Pathologies Flashcards
Primary Lymphedema
A congenital disorder, or at puberty, or after 35 years old due to genetic mutation. Unilateral foot or calf affected. Mostly women affected. Patho is caused by dysplasia of the lymphatic system. Or other vascular abnormalities.
Secondary Lymphedema
Results from insult, injury, or obstruction to the lymphatic system. An excessive accumulation of fluid in tissue spaces from trauma, infection, radiation, or surgery. Seen usually from removing axillary inguinal or iliac nodes for metastatic tumor. Filariasis, tumors, breast cancer (1/5 women with b.c. will develop it) S/S: Swelling in one arm/leg, heavy and achy limbs, altered sensation, stages Stages: 0-3 Stage 0- No visible changes Stage 1- Reversible swelling, pitting edema Stage 2- Irreversible swelling, non-Pitting edema in late stages, stemmer’s sign + (you cannot lift and pinch the skin) Stage 3- Severe swelling, skin permanently damaged, large skin folds, BRAWNY
Differentiate Normal to Pathological Lymph Nodes
Normal Lymph Nodes- Supple, Non-tender, Mobile Infected or Inflamed Lymph Nodes- Firm and Enlarged , Tender, WARM, MOBILE Malignant Lymph Nodes- Firm and grow in size, Non-tender, immobile
Dermatitis vs Cellulitis
Derm is general skin rash. Swelling is not typical with dermatitis and does not have associated rash
Cellulitis is bacterial skin infection
If lymph nodes are tender to touch, but mobile at exam, what is the next course of action?
REFER THE PATIENT TO PHYSICIAN! Asking a person about fever is not best, because it’s redundant. Also, according to NPTE, do not refer to specialist. Refer to PCP.
Diff Dx Lipedema vs Lymphedema
Lipedema is excessive accumulation of fatty deposits. Found in UE and LE, bilaterally and symmetrical. Typically due to hormonal imbalances such as pregnancy and pub erty. NEGATIVE stemmer’s. SWELLING DOES NOT GO PAST ANKLES/WRISTS
Precautions for BP?
Do not take BP in affected arm.
What is Lymphangitis?
Inflammation of lymph vessels beneath skin. Caused by an infection leaked to lymph vessels and spreads to lymphatic system. S/S include red streaks, tenderness, muscle aches, swollen or tender lymph nodes. Treated by antibiotics or antifungals or antivirals, as well as elevation.
What is Lymphadenitis?
Enlargement of one or 2 lymph nodes due to infection.
Nodes that increase in size
Nodes that are painful to touch
Nodes that are soft or matted together
Redness or red streaking of the skin over nodes
Nodes that are filled with pus (an abscess)
Fluid that drains from the nodes to the skin
Physician will perform tests to determine what kind of infection is present. As well as medicines to reduce swelling
What is Peripheral Vascular Disease?
Any disorder that interferes with the arterial or venous blood flow of the extremities. It is a lack of adequate blood flow to region or regions of the body.
What is arterial insufficiency?
It is caused by: Smoking, obesity, sedentarianism, cardiac disease, diabetes, HTN, renal disease, high cholesterol.
Two types of AI: Atherosclerosis (damage to lining of vessels with plaque) and arteriosclerosis (thickening or hardening of walls)
S/S include: Pale and cool skin, abnormal nail growth, little leg and foot hair, LATERAL MALLEOLAR WOUNDS, dry and shiny skin, intermittent claud and pain at rest.
Decreased pulses, pallor on leg elevation, rubor when dependent.
Arterial Wounds Presentation?
Lateral Malleoli, Dorsum of the Foot, Toes
Wound base is necrotic and pale, lacks granulation
Dry gangrene
Deep
Dry wound bed
Wounds are painful
Defined borders
Venous Insufficiency
Venous Insufficiency is inadequate draining of venous blood to heart. Results in edema/ulcerations
Caused by aging, lack of exercise, pregnancy, long hours of standing, restrictive clothing.
S/S: edema, heaviness, fatigue, HEMOSIDERIN STAINING, fibrosis, increased skin temp
Characteristics of Venous Wounds:
Medial malleoli, edematous, heavy drainage, mildy painful, shallow, uneven borders, hemosiderin staining
What is a neuropathic ulcer?
PAD is primary cause of impairment as well as diabetes. Typically shows up on the soles of the feet!
Could lead to charcot foot (deformation, inflammation)
Check lifestyle, dorsalis pedis pulse, venous refill, 10 gram monofilament, achilles tendon reflex
*WAGNER SCALE IS USED FOR NEUROPATHIC ULCERS
Pathophysiology of Pressure Injuries/Ulcers?
A pressure ulcer is caused by unrelieved pressure causing damage in underlying tissue. Usually occurs over bony prominences. Caused by xternal pressure, friction, shearing forces, maceration, dehydration, malnutrition, decreased circulation
Intrinsic factors include decreased sensation, impaired mobility or activity levels, incontinence, diaphoresis, impaired nutritional status, altered levels of conciousness
Wounds CANNOT be back staged. IT WILL ALWAYS REMAIN THE SAME FOR DOCUMENTATION. (ex. Stage 2 HEALING ulcer)
What are the Pressure Stages of ulcers?
Stage 1- Skin intact, observable changes in temperature (warmth/coolness), texture (firm or boggy feel), color (red, blue, purple), sensation (pain or itching). NON BLANCHABLE
Stage 2- Partial-thickness skin loss. Involves the epidermis and dermis or both. It is superficial and looks like a blister or shallow crater or abrasion
Stage 3- Full-thickness. Deep crater. Damage or necrosis to subcutaneous tissue, which extends down to fascia. Fascia not affected
Stage 4-Sinus tracts present, necrosis and damage extends all the way to joint/muscle/bone
Unstageable- The depth of a wound with eschar or more with 50% necrotic tissue once debrided. They are covered in necrotic tissue
Position changes?
If able to move by themselves, every 15 min
If lying down, every 2 hours
If sitting, every hour
What is Psoriasis?
Hereditary, chronic, recurrent inflammatory but noninfectious dermatosis characterized by well defined erythematous plaques covered with a silvery scale. Quickly replicating keratinocytes
Flare ups occur in cold weather, severe anxiety, and emotional stress.
Normal skin cells 26-28 days. Psoriatic skin is 3-4 days.
Flare-ups are more
common in the winter as a result of dry skin and lack of
sunlight
(1) topical preparations, (2)
phototherapy, (3) antimetabolites, (4) oral retinoid
therapy, and ( 5 ) immunosuppressants.
Staph occurence is high on plaques
Diff dx: Rh Arthritis has more frequent involvement of the distal interphalangeal joints, asymmetrical distribution of affected joints. Joints are less tender in PA
What is melanoma?
Neoplasm of skin from melanocytes
What is sarcoidosis?
*Felix had this
Inflammatory cells all over the body. Triggered by immune system reaction from unknown etiology. Can affect skin, heart, lungs, and lymph nodes.
S/S depend on which area is affected.
What is a DTI?
A suspected deep tissue injury (DTI) is a purple or maroon local area of discolored skin that is due to damage of underlying soft tissue. The DTI may have a softer feel or a difference in temperature in comparison to the surrounding tissue. In patients with a spinal cord injury, a DTI is often caused by shear or pressure that occurs on the ischial tuberosities as a result of inadequate weight shifting or positioning
*USUALLY PURPLE OR MAROON AND SOFTER THAN SURROUNDING TISSUE
What is a Superficial Thickness Burn?
Affects only the epidermis layer of the skin The wound is typically dry, erythematous, and painful Skin typically heals within 2-5 days.
From sunburn, exposure to hot liquids
What is a Partial Thickness Burn (2nd degree)?
A burn that destroys the epidermis and the dermis.
*THIS IS SEPARATED INTO SUPERFICIAL PARTIAL THICKNESS AND DEEP PARTIAL THICKNESS
What is a superficial partial thickness burn?
Destruction of the epidermis and damage to papillary layer.
- Presence of blisters can be seen, which these can be broken leaving the wound surface moist, red, and very PAINFUL (Sensate)
- 7-14 days to heal and should heal normally without scarring
Blanches with normal capillary refill
What is a deep partial thickness burn?
- Destruction of the epidermis, the papillary layer of the dermis, and into the RETICULAR LAYER of the dermis - These ones are typically moist, painful, edematous and red. (can be white if very deep) - 21-35 or more days to heal. INCREASED LIKELIHOOD TO SCAR
Blanches with delay capillary refill…WAXY
What is a Full Thickness Burn?
Goes UP TO SUB Q (fat). Does not damage muscle or tendon. Dry, firm, leathery eschar, edematous, insensate
*REQUIRES SKIN GRAFTING AND WILL SCAR. MONTHS TO HEAL
No blanching or capillary refill
What is a Subdermal Thickness Burn?
Destroys all levels of skin. Charred (caused by flame) - Gray or brown (caused by chemical) - Edema is present in all subdermal burns - Pain is related to inflammation of the adjacent tissues but not IN THE WOUND
No natural healing. WILL NEED GRAFTING. SCARRING PRESENT.
Apply the Rule of 9s to a body?
- Rule of Nines - 11 different regions each 9% - 1% given to the genitalia
“Serious burns include involvement of the hands, feet, face, genitalia, perineum, or major joints” (anything that affects a patient’s function)
Lunden and Browder chart show that the head percentage change for a developing child
What is a Major Burn?
>30%
What is the Pathophysiology of burns?
Cell Lysis occurs, potassium enters into the blood. So hyperkalemia occurs.
Increased capillary permeability- the capillaries feed a bunch of fluid into the skin. Creating edema. Hyponutremia occurs. Deep-partial thickness, full thickness, and subdermal burns.
Diminished blood volume due to decreased blood pressure, decreased cardiac output, decreased tissue perfusion.
What is the bodies response to burn shock?
- Increased Sympathetic response - Tachycardia - Peripheral vasoconstriction - Hyperglycemia (corticoid hormones) - Increased Metabolism: Response to bacterial load and injury Infection: Loss of the skin barrier increases risk
Pulmonary Complications: Pulmonary edema (capillary fluid shift) - Inhalation injury - Damage to airways - Gas transport cells
What is Systemic Lupus Erythemateous?
Chronic Inflammatory Autoimmune Disorder, Hereditary Component and Women mostly.
Positive ANA
What is Herpes Zoster?
What is a Nevus?
Another word for Mole
