Lecture 4 - Pathologies of Veins

Question 1

the systemic venous system contains veins that drain into the right atrium, what are the 3 veins?

Answer 1

coronary sinus
superior vena cava
inferior vena cava

Question 2

coronary sinus drains…

Answer 2

venous blood from heart

Question 3

SVC drains…

Answer 3

blood above diaphragm

Question 4

IVC drains…

Answer 4

blood from under diaphragm

Question 5

azygus system serves as…

Answer 5

bypass from IVC to SVC

Question 6

hepatic portal vein collects blood from…

Answer 6

gi tract and delivers to the liver for processing before draining into IVC

Question 7

define ‘venous thrombosis’

Answer 7

a partial or complete occlusion of a vein by a thrombus with secondary inflammation = thrombophlebitis in the wall of the vein

Question 8

what are 4 types of venous thrombosis?

Answer 8

acute
chronic
superficial (saphenous vein)
deep (femoral and iliac veins) - DVT

Question 9

____ DVTs are much more likely to become pulmonary emboli

Answer 9

proximal

Question 10

what is the third most common CVD after acute coronary artery episodes and cerebrovascular accidents?

Answer 10

DVT (30-60% of those having major surgery or CVA develop DVT up to 4 weeks after)

Question 11

what are 4 risk factors for thrombosis?

Answer 11

venous stasis (d/t immobility)
increased coagulability
injury of venous wall (IV, surgery)
lifestyle (smoking, HRT)

Question 12

name and define 2 different types of thrombi?

Answer 12

mural thrombus - attached to wall DOES NOT occlude

occlusive thrombus - begins by attaching and progresses to occlude completely

Question 13

what are 4 fates of a thrombi?

Answer 13

lysis and resolution
organization
recanalization
embolism

Question 14

what are 3 symptoms that prevent with lower extremity DVT?

Answer 14

dull ache
tight or painful calf
leg or calf swelling

Question 15

what are 3 symptoms that prevent with upper extremity DVT?

Answer 15

edema
pain
redness (usually superficial -SVT)

Question 16

define ‘saddle embolus’

Answer 16

thromboembolus of main pulmonary artery

Question 17

what causes a pulmonary elbolism?

Answer 17

most often thrombi from large veins of pelvis and leg - occur without apparent warning

Question 18

what are 5 signs and symptoms, depending on size and location?

Answer 18

sudden death
chest pain, worse by inspiration
tachy
dyspnea, persistent cough
hemoptysis

Question 19

what are 2 tests for a DVT?

Answer 19

d-dime test

doppler ultrasonography

Question 20

what are 4 ways to prevent a DVT?

Answer 20

early mobilization post surgery
prophylactic anticoagulants (NSAD, heparin, warfarin)
elastic stocking after surgery
pneumatic pressure devices

Question 21

define ‘varicose veins’

Answer 21

vein that has enlarged and twisted, often appearing as a bulging, blue bv that is clearly visible (valvular insufficiency)

Question 22

what vein is usually affected by varicose veins?

Answer 22

saphenous vein

Question 23

what 3 things can varicosity lead to?

Answer 23

tortuosity
valve incompetence
thrombosis risk

Question 24

what are 3 risk factors of varicose veins?

Answer 24

heavy lifting
prolonged sitting
hormonal changes

Question 25

what are 2 forms of treatment for severe varicose veins?

Answer 25

sclerotherapy | laser venous ablation

Question 26

define 'sclerotherapy'

Answer 26

varicose veins treatment by injecting an irritant that causes inflammation, coagulation of blood and narrowing of bv

Question 27

define 'chronic venous insufficiency'

Answer 27

inadequate venous return over long period of time (aka postphlebitis syndrome or venous stasis) - may follow severe DVT or unrelated

Question 28

what are 3 causes of CVI?

Answer 28

leg trauma varicose veins neoplastic obstruction of pelvic veins

Question 29

how does CVI occur when there is damage to the vein valves?

Answer 29

increased venous pressure and stasis blood flows bi-directionally superficial vein dilate due to venous HTN edema and brownish discoloration of skin

Question 30

what are 3 contributing factors of CVI ulcers?

Answer 30

poor nutrition immobility previous or present trauma

Question 31

what are 3 goals for treatment of CVI and varicose veins?

Answer 31

increase venous return with elevation reduce edema topical ulcer care if needed

Question 32

define 'raynaud's phenomenon'

Answer 32

vasospastic disorder secondary to another disease

Question 33

define 'raynaud's disease'

Answer 33

a primarily idiopathic vasospastic disorder

Question 34

what 5 conditions is raynaud's phenomenon secondary to?

Answer 34

``` Buerger's CT disorders (sjogren, scleroderma) polymyositis and dermatomyositis SLE RA ```

Question 35

what can raynaud's phenomenon be a sign of?

Answer 35

occult neoplasm - esp if unilateral

Question 36

raynaud's disease accounts for what % of all people affected by vasomotor diseases?

Answer 36

65% (80% are women 20-49 years old)

Question 37

raynaud's disease is caused by?

Answer 37

hypersensitivity of digital arteries to cold release of serotonin genetic susceptibility to vasospasm

Question 38

what are 2 types of malignant vascular neoplasms?

Answer 38

hemangiopericytoma (sm. mm cells in capillaries and arterioles - lower extremities and retro peritoneum) Kaposi's sarcoma (rare neoplasm of dermal bv - most common cancer in people with AIDS)

Question 39

10-50% of vascular neoplasms metastasize to....

Answer 39

lung bone liver lymph node