Class 15: LEV Pathology & Scanning

Question 1

5 venous diseases?

Answer 1

1. acute venous thrombosis
2. chronic venous thrombosis
3. valvular insufficiency
4. varicose veins
5. venous hypertension

Question 2

what is virchow’s triad?

Answer 2

risk factors for venous disease:
1. venous stasis
2. hypercoagulability of blood
3. changes/injury to venous walls

Question 3

myeloproliferative disorders can cause venous stasis. T/F?

Answer 3

false – it can cause hypercoagulability of blood

Question 4

what are myeloproliferative disorders?

Answer 4

abnormal growth of red blood cells in the bone marrow

Question 5

4 S&S of acute DVT?

Answer 5

1. swelling
2. pain with acute onset
3. redness/erythema
4. warmth

Question 6

5 S&S of chronic DVT

Answer 6

1. swelling
2. heaviness
3. brawny discoloration
4. ulceration
5. varicosities

Question 7

where does brawny discoloration occur and what can it indicate?

Answer 7

occurs at the gaiter zone and it can indicate ulcer formation

Question 8

what is varicositis?

Answer 8

inflamed venous wall after developing varicose veins

Question 9

where can thrombosis form in the deep veins?

Answer 9

they can occur anywhere, but the most common location are at the valve cusps

Question 10

thrombosis can cause ___ restrictions and lead to ___ ___

Answer 10

flow restrictions –> venous HTN

Question 11

what is the most serious consequence of DVT?

Answer 11

pulmonary embolism

Question 12

5 sequela of DVT

Answer 12

1. collateral formation
2. valvular damage
3. venous HTN
4. skin changes
5. varicose veins

Question 13

what is valvular damage?

Answer 13

vein wall laxity due to stiffened/leaky valves

Question 14

valvular damage can lead to: (3)

Answer 14

1. skin changes
2. varicose veins
3. venous HTN

Question 15

varicose veins can be separated into two types. what are they?

Answer 15

1. primary
2. secondary

Question 16

what are primary varicose veins?

Answer 16

these are hereditary, not DVT related, and affects the GSV & LSV

Question 17

what are secondary varicose veins?

Answer 17

incompetent valves of the deep & communicating venous systems

real pathology

Question 18

what causes secondary varicose veins?

Answer 18

• repeated episodes of DVT
• pregnancy
• obesity

Question 19

which type of varicose veins can collaterals form?

Answer 19

secondary

Question 20

4 types of skin changes due to DVT?

Answer 20

1. edema
2. redness, brawny discoloration
3. phlegmasia alba dolens
4. phlegmasia cerulea dolens

Question 21

another name for phlegmasia alba dolens?

Answer 21

milk leg/white leg

Question 22

what is phlegmasia alba dolens?

Answer 22

extensive acute iliofemoral DVT –> arterial spasms –> severe swelling

Question 23

what is phlegmasia cerulea dolens?

Answer 23

DVT –> decreased venous outflow –> deceased arterial flow –> tissue hypoxia –> cyanosis –> gangrene

Question 24

where are venous ulcers located?

Answer 24

near the medial malleolus

Question 25

where are arterial ulcers located?

Answer 25

outer bony prominences, toes, tibial area

Question 26

pain level of venous ulcers?

Answer 26

mild

Question 27

pain level of arterial ulcers?

Answer 27

severe

Question 28

appearance of venous ulcers?

Answer 28

- irregular and shallow - venous ooze - brawny discoloration - varicosities

Question 29

appearance of arterial ulcers?

Answer 29

- regular & deep - little bleeding - skin is shiny & hairless - thickened toenails

Question 30

patient position for LEV duplex scanning

Answer 30

- reversed trendelenberg (torso elevated 10-20 degrees) - hips rotated externally

Question 31

a diagnostic criteria for DVT includes ____ to compress vein

Answer 31

inability to compress vein

Question 32

a diagnostic criteria for DVT includes ____ thrombus

Answer 32

visualization of a thrombus

Question 33

a diagnostic criteria for DVT is the vein looks ____

Answer 33

distended

Question 34

a diagnostic criteria for DVT includes ____ Doppler signals

Answer 34

abnormal

Question 35

a diagnostic criteria for DVT includes ___ or ____ augmentation

Answer 35

reduced/absent augmentation

Question 36

a diagnostic criteria for DVT includes ___ or ___ color

Answer 36

reduced/absent CD

Question 37

U/S appearance of acute DVT (5)

Answer 37

1. may be sonolucent 2. spongy 3. loosely attached/tail of the dog 4. expansion of lumen 5. no collaterals

Question 38

U/S appearance of chronic DVT (5)

Answer 38

1. echogenic thrombus 2. well attached 3. smaller vessel size 4. irregular vein walls 5. collaterals have formed

Question 39

3 treatment options for DVT

Answer 39

1. medical treatment 2. anticoagulant treatment 3. surgical treatment

Question 40

surgical treatment for DVT is for patients who can't use ____ treatment

Answer 40

anticoagulant

Question 41

what type of device is inserted in the IVC to break up clots?

Answer 41

venal caval interruption devices/green field filters

Question 42

3 other imaging modalities for LEV

Answer 42

1. isotope venography 2. contrast venography/phlebography 3. lung perfusion scan

Question 43

abnormal waveform for lower extremity venous?

Answer 43

steady continuous flow without breaks during respiration