; shallow, irregular shape

A: deep regular shape punched out appearance

Question 16

what are skin changes in venous ulcers versus arterial?

Answer 16

V: stasis changes: inflammation, infection, brawny discoloration, presence of varicosities
A: trophic changes: dryness, scaly, atrophy, shiny skin, loss of hair, thickened toenails

Question 17

what is the pain level on venous ulcers vs arterial?

Answer 17

V: mild
A: severe

Question 18

what is bleeding level on venous ulcers vs arterial?

Answer 18

V; venous ooze

A: little

Question 19

what is pittying edema?

Answer 19

fluid in sub tissue
depression of skin surface with manual pressure
can be related to may conditions

Question 20

what conditions can cause pitting edema?

Answer 20

fluid retention
CHF
elevated venous pressure

Question 21

what is lymphedema?

Answer 21

fluid accumulates when lymph nodes and lymph vessel are removed or damaged

Question 22

what drains excess fluid from tissue?

Answer 22

lymphatic system

Question 23

when is lymphedema freq seen?

Answer 23

after many types of cancer surgery

Question 24

T/F lymphema is a non pitting edema

Answer 24

true

Question 25

what is paget-schroetter syndrome?

Answer 25

stress. effort thrombosis involves the axillary or subclavian vein venous component of TOS young athletes

Question 26

based on virchows triad what is a trauma to the vessel/ endothelial damage?

Answer 26

paget-schroetter syndrome

Question 27

what is an example of venous stasis based on virchows triad?

Answer 27

SVC syndrome

Question 28

what are examples of venous stasis?

Answer 28

immbolility, chronic obstructive pulmonary disease, obesity, pregnancy, previous DVT, extrinsic compression

Question 29

what is SVC syndrome?

Answer 29

obstruction by neoplasm (benign or malignant) edema and engorgement of vessels evident) pt may have cough or difficulity breathing flow to the UE remains the same during inspiration i.e continuous flow

Question 30

why is surgery a risk factor for DVT?

Answer 30

may be due to alteration in endothelial cell function

Question 31

what are examples of hypercoagulabilty?

Answer 31

certain protein deficiencies, pregancy, cancer, hormones i.e estrogen intake

Question 32

where is acute thrombosis freq seen

Answer 32

intraluminal thromi frq begin at valve cusps or in soleal sinuses secondary to stagnation

Question 33

T/F thromi resulting from trauma do not occur at any site

Answer 33

false

Question 34

what is chronic venous insufficiency?

Answer 34

stretching of walls results in damage to valves | increased venous pressure causes flow changes

Question 35

what is post-phlebitic syndrome?

Answer 35

chronic flow changes result in persistent edema, stasis changes and pain may also lead to ulceration

Question 36

what is pulmonary embolism?

Answer 36

thrombus breaks loose | travels into pulmonary circulation

Question 37

how do they diagnosis PE?

Answer 37

CTA chest and pulmonary angiography are currently the definitive diangosit tools can be life threatening

Question 38

what is valvular incompetence?

Answer 38

valves no longer maintain uni-directional flow | calf muscle pump no longer forces blood cephalad toward heart or from superficial system into deep

Question 39

what are results of valvular incompetence?

Answer 39

increase pressure/ venous HTN ambulatory venous HTN: increasing pressure when patient stands or walks precipiates edema, varicosities and ulcers fluid, red blood cells and fibrinogen may leak into surrounding tissue. hemosiderin from breakdown of stagnant red blood cells cause brawny discoloration breakdown of other substances prevents proper tissue nutrition and oxygenation

Question 40

what is primary varicose veins>

Answer 40

dilated veins secondary to valvular incompetence of superfical system. deep system intact

Question 41

what is secondary varicose veins

Answer 41

dilated veins caused by incompetence of the superficial system resulting from a deep venous obstruction. deep system not intact

Question 42

what are congential venous diseases?

Answer 42

avalvular (valveless) veins AVM klippel trenaunay

Question 43

what is klippel trenaunay syndrome>

Answer 43

can include multiple varicosites of the superficial system and hypoplastic or absent deep veins

Question 44

what is portal HTN?

Answer 44

elevated venous pressure results from obstruction of blood flow may result in reverse flow in the portal vein and increased portal venous pressure that impedes blood flow into the liver

Question 45

what is portal HTN related to>

Answer 45

to some form of advances chronic liver disease cirrhosis hepatitis

Question 46

what causes IVC tumor>

Answer 46

RCC