Peripheral Vascular Flashcards
AAO etiologies ?
Thrombosis (clot)
Embolism
Arterial spasm
Can occur in association with atherosclerosis
AAO 6P’s?
Pallor
Pain – sudden, severe, esp distal to the occlusion, no position alleviates pain
Paresthesia
Paralysis
Pulselessness
Poikilothermia - varying temp
AAO tx?
dependent on cause, but urgent
Thrombectomy
+/- heparinization
Raynaud’s Disease patho?
Episodic spasm of small arteries and arterioles. No organic occlusion
Raynaud’s Disease and Phenomenon
secondary to other conditions such as CT diseases, vasc diseases, blood dyscrasias or occup exposures ( LUPUS, scleroderma)
Raynaud’s Disease and Phenomenon epidemiology?
young females
Raynaud’s Disease symptoms and triggers?
Symptoms – 1 or more distal fingers, usually bilaterally. None/mild pain. Numbness, tingling lasting few minutes
Triggers – exposure to cold, emotional upset
bettie in warm environment
Raynaud’s Disease signs?
color changes
white – blue – red
Raynaud’s Disease tests?
Tests – no specific tests, but rule out the diseases that can cause phenomenon
Raynauds Tx?
Tx – keep hands warm
- maybe vasodilators, if severe
Varicose Veins patho?
Superficial veins that are dilated, tortuous
Valves have become incompetent
VV epidemiology?
Familial
Long periods of increased venous pressure
Secondary to thrombophlebitis
VV symptoms and signs?
Symptoms – maybe none, or leg fatigue, ache, heaviness
Signs – dilated veins, +/- tissue changes
VV Dx?
Clinical, doppler
VV Tx?
Prevention
Support hose
Surgical stripping
Superficial Thrombophlebitis patho?
Usually involves the saphenous system
Clot formation and inflammation in a superficial vein
ST symptoms and signs?
Symptoms – sudden inflammation and localized pain
Signs – local redness, pain, mild edema, palpable cord
ST causes?
-spontaneous
-pooled blood (pregnancy, post partum,
varicose veins)
-secondary to trauma (e.g. IV, contusion)
ST tx?
heat, bedrest, elevation, anti-inflam. Usually benign and brief unless deep system is affected, too
Anticoagulation therapy not needed
DVT patho?
Clot in a deep vein, often originating in the calf
50-80% of calf DVTs propagate proximally to deep thigh veins (ilial, femoral and popliteal)
DVT in iliofemoral veins cause most PEs
Most calf DVT’s spontaneously resolve
DVT risk factors/ epidemiologist?
CHF
Recent hip surgery
Neoplasm
Pelvic fx
OC’s Smoking
Varicose veins Prolonged inactivity
TraumaDVT symptoms and signs?
Symptoms – often painless at first, can be a tight, bursting pain, worse with walking, better with elevation
Signs – edema, +/- calf tenderness
- resultant PE may be the first sign
DVT Dx?
Doppler, venogram
DVT prevention
leg exercises during bedrest
- anticoagulants - leg elevation - elastic stockings
CVI patho?
Chronic venous engorgement from
a. Incompetent valves
b. Venous occlusion (trauma and/or
edema of surrounding tissues)
CVI epidemiology?
Epidemiology - +60 y.o., obese, history of leg injury or prolonged standing
CVI symptoms?
painless or diffuse leg ache, worse with dependency and as day wears on, alleviated with elevation
CVI signs?
- chronic edema, particularly at ankle
- stasis dermatitis
- brown pigmentation
- +/- ulceration that is painLESS
normal pulses - thickened skin (or narrowed extremity)
- normal temperature
- no gangrene
CVI Dx?
clinical, duplex doppler
CVI Tx?
leg elevation
elastic stocking
Interstitial Edema patho?
increased interstitial fluid
IE etiologies?
lymphatic dysfunction
- problems with hydrostatic or osmotic
pressure in capillary bed as blood goes
from artery to vein
CHF
Nephrotic syndrome
Cirrhosis
Malnutrition
Medications
Prolonged sitting or standing or ill-fitting shoes (orthostatic edema)
IE PE?
No ulcer, pigmentation, ulcers or skin thickening
Usually bilateral, involves foot also
Lymphedema etiology?
congenital
- inflammatory - mechanical
Lymphedema - mechanical causes?
tumor, trauma, fibrosis, metastatic node disease, post-op patients (e.g. s/p lymph node dissection)
Lymphedema PE?
Soft at first, becomes hard and non-pitting
Skin thickens
No ulceration or pigmentation changes
Usually painless
Lymphedema Tx?
elevation
- elastic bandages - massage - avoid secondary cellulitis - possible intermittent diuretic
Acute Lymphangitis patho?
Acute bacterial infection
Portal of entry – chronic ulcer or acute injury
Infection spreads up lymphatic channels
Acute Lymphangitis Sxs?
tenderness to palpation
- fever, chills, malaise - red streaks on skin - tender, enlarged lymph nodes
Acute Lymphangitis Tx?
AB’s, heat, elevation, immobilization, pain meds
Thromboangiitis Obliterans (Buerger’s disease) patho?
Occlusion of small arteries and veins of fingers, toes due to inflammation or thrombus
Thromboangiitis Obliterans (Buerger’s disease) epidemioogy?
young men> women, less than 40, smokers
Thromboangiitis Obliterans severities?
Intermittent claudication – typically arch of foot, or hands that ↑with exercise,
↓ with rest
Rest pain – chronic and persistent
Thromboangiitis Obliterans signs?
distal coldness, numbness, cyanosis, ulceration, gangrene
Thromboangiitis Obliterans Tx?
Stop smoking! Otherwise intermittent course with possible amputation
Pressure ulcers (Decubitus ulcers, bedsores) epidemiology?
bed/wheelchair-confined patients, especially:
- emaciated
- elderly
- neuro-compromised, (unconscious,
paralyzed)
- diabetic
Pressure sores result from?
- Sustained compression which obliterates blood flow to skin
Ex – wheelchair, bedridden - Shearing forces
Ex -from dragging pt up in bed
instead of lifting
Pressure sore sites?
sacral area, buttocks (ischial tuberosity), greater trochanters, knees, heel, occiput, ears, elbows
Roll your patient over and check all areas
Pressure sore Tx?
- turn patient every hour
- water or air-filled mattress
- alternating pressure mattress
- foam pads, egg crate mattresses
Pressure sores - early ulcer tx?
topical tx to promote granulation
Pressure sore - advanced ulcers tx?
surgical debridement
treat any accompanying infection
