Leg Edema and Cramping

Question 1

Normal venous pressure

Answer 1

80mm Hg in deep veins

20-30mm Hg in superficial veins

Question 2

Cephalad venous blood flow

what brings blood back up from veins towards heart

Answer 2

Biscuspid venous valves
Effective muscle contractions
Normal respirations

Question 3

Dark areas on face or ankles

Answer 3

blood pooling, can’t move onto next location and is stuck in one area breaking down= dark purple/brown (may see this under eyes when someone has allergies)

Question 4

LE edema occurs in response to

Answer 4

Increased venous or lymphatic pressures
Decreased intravascular oncotic pressure
Increased capillary leak
Local injury or infection

Question 5

Most common cause of LE edema

Answer 5

chronic venous insufficiency

Question 6

Always check….

Answer 6

Always check potassium AND magnesium levels

May need to give magnesium too

Question 7

How hyperthyroidism

Answer 7

• If pt hypothyroid, taking TOO MUCH medication, TSH is low and they have induced hypothyroidism= may get leg CRAMPING
• If someone isn’t taking ENOUGH thyroid medication= may see leg SWELLING

Question 8

DVT causes

Answer 8

Malignancy, esp untreated
Recent limb immobilization or paralysis
Bedridden >3 days due to surgery in past 4wk
Previous DVT

Question 9

DVT Signs/Symptoms

Answer 9

Localized tenderness along deep veins
Swelling of entire leg
Swelling of one calf >3cm (normal for \_\_\_ calf to be larger than \_\_\_)  
Ipsilateral pitting edema
Collateral superficial veins

Question 10

For DVT, you MUST use _______

Answer 10

NEED to use DVT prophylaxis (ex: heparin, lovanox, compression stockings)

Check for Homann sign

Question 11

DVTs and women over 35 years old

Answer 11

Oral contraceptives over the age of 35, be careful (larger amount of hormone predisposes them to coagulopathy)

Question 12

Bilateral involvement with improvement after awakening may be caused by

Answer 12

Systemic (heart failure, cirrhosis)

Question 13

Heavy legs or itching may be caused by

Answer 13

Chronic venous insufficiency

Question 14

LE swelling or inflammation with recent DVT may be caused by

Answer 14

Postphlebetic syndrome

Question 15

Ultrasound is used diagnostically to test for

Answer 15

arterial or venous insufficiency depending on cause

DVT- venous doppler
Arterial- arterial or venous doppler
Checking for clots and narrowing

Question 16

D-dimer

Answer 16

usually done in ER only, if VERY high may indicate coagulopathy or inflammation

Question 17

Other diagnostic testing for LE edema

Answer 17

• Ankle brachial pressure index
• CT (can see muscle tear, subcutaneous swelling)
• D-dimer
• Ultrasound
• Kidney function/urine analysis (looking for protein first, and also RBC or WBC casts, looking for signs of nephritis)

Question 18

Chronic liver cirrhosis, LFTs will _______

Answer 18

NOT be elevated, it wont be putting anything out anymore (due to excessive damage over time)

Question 19

Treatment- Compression stockings are used for

Answer 19

for VENOUS issue, not usually arterial issues; helps bring blood back UP to heart, reason it doesn’t help with arterial problems, because in arteries blood is moving AWAY from heart

Question 20

Treatment- OMM is better for

Answer 20

• better for VENOUS issues, don’t do OMM for ARTERIAL issues; venous stasis, lymphedema, etc. can do OMM
• will see skin changes, can feel changes in muscle

Question 21

Treatment- Aspirin and walking helps for

Answer 21

-PAD: for ARTERIAL disease, walking helps because if you have a clogged vessel and force a lot of blood through, eventually breakdown of clot will occur, it will open up the vessel more, OR it will create microcirculation, more new vessels form around the area of blockage to help perfuse the area better, lessens pain eventually. Aspirin thins blood which helps it move through easier

Question 22

If left untreated, cellulitis may lead to

Answer 22

compartment syndrome (infection can spread from this, it’s a medical emergency, may cause sepsis)
-Can use CT to check for compartment syndrome if you suspect this (can see infection or changes in muscle and fascia)

Question 23

LIFE THREATENING cases of LE edema

Answer 23

• High risk for DVT
• Compartment syndrome
• Acute edema that impairs ability to function