Peripheral Vascular Flashcards by Korey koper

AAO etiologies ?

Thrombosis (clot)
Embolism
Arterial spasm

Can occur in association with atherosclerosis

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AAO 6P’s?

Pallor

Pain – sudden, severe, esp distal to the occlusion, no position alleviates pain

Paresthesia
Paralysis
Pulselessness
Poikilothermia - varying temp

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AAO tx?

dependent on cause, but urgent
Thrombectomy
+/- heparinization

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Raynaud’s Disease patho?

Episodic spasm of small arteries and arterioles. No organic occlusion

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Raynaud’s Disease and Phenomenon

secondary to other conditions such as CT diseases, vasc diseases, blood dyscrasias or occup exposures ( LUPUS, scleroderma)

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Raynaud’s Disease and Phenomenon epidemiology?

young females

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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

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Raynaud’s Disease signs?

color changes

white – blue – red

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Raynaud’s Disease tests?

Tests – no specific tests, but rule out the diseases that can cause phenomenon

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Raynauds Tx?

Tx – keep hands warm

- maybe vasodilators, if severe

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Varicose Veins patho?

Superficial veins that are dilated, tortuous

Valves have become incompetent

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VV epidemiology?

Familial
Long periods of increased venous pressure
Secondary to thrombophlebitis

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VV symptoms and signs?

Symptoms – maybe none, or leg fatigue, ache, heaviness

Signs – dilated veins, +/- tissue changes

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VV Dx?

Clinical, doppler

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VV Tx?

Prevention
Support hose
Surgical stripping

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Superficial Thrombophlebitis patho?

Usually involves the saphenous system

Clot formation and inflammation in a superficial vein

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ST symptoms and signs?

Symptoms – sudden inflammation and localized pain

Signs – local redness, pain, mild edema, palpable cord

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ST causes?

-spontaneous
-pooled blood (pregnancy, post partum,
varicose veins)
-secondary to trauma (e.g. IV, contusion)

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ST tx?

heat, bedrest, elevation, anti-inflam. Usually benign and brief unless deep system is affected, too

Anticoagulation therapy not needed

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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

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DVT risk factors/ epidemiologist?

CHF	 		
Recent hip surgery 
 Neoplasm
              Pelvic fx                      
	OC’s 			Smoking
	Varicose veins	Prolonged inactivity
    Trauma

DVT 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?

1. Sustained compression which obliterates blood flow to skin Ex – wheelchair, bedridden 2. 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