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PVD > Chronic Venous Insufficiency, Deep Vein Thrombosis & edema > Flashcards

Chronic Venous Insufficiency, Deep Vein Thrombosis & edema Flashcards

1
Q

Vein have high complience, what does that mean?

A

can store considerable volume of blood

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2
Q

valves

A

ensure unidirectional flow

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3
Q

Thin walls

A

pressure exceeding blood pressure can easily collapse vein

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4
Q

3 types of veins

A

Deep
Perforating
Superficial

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5
Q

deep veins are found in

A

Muscular layer

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6
Q

Perforating veins are found in

A

Commuicating

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7
Q

Superficial veins are found in

A

between skin and deep fascia

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8
Q

Chronic venous insufficiency causes

A

Illiofemoral thrombophlebitis
incompetent valves
Primary varicose vein
Obstruction due to neoplasm or AV fistula

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9
Q

what is the 1st manifestation on chronic venous insufficiency ?

A

Edema

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10
Q

Edema due to chronic venous insufficiency starts in and disappears at?

A

latter part of the day

at night due ti recumbent position

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11
Q

Edema due to chronic venous insufficiency is mainly in

A

the foot and the ankle

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12
Q

Edema due to chronic venous insufficiency is

A

subcutaneous and not deep

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13
Q

Chronic Venous insufficiency can lead to

A
  • Edema
  • Venous dermatitis
  • Induration (hardenning)
  • ulcerations
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14
Q

Venous dermatitis can lead to

A

Eczema
id reaction
Hemosiderin deposits

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15
Q

id reaction is due to

A

Autosensitization reaction

Immune response to original dermatitis

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16
Q

Induration

A

Subcutaneous fibrosis

Hard and brawny skin

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17
Q

Ulcerations

A

Irritated areas of skin that lose vital nutrients secondary to edema

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18
Q

Ulcerations usually happen in

A

medial aspect of the ankle ( gaiter area)

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19
Q

theories of ulceration formation

A

Fibrin cuff theory
GF trapping theory
WBC trapping theory

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20
Q

fibrin cuff theory

A 
fibrin accumulates in pericapillary space 
This cuff has impaired fibrinolysis 
increases diffusion barrier
inhibit repair process 
maintains inflammatory process
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21
Q

GF trapping theory

A

GF are trapped by fibrin

GF become unavailable to facilitate healing

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22
Q

WBC trapping theory

A

WBC trapped in capillaries
Releases inflammatory mediators & proteolytic enzymes
May increase permeability or impede blood flow to skin

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23
Q

Differential diagnosis for chronic venous insufficiency

A 
CHF
Chronic glomerulonephritis
Lymphedema
AV fistula
Neoplasm
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24
Q

treatment foe chronic venous insufficiency

A 
Elevate legs 
Pressure stockings and dressings
kendell pumps 
Corticosterioud cream for dermatitis 
Skin grafting for ulcers
Vein stripping ( need venogram,It is used to remove a damaged vein and prevent complications of vein damage )
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25
Q

DVT

A

Blood clot forming in a deep vein, usually in the legs

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26
Q

Causes of DVT

A

From periods of immobilization
Due to blood dyscrasia
Anything that causes blood not to circulate or clot normally

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27
Q

Virchow’s triad

A

Venous stasis
Vascular injury
Hypercoagulability

Presence of 1 of 3 of the above can alter hemostatic balance and can lead to thrombosis

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28
Q

Risk factors for DVT

A

Immoblization

Inheritable blood clotting disorders

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29
Q

Inheritable blood clotting disorders

A

Deficiencies in antithrombin, protein C or Protein S

Mutations of Factor V (Leiden) or factor II

30
Q

Factor V leiden

A

Autosomal dominant mutation

Leiden variant cannot be inactivated by protein C leading to hypercoagulable state

31
Q

Factor II mutation

A

Autosomal dominant mutation

Body produces too much prothrombin

32
Q

Risk factors for DVT

A
  • Surgery
  • Pregnancy (increase pressure in LE veins )
  • over weight/obsese (increase pressure in LE veins)
  • Heart failure
  • BCP/HRT (Birth control pills, hormone replacemet therapy )
  • Cancer
  • Histology of DVT/PE in self or family
  • Smoking
33
Q

General anesthetics can cause 22-38% venous dilation due to

A

loss of muscle tone

34
Q

signs and symptoms of DVT

A 
Erythema
Edema
Leg pain
Warmth
Tenderness
Homan's sign
Pratt's sign & test
35
Q

Differential diagnosis of DVT

A 
Cellulitis 
Baker's cyst
Heart failure 
Superficial thrombophlebitis 
Varicose vein 
Edema 
Lymphedema 
Achilles ruptuture
36
Q

Caprini

A

Uses individual risk factors to place pts in 1of 4 categories
low , moderate , high & highest

37
Q

DVT prophylaxis

A

Mechanical

Pharmacological

38
Q

Compression device

A

prevents swelling and reduces pooling of blood

39
Q

Coumarin

A

Interfere with vitamin K dependant coagulation factors (II,VII,IX,X)
Warfarin requires 36-72 hrs to reach stable loading dose
Reversed by vitamin k or FFP

40
Q

Heparin

A

In the presence of antithrombin III it inactivates factors IIa, Xa, IXa, XIIa
prevents fibrin formation by deactivating thrombin
aPPT monitors heparin
OD REVERSIBLE WITH PROTAMINE SULFATE

41
Q

low molecular weight heparin (LMWH)

A

70-80% risk reduction for DVT
Enoxaprin (Lovenox) starting 12-24 hrs post-op
Requires no monitoring

42
Q

What are some tests for DVT?

A

US
CT/MRI
blood tests ( D-dimer)
Venography

43
Q

What are goals of DVT treatment

A

Stop clot from increasing in size
Prevent clot from breaking loose
Prevent recurrent DVT

44
Q

thrombolytics

A

tPA through IV to break up existing clots

45
Q

IVC filter aka

A

Greenfield filter

46
Q

IVC filter prevent

A

clots that break loose from becoming PE

Used in pts who are unable to take medications

47
Q

complications of DVT

A

Post phlebitic syndrome (25-50% withing 2 years)
PE
Paradoxical stroke (Ischemic )

48
Q

Post phlebitic syndrome

A

Edema
Leg pain
Skin discoloration

49
Q

Paradoxical stroke (Ischemic )

A

Thrombus passes through patent foramen ovale

50
Q

Symptoms of Pulmonary Embolism

A 
unexplained sudden SOB 
Chest pain (CP ) that worsens with coughing or deep respirations 
Lightheadedness
sense of anxiety
Hemoptysis (blood in sputum )
51
Q

Edema

A

abnormal accumulation of fluid in interstitial tissues eithe rby increases secretion of fluid or impaired removal of fluid

52
Q

Etiology of edema

A 
Increased salt intake 
sun burn 
Heart failure
Renal disease
liver disease
Pregnancy 
Medications
53
Q

Generalized edama is due to

A

Hypoalbuminemia
Burns
Infections

54
Q

CHF

A 
Heart weakness
Pumping blood less effectively
Accumulation of fluid 
Decrease CO
Kidney sense low blood volume from decreased CO and retain salt and water
55
Q

IN CHF if fluid builds up rapidly

A

Pulmonary edema

56
Q

Nephrotic Syndrome

A

Increased permeability of glomerulus capillary walls –> Proteinuria, Hypoalbuminemia, Edema

57
Q

Low protein levels in blood results in

A

fluid accumulation

58
Q

Localized edema

A

Chronic insufficiency

Increased back pressure

59
Q

What is the most common form of edema?

A

pitting

60
Q

pitting edema typically occurs in

A

Chronic situations

61
Q

Non pitting edema typically occurs in

A

Acute situations

62
Q

lead to Pitting edema

A

Cirrhosis of liver
CHF
Lymphedema
Myexedema (severe hypothyroidism.)

63
Q

Lead to non pitting edema

A

Injury
Infection
DVT

64
Q

treatment for Edema

A 
Address underlying cause of edema 
Can prescribe diuretic medications to reduce fluid 
Reduce sodium intake 
LE elevation
Compression therapy
65
Q

Lymphedema

A

stasis of lymph resulting in swelling

66
Q

Hereditary form of lymphedema

A

Milroy’s

67
Q

Praecox

A

Lymphedema praecox is a condition characterized by swelling of the soft tissues in which an excessive amount of lymph has accumulated, and generally develops in females

Present sppntaneously without cause

68
Q

Secondary lymphedema

A

Obstructive

Inflammatory

69
Q

Examples of obstructive lymphedema

A

Malignant obstruction
Surgical removal of lymph nodes
Pressure
Radiation treatment

70
Q

Examples of Inflammatory Lymphedema

A

Recurrent cellulitis
Filariasis ( parasitic infectious disease )
Secondary to injury

PVD (5 decks)

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